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Janmohamed A, Doledec D, Dissieka R, Jalloh UH, Juneja S, Beye M, Ndiaye F, Jumbe T, Baker MM. Vitamin A supplementation coverage and associated factors for children aged 6 to 59 months in integrated and campaign-based delivery systems in four sub-Saharan African countries. BMC Public Health 2024; 24:1189. [PMID: 38678255 DOI: 10.1186/s12889-024-18707-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/24/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Vitamin A deficiency (VAD) is a leading contributor to the poor health and nutrition of young children in sub-Saharan Africa. Funding constraints are compelling many countries to shift from longstanding campaigns to integrating vitamin A supplementation (VAS) into routine health services. We assessed child VAS coverage and associated factors for integrated delivery systems in Mozambique, Senegal, and Sierra Leone and for a campaign-based delivery strategy in Tanzania. METHODS Data were obtained using representative household surveys administered to primary caregivers of N = 16,343 children aged 6-59 months (Mozambique: N = 1,659; Senegal: N = 7,254; Sierra Leone: N = 4,149; Tanzania: N = 3,281). Single-dose VAS coverage was assessed and bivariate and multivariable associations were examined for child VAS receipt with respect to rural or urban residence; child age and sex; maternal age, education, and VAS program knowledge; and household wealth. RESULTS VAS coverage for children aged 6-59 months was 42.8% (95% CI: 40.2, 45.6) in Mozambique, 46.1% (95% CI: 44.9, 47.4) in Senegal, 86.9% (95% CI: 85.8, 87.9) in Sierra Leone, and 42.4% (95% CI: 40.2, 44.6) in Tanzania and was significantly higher for children 6-11 vs. 24-59 months in Mozambique, Senegal, and Tanzania. In Sierra Leone, children aged 12-23 months (aOR = 1.86; 95% CI: 1.20, 2.86) and 24-59 months (aOR = 1.55; 95% CI: 1.07, 2.25) were more likely to receive VAS, compared to those 6-11 months. Maternal awareness of VAS programs was associated with higher uptake in Mozambique (aOR = 4.00; 95% CI: 2.81, 5.68), Senegal (aOR = 2.72; 95% CI: 2.35, 3.15), and Tanzania (aOR = 14.50; 95% CI: 10.98, 19.17). Increased household wealth was associated with a higher likelihood of child VAS in Senegal and Tanzania. CONCLUSIONS Our findings indicate routine delivery approaches for VAS are not achieving the level of coverage needed for public health impact in these settings. Intensive outreach efforts contributed to the higher coverage in Sierra Leone and highlight the importance of reducing the burdens associated with seeking supplementation at health facilities. As countries move towards incorporating VAS into routine health services, the essentiality of informed communities and potential losses for older children and socio-economically disadvantaged populations are key considerations in the sub-Saharan African context.
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Affiliation(s)
- Amynah Janmohamed
- Helen Keller International Vitamin A Supplementation Africa Regional Office, Nairobi, Kenya
| | - David Doledec
- Helen Keller International Vitamin A Supplementation Africa Regional Office, Nairobi, Kenya
| | - Romance Dissieka
- Helen Keller International Vitamin A Supplementation Africa Regional Office, Nairobi, Kenya
| | - Umu H Jalloh
- Helen Keller International, Freetown, Sierra Leone
| | | | | | | | | | - Melissa M Baker
- Helen Keller International Vitamin A Supplementation Africa Regional Office, Nairobi, Kenya.
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Tan X, Tan PY, Gong YY, Moore JB. Overnutrition is a risk factor for iron, but not for zinc or vitamin A deficiency in children and young people: a systematic review and meta-analysis. BMJ Glob Health 2024; 9:e015135. [PMID: 38599666 PMCID: PMC11015307 DOI: 10.1136/bmjgh-2024-015135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/14/2024] [Indexed: 04/12/2024] Open
Abstract
INTRODUCTION Traditionally associated with undernutrition, increasing evidence suggests micronutrient deficiencies can coexist with overnutrition. Therefore, this work aimed to systematically review the associations between iron, zinc and vitamin A (VA) status and weight status (both underweight and overweight) in children and young people. METHODS Ovid Medline, Ovid Embase, Scopus and Cochrane databases were systematically searched for observational studies assessing micronutrient status (blood, serum or plasma levels of iron, zinc or VA biomarkers) and weight status (body mass index or other anthropometric measurement) in humans under 25 years of any ethnicity and gender. Risk of bias assessment was conducted using the American Dietetic Association Quality Criteria Checklist. Where possible, random effects restricted maximum likelihood meta-analyses were performed. RESULTS After screening, 83 observational studies involving 190 443 participants from 44 countries were identified, with many studies having reported on more than one micronutrient and/or weight status indicator. Iron was the most investigated micronutrient, with 46, 28 and 27 studies reporting data for iron, zinc and VA status, respectively. Synthesising 16 records of OR from seven eligible studies, overnutrition (overweight and obesity) increased odds of iron deficiency (ID) (OR (95% CI): 1.51 (1.20 to 1.82), p<0.0001, I2=40.7%). Odds appeared to be higher for children living with obesity (1.88 (1.33 to 2.43), p<0.0001, I2=20.6%) in comparison to those with overweight (1.31 (0.98 to 1.64), p<0.0001, I2=40.5%), although between group differences were not significant (p=0.08). CONCLUSIONS Overnutrition is associated with increased risk of ID, but not zinc or VA deficiencies, with an inverted U-shaped relationship observed between iron status and bodyweight. Our results highlight significant heterogeneity in the reporting of micronutrient biomarkers and how deficiencies were defined. Inflammation status was rarely adequately accounted for, and the burden of ID may well be under-recognised, particularly in children and young people living with overnutrition. PROSPERO REGISTRATION NUMBER CRD42020221523.
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Affiliation(s)
- Xiaomian Tan
- School of Food Science and Nutrition, University of Leeds, Leeds, West Yorkshire, UK
| | - Pui Yee Tan
- School of Food Science and Nutrition, University of Leeds, Leeds, West Yorkshire, UK
| | - Yun Yun Gong
- School of Food Science and Nutrition, University of Leeds, Leeds, West Yorkshire, UK
| | - J Bernadette Moore
- School of Food Science and Nutrition, University of Leeds, Leeds, West Yorkshire, UK
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Sachdev HS, Reddy GB, Pullakhandam R, Ghosh S, Rajkumar H, Kurpad AV. A vicious turn to the saga of vitamin A deficiency in India. Eur J Clin Nutr 2024; 78:360-361. [PMID: 38135710 DOI: 10.1038/s41430-023-01389-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/16/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Affiliation(s)
- H S Sachdev
- Sitaram Bhartia Institute of Science and Research, New Delhi, India.
| | - G B Reddy
- National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India
| | - R Pullakhandam
- National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India
| | - S Ghosh
- St. John's Medical College, Bengaluru, India
| | - H Rajkumar
- National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India
| | - A V Kurpad
- St. John's Medical College, Bengaluru, India.
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Tan PY, Loganathan R, Teng KT, Mohd Johari SN, Lee SC, Selvaduray KR, Ngui R, Lim YAL. Supplementation of red palm olein-enriched biscuits improves levels of provitamin A carotenes, iron, and erythropoiesis in vitamin A-deficient primary schoolchildren: a double-blinded randomised controlled trial. Eur J Nutr 2024; 63:905-918. [PMID: 38240773 DOI: 10.1007/s00394-023-03314-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 12/18/2023] [Indexed: 03/19/2024]
Abstract
PURPOSE Vitamin A deficiency (VAD) remains a significant contributor to childhood morbidity and mortality in developing countries; therefore, the implementation of sustainable and cost-effective approaches to control VAD is of utmost pertinence. This study aims to investigate the efficacy of red palm olein (RPO)-enriched biscuit supplementation in improving vitamin A, haematological, iron, and inflammatory status among vitamin A-deficient schoolchildren. METHODS We conducted a double-blinded, randomised controlled trial involving 651 rural primary schoolchildren (8-12 years) with VAD in Malaysia. The schoolchildren were randomised to receive either RPO-enriched biscuits (experimental group, n = 334) or palm olein-enriched biscuits (control group, n = 317) for 6-month duration. RESULTS Significant improvements in retinol and retinol-binding protein 4 levels were observed in both groups after supplementation (P < 0.001). The improvement in retinol levels were similar across groups among subjects with confirmed VAD (P = 0.40). Among those with marginal VAD, greater improvement in retinol levels was recorded in the control group (P < 0.001) but lacked clinical significance. The levels of α- and β-carotenes, haematological parameters (haemoglobin, packed cell volume, mean corpuscular volume and mean corpuscular haemoglobin) and iron enhanced more significantly in the experimental group (P < 0.05). The significant reduction in the prevalence of microcytic anaemia (- 21.8%) and high inflammation (- 8.1%) was only observed in the experimental group. CONCLUSION The supplementation of RPO-enriched biscuits enhanced levels of provitamin A carotenes, iron, and erythropoiesis, and exhibited anti-inflammatory effects. Therefore, the incorporation of RPO into National Nutritional Intervention Programs may be a potential measure to improve the health status of vitamin A-deficient children, among various other interventions. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov (NCT03256123).
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Affiliation(s)
- Pei Yee Tan
- Nutrition Unit, Division of Product Development and Advisory Services, Malaysian Palm Oil Board, No. 6, Persiaran Institusi, Bandar Baru Bangi, 43000, Kajang, Selangor, Malaysia
- Department of Parasitology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Radhika Loganathan
- Nutrition Unit, Division of Product Development and Advisory Services, Malaysian Palm Oil Board, No. 6, Persiaran Institusi, Bandar Baru Bangi, 43000, Kajang, Selangor, Malaysia.
| | - Kim-Tiu Teng
- Nutrition Unit, Division of Product Development and Advisory Services, Malaysian Palm Oil Board, No. 6, Persiaran Institusi, Bandar Baru Bangi, 43000, Kajang, Selangor, Malaysia
| | | | - Soo Ching Lee
- Type 2 Immunity Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institute of Health, Bethesda, MD, USA
| | - Kanga Rani Selvaduray
- Nutrition Unit, Division of Product Development and Advisory Services, Malaysian Palm Oil Board, No. 6, Persiaran Institusi, Bandar Baru Bangi, 43000, Kajang, Selangor, Malaysia
| | - Romano Ngui
- Department of Parasitology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
- Department of Paraclinical Sciences, Faculty of Medicine & Health Sciences, Universiti Malaysia Sarawak, 94300, Kota Samarahan, Sarawak, Malaysia
| | - Yvonne Ai-Lian Lim
- Department of Parasitology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
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Ishaq MU, Kunwar D, Qadeer A, Komel A, Safi A, Malik A, Malik L, Akbar A. Effect of vitamin A on maternal, fetal, and neonatal outcomes: An overview of deficiency, excessive intake, and intake recommendations. Nutr Clin Pract 2024; 39:373-384. [PMID: 38030585 DOI: 10.1002/ncp.11096] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/29/2023] [Accepted: 11/05/2023] [Indexed: 12/01/2023] Open
Abstract
Vitamin A imbalance during pregnancy and lactation is a global public health concern with potentially negative consequences for fetuses and neonates. Inadequate vitamin A intake during this critical period can lead to anemia, weakened immune function, night blindness, and increased susceptibility to infections. Conversely, excessive intake of vitamin A can result in birth defects, hypercalcemia, and psychiatric symptoms. This review aims to identify risk factors contributing to vitamin A deficiency in pregnant women and its impact on maternal, fetal, and neonatal outcomes. It also examines the effects of high-dose vitamin A supplementation during pregnancy on offspring health. By analyzing existing literature and recommendations, the review emphasizes the significance of vitamin A in the development of various body systems and organs. It provides a comprehensive overview of the effects of vitamin A during pregnancy and lactation, encompassing deficiencies, excessive intake, and supplementation guidelines. The need for further research in this field is highlighted. In conclusion, maintaining a balanced vitamin A status is crucial during pregnancy to promote better outcomes for fetuses and newborns. Effective monitoring and intervention strategies are essential to address vitamin A deficiency and excess in pregnant women, thereby improving fetal and neonatal health.
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Affiliation(s)
| | - Digbijay Kunwar
- Department of Medicine, Nishtar Medical University, Multan, Pakistan
| | - Abdul Qadeer
- Department of Medicine, Nishtar Medical University, Multan, Pakistan
| | - Aqsa Komel
- Department of Medicine, Nishtar Medical University, Multan, Pakistan
| | - Adnan Safi
- Department of Medicine, Lahore General Hospital, Lahore, Pakistan
| | - Aqsa Malik
- Department of Medicine, Fatima Memorial College of Medicine and Dentistry, Lahore, Pakistan
| | - Linta Malik
- Department of Medicine, Nishtar Medical University, Multan, Pakistan
| | - Anum Akbar
- Department of Pediatrics, University of Nebraska Medical Centre, Omaha, Nebraska, USA
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Victor CP, Leon JS, Williams AM. Vitamin A biomarkers were associated with α(1)-acid glycoprotein and C-reactive protein over the course of a human norovirus challenge infection. Br J Nutr 2024; 131:482-488. [PMID: 37694547 PMCID: PMC10784129 DOI: 10.1017/s0007114523002076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/26/2023] [Accepted: 09/06/2023] [Indexed: 09/12/2023]
Abstract
Retinol binding protein (RBP) is used as a proxy for retinol in population-based assessments of vitamin A deficiency (VAD) for cost-effectiveness and feasibility. When the cut-off of < 0·7 μmol/l for retinol is applied to RBP to define VAD, an equivalence of the two biomarkers is assumed. Evidence suggests that the relationship between retinol and RBP is not 1:1, particularly in populations with a high burden of infection or inflammation. The goal of this analysis was to longitudinally evaluate the retinol:RBP ratio over 1 month of follow-up among fifty-two individuals exposed to norovirus (n 26 infected, n 26 uninfected), test whether inflammation (measured as α-1-acid glycoprotein (AGP) and C-reactive protein (CRP)) affects retinol, RBP and the ratio between the two and assess whether adjusting vitamin A biomarkers for AGP or CRP improves the equivalence of retinol and RBP. We found that the median molar ratio between retinol and RBP was the same among infected (0·68) and uninfected (0·68) individuals. AGP was associated with the ratio and RBP individually, controlling for CRP, and CRP was associated with both retinol and RBP individually, controlling for AGP over 1 month of follow-up. Adjusting for inflammation led to a slight increase in the ratio among infected individuals (0·71) but remained significantly different from the expected value of one. These findings highlight the need for updated recommendations from the WHO on a cut-off value for RBP and an appropriate method for measuring and adjusting for inflammation when using RBP in population assessments of VAD.
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Affiliation(s)
- Courtney P. Victor
- Hubert Department of Global Health, Emory University, Atlanta, GA30322, USA
| | - Juan S. Leon
- Hubert Department of Global Health, Emory University, Atlanta, GA30322, USA
| | - Anne M. Williams
- Hubert Department of Global Health, Emory University, Atlanta, GA30322, USA
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
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Gupta PM, Madewell ZJ, Gannon BM, Grahn M, Akelo V, Onyango D, Mahtab S, Madhi SA, Giri J, Blau DM, Ramakrishnan U, Stein AD, Whitney CG, Young MF, Tanumihardjo SA, Suchdev PS. Hepatic Vitamin A Concentrations and Association with Infectious Causes of Child Death. J Pediatr 2024; 265:113816. [PMID: 37931699 PMCID: PMC10869935 DOI: 10.1016/j.jpeds.2023.113816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES To assess postmortem vitamin A (VA) concentrations in children under 5 years of age and evaluate the association between VA deficiency (VAD) and infectious causes of death (CoD). STUDY DESIGN In this cross-sectional study from the Child Health and Mortality Prevention Surveillance (CHAMPS) Network, liver biopsies collected within 72 hours of death were analyzed from 405 stillbirths and children under 5 years in Kenya and South Africa. Total liver VA (TLVA) concentrations were quantified using ultra-performance liquid chromatography, and cutoffs of ≤0.1 μmol/g, >0.1 to <0.7 μmol/g, ≥0.7 to <1.0 μmol/g, and ≥1.0 μmol/g were used to define VAD, adequate VA status, high VA, and hypervitaminosis A, respectively. CoD were determined by expert panel review. RESULTS Among 366 liver samples with viable extraction, pooled prevalences of VAD, adequacy, high VA, and hypervitaminosis were 34.2%, 51.1%, 6.0%, and 8.7%, respectively. VAD was more common among neonates compared with stillbirths, infants, or children, and among those with low birthweight (LBW), underweight, or stunting (P < .05). When adjusting for site, age, and sex, there was no significant association of VAD with increased infectious CoD (OR 1.9, 95% confidence interval [CI] 0.9, 3.8, P = .073). In stratified analyses, VA deficient boys, but not girls, had an increased risk of infectious CoD (OR 3.4, 95% CI 1.3, 10.3, P = .013). CONCLUSIONS Definitive postmortem assessment of VA status identified both VAD and VA excess among children under 5 years of age in Kenya and South Africa. VAD in boys was associated with increased risk of infectious mortality. Our findings may inform a transition from universal VA supplementation (VAS) to targeted strategies in certain countries.
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Affiliation(s)
- Priya M Gupta
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Zachary J Madewell
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA
| | - Bryan M Gannon
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI
| | - Michael Grahn
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI
| | - Victor Akelo
- US Centers for Disease Control and Prevention-Kenya, Kisumu, Kenya
| | | | - Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Judith Giri
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Dianna M Blau
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA
| | - Usha Ramakrishnan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Aryeh D Stein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Cynthia G Whitney
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Melissa F Young
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | | | - Parminder S Suchdev
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA; Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA; Department of Pediatrics, Emory University, Atlanta, GA.
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Szabó É, Csölle I, Felső R, Kuellenberg de Gaudry D, Nyakundi PN, Ibrahim K, Metzendorf MI, Ferenci T, Lohner S. Benefits and Harms of Edible Vegetable Oils and Fats Fortified with Vitamins A and D as a Public Health Intervention in the General Population: A Systematic Review of Interventions. Nutrients 2023; 15:5135. [PMID: 38140394 PMCID: PMC10745565 DOI: 10.3390/nu15245135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
This systematic review aims to assess whether edible vegetable oils and fats fortified with vitamin A and/or D are effective and safe in improving vitamin intake and ameliorating deficiency states in the general population. In November 2022, we systematically searched MEDLINE, Cochrane CENTRAL, Scopus, Global Index Medicus, ClinicalTrials.gov, and WHO ICTRP (International Clinical Trials Registry Platform) for randomized controlled trials (RCT) and non-randomized studies of interventions (NRSI) investigating the fortification of edible vegetable oils and fats with either vitamin A or vitamin D or both as compared to the same vegetable oils and/or fats without vitamin A and D fortification or no interventions, in the general population, without age restriction. We assessed the methodological quality of included RCTs using Cochrane's risk of bias tool 2.0 and of NRSIs using ROBINS-I tool. We performed random-effects meta-analysis and assessed certainty of evidence using GRADE. We included eight studies. Available evidence showed no significant effect of fortification with vitamin A on serum retinol levels (RCTs: MD 0.35 µmol/L, 95% CI -0.43 to 1.12; two trials; 514 participants; low-certainty evidence; CCTs: MD 0.31 µmol/L, 95% CI -0.18 to 0.80; two trials; 205 participants; very low-certainty evidence) and on subclinical vitamin A deficiency. Low-certainty evidence showed no effect of vitamin D fortification on serum 25-hydroxy vitamin D concentration (MD 6.59 nmol/L, 95% CI -6.89 to 20.07; one trial; 62 participants). In conclusion, vitamin A-fortified vegetable oils and fats may result in little to no difference in serum retinol levels in general populations. The dose of vitamin A used in the trials may be safe but may not be sufficient to reduce subclinical vitamin A deficiency. Further, the evidence suggests that vitamin D fortification results in little to no difference in serum 25-hydroxy vitamin D concentration. Several aspects of providing fortified oils and fats to the general population as a public health intervention should be further investigated, including optimal fortification dose, effects on vitamin D deficiency and its clinical symptoms and potential adverse effects.
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Affiliation(s)
- Éva Szabó
- Cochrane Hungary, Clinical Centre of the University of Pécs, Medical School, University of Pécs, 7623 Pécs, Hungary; (É.S.); (I.C.); (R.F.); (D.K.d.G.)
- Department of Biochemistry and Medical Chemistry, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Ildikó Csölle
- Cochrane Hungary, Clinical Centre of the University of Pécs, Medical School, University of Pécs, 7623 Pécs, Hungary; (É.S.); (I.C.); (R.F.); (D.K.d.G.)
- National Laboratory for Human Reproduction, University of Pécs, 7624 Pécs, Hungary
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary;
| | - Regina Felső
- Cochrane Hungary, Clinical Centre of the University of Pécs, Medical School, University of Pécs, 7623 Pécs, Hungary; (É.S.); (I.C.); (R.F.); (D.K.d.G.)
- National Laboratory for Human Reproduction, University of Pécs, 7624 Pécs, Hungary
- Genomics and Bioinformatics Core Facility, Szentágothai Research Centre, University of Pécs, 7624 Pécs, Hungary
| | - Daniela Kuellenberg de Gaudry
- Cochrane Hungary, Clinical Centre of the University of Pécs, Medical School, University of Pécs, 7623 Pécs, Hungary; (É.S.); (I.C.); (R.F.); (D.K.d.G.)
| | - Patrick Nyamemba Nyakundi
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary;
- Department of Public Health Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
| | - Kazahyet Ibrahim
- Department of Public Health Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
| | - Maria-Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany;
| | - Tamás Ferenci
- Physiological Controls Research Center, Obuda University, 1034 Budapest, Hungary;
- Department of Statistics, Corvinus University of Budapest, 1093 Budapest, Hungary
| | - Szimonetta Lohner
- Cochrane Hungary, Clinical Centre of the University of Pécs, Medical School, University of Pécs, 7623 Pécs, Hungary; (É.S.); (I.C.); (R.F.); (D.K.d.G.)
- Department of Public Health Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
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Eyeberu A, Getachew T, Tiruye G, Balis B, Tamiru D, Bekele H, Abdurke M, Alemu A, Dessie Y, Shiferaw K, Debela A. Vitamin A deficiency among pregnant women in Ethiopia: a systematic review and meta-analysis. Int Health 2023; 15:630-643. [PMID: 37264928 PMCID: PMC10629954 DOI: 10.1093/inthealth/ihad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/21/2023] [Accepted: 05/12/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Vitamin A deficiency (VAD) during pregnancy is a public health challenge in low-income countries. There are inconsistent findings that can affect policy in planning appropriate intervention. This systematic review and meta-analysis were conducted to summarize the evidence in order to identify existing gaps and propose strategies to reduce VAD during pregnancy in Ethiopia. METHODS This study included published and unpublished observational studies searched from different databases (PubMed, CINHAL [EBSCO], Embase, Google Scholar, Directory of Open Access Journals, Web of Sciences, MEDLINE, Cochrane Library, Scopus, Google Search and MedNar). Statistical analysis was conducted using Stata version 14 software. Heterogeneity and publication bias were assessed. Forest plots were used to present the pooled prevalence using the random effects model. RESULTS A total of 37 618 pregnant women from 15 studies were included. The overall pooled prevalence of VAD was 29% (95% confidence interval 21 to 36) with I2=99.67% and p<0.001. Socio-economic and sociodemographic factors were identified as affecting vitamin A deficiencies among pregnant women. CONCLUSIONS Nearly one-third of pregnant women in Ethiopia had VAD. Strengthening intervention modalities that aimed to increase the uptake of vitamin A-rich foods can avert VAD among pregnant women in Ethiopia.
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Affiliation(s)
- Addis Eyeberu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tamirat Getachew
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Getahun Tiruye
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bikila Balis
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dawit Tamiru
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Habtamu Bekele
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mohommed Abdurke
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addisu Alemu
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kasiye Shiferaw
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adera Debela
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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10
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Carvalho MCDC, Araujo JKCP, da Silva AGCL, da Silva NS, de Araújo NK, Luchessi AD, Ribeiro KDDS, Silbiger VN. Retinol Levels and Severity of Patients with COVID-19. Nutrients 2023; 15:4642. [PMID: 37960295 PMCID: PMC10650184 DOI: 10.3390/nu15214642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/11/2023] [Accepted: 08/22/2023] [Indexed: 11/15/2023] Open
Abstract
The new coronavirus infection represents a serious threat to global health and economies. In this sense, it is paramount to know the nutritional factors that may be related to the prognosis of the disease. Evidence shows that vitamin A may play an important preventive and therapeutic role in supporting respiratory infections as in COVID-19. The aim of our study was to evaluate the association of vitamin A (retinol) status with the prognosis of the disease. A case-control study from a cohort study was conducted in Brazil between May and October 2020. The study population was chosen by convenience, consisting of participants diagnosed with COVID-19. Recruitment was carried out using different approaches, including through dissemination on social media and in four hospitals in the city of Natal/RN, Brazil, recruiting participants from the COVID-19 ward and hospitalized participants who tested positive for the disease. The participants were allocated into two groups according to severity, with a group of mild (n = 88) or critical (n = 106) patients and compared to a control group (selected before the pandemic, n = 46). The extraction of retinol serum was performed and analyzed using the high-performance liquid chromatography method (HPLC). The retinol level was calculated in mmol/L, and levels below 0.7 μmol/L (20 µg/dL) were considered to be a vitamin A deficiency. Our findings suggest that the participants with mild and critical COVID-19 had lower retinol levels compared to the healthy controls (p = 0.03). In addition, milder cases of COVID-19 were associated with increased symptoms and prolonged symptoms after 90 days since the beginning of infection. However, the survival analysis showed no association with higher cases of death among participants with vitamin A deficiency (p = 0.509). More studies are needed to understand how nutritional status, including vitamin A levels, can influence prognosis and is a risk factor for the development of long COVID syndrome.
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Affiliation(s)
- Maria Clara da Cruz Carvalho
- Graduate Program in Pharmaceutical Science, Federal University of Rio Grande do Norte, Natal 59078-900, RN, Brazil
| | | | | | - Nayara Sousa da Silva
- Department of Clinical and Toxicological Analyses, Federal University of Rio Grande do Norte, Natal 59078-900, RN, Brazil;
| | - Nathalia Kelly de Araújo
- Graduate Program of Chemistry, Chemistry Institute, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
| | - Andre Ducati Luchessi
- Graduate Program in Pharmaceutical Science, Federal University of Rio Grande do Norte, Natal 59078-900, RN, Brazil
- Department of Clinical and Toxicological Analyses, Federal University of Rio Grande do Norte, Natal 59078-900, RN, Brazil;
- Graduate Program of Chemistry, Chemistry Institute, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
| | - Karla Danielly da Silva Ribeiro
- Department of Nutrition, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal 59078-900, RN, Brazil
- Graduate Program in Nutrition, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal 59078-900, RN, Brazil
| | - Vivian Nogueira Silbiger
- Undergraduate Program of Nutrition, Federal University of Rio Grande do Norte, Natal 59078-900, RN, Brazil; (J.K.C.P.A.); (V.N.S.)
- Department of Clinical and Toxicological Analyses, Federal University of Rio Grande do Norte, Natal 59078-900, RN, Brazil;
- Graduate Program of Chemistry, Chemistry Institute, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
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11
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Hess SY, Wessells KR, Haile D, Rogers LM, Tan X, Barros JG, Bourassa MW, Gorstein J, Brown KH. Comparison of Published Estimates of the National Prevalence of Iron, Vitamin A, and Zinc Deficiency and Sources of Inconsistencies. Adv Nutr 2023; 14:1466-1478. [PMID: 37634853 PMCID: PMC10721533 DOI: 10.1016/j.advnut.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/21/2023] [Accepted: 08/18/2023] [Indexed: 08/29/2023] Open
Abstract
Micronutrient deficiencies result in a broad range of adverse health and functional consequences, but the true prevalence of specific deficiencies remains uncertain because limited information is available from nationally representative surveys using recommended biomarkers. The present review compares various reported national deficiency prevalence estimates for nutrients and years where the estimates overlap for individual countries that conducted nationally representative surveys and explores possible reasons for any discrepancies discovered. Nationally representative micronutrient status surveys that were conducted since 2000 among preschool-aged children or women of reproductive age and included assessment of iron, vitamin A, or zinc status based on recognized biomarkers were considered eligible for inclusion, along with any modeled deficiency prevalence estimates for these same countries and years. There was considerable variation across different published prevalence estimates, with larger inconsistencies when the prevalence estimate was based on proxies, such as hemoglobin for iron deficiency and dietary zinc availability for zinc deficiency. Numerous additional methodological issues affected the prevalence estimates, such as which biomarker and what cutoff was used to define deficiency, whether the biomarker was adjusted for inflammation, and what adjustment method was used. For some country-years, the various approaches resulted in fairly consistent prevalence estimates. For other country-years, however, the results differed markedly and changed the conclusions regarding the existence and severity of the micronutrient deficiency as a public health concern. In conclusion, to determine micronutrient status, we consider the assessment of one of the recommended biomarkers in a population representative survey as the best available information. If indicated, results should be adjusted for inflammation and generally acceptable cutoffs should be applied to facilitate comparisons, although individual countries may also apply nationally defined cutoffs to determine when and where to intervene. Global consensus is needed on best practices for presenting survey results and defining the prevalence of deficiency.
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Affiliation(s)
- Sonja Y Hess
- Institute for Global Nutrition and Department of Nutrition, University of California Davis, Davis, CA, United States; Micronutrient Forum, Washington, DC, United States.
| | - K Ryan Wessells
- Institute for Global Nutrition and Department of Nutrition, University of California Davis, Davis, CA, United States
| | - Demewoz Haile
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
| | | | - Xiuping Tan
- Institute for Global Nutrition and Department of Nutrition, University of California Davis, Davis, CA, United States
| | - Jonathan G Barros
- Institute for Global Nutrition and Department of Nutrition, University of California Davis, Davis, CA, United States
| | | | | | - Kenneth H Brown
- Institute for Global Nutrition and Department of Nutrition, University of California Davis, Davis, CA, United States
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12
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Castro IRRD, Normando P, Farias DR, Berti TL, Schincaglia RM, Andrade PG, Bertoni N, Lacerda EMDA, Anjos LAD, Boccolini CS, Reis MCD, Bezerra FF, Pedrosa LFC, Jordão Junior AA, Lira PICD, Kac G, Vertulli Carneiro LB, Alves-Santos NH. Factors associated with anemia and vitamin A deficiency in Brazilian children under 5 years old: Brazilian National Survey on Child Nutrition (ENANI-2019). CAD SAUDE PUBLICA 2023; 39Suppl 2:e00194922. [PMID: 37792880 PMCID: PMC10552616 DOI: 10.1590/0102-311xen194922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/13/2023] [Accepted: 03/02/2023] [Indexed: 10/06/2023] Open
Abstract
Factors associated with anemia and vitamin A deficiency were investigated in 7,716 children 6-59 months of age studied in the Brazilian National Survey on Child Nutrition (ENANI-2019). We adopted a hierarchical approach based on a United Nations Children's Fund (UNICEF) theoretical model with three levels, stratifying by age (6-23; 24-59 months). Prevalence ratio (PR) and 95% confidence interval (95%CI) were estimated. Enabling determinants: a higher prevalence of anemia was observed in children 6-23 months whose mothers had ≤ 7 years of schooling (PR = 1.92; 95%CI: 1.10; 3.34), < 20 years old (PR = 2.47; 95%CI: 1.34; 4.56) or 20-30 years old (PR = 1.95; 95%CI: 1.11; 3.44), mixed-race (PR = 1.57; 95%CI: 1.06; 2.23); and in children 24-59 months in the North Region (PR = 3.11; 95%CI: 1.58; 6.13). A higher prevalence for vitamin A deficiency was observed in children 6-23 months from Central-West (PR = 2.32; 95%CI: 1.33; 4.05), and in children 24-59 months living in the North (PR = 1.96; 95%CI: 1.16; 3.30), South (PR = 3.07; 95%CI: 1.89; 5.01), and Central-West (PR = 1.91; 95%CI: 1.12; 3.25) and whose mothers were 20-34 years (PR = 1.62; 95%CI: 1.11; 2.35). Underlying determinants: the presence of more than one child < 5 years old in the household was associated with a higher prevalence of anemia (PR = 1.61; 95%CI: 1.15; 2.25) and vitamin A deficiency (PR = 1.82; 95%CI: 1.09; 3.05) in children 6-23 months. Immediate determinants: consumption of 1-2 groups of ultra-processed foods in children 24-59 months (PR = 0.44; 95%CI: 0.25; 0.81) and lack of breastfeeding in the day before in children 6-23 months (PR = 0.56; 95%CI: 0.36; 0.95) were associated with lower prevalence of anemia and vitamin A deficiency. Public policies focused on geographically and socially vulnerable groups are needed to promote equity.
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Affiliation(s)
| | - Paula Normando
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Dayana Rodrigues Farias
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Talita Lelis Berti
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Pedro Gomes Andrade
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Neilane Bertoni
- Divisão de Pesquisa Populacional, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brasil
| | | | | | - Cristiano Siqueira Boccolini
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | | | | | | | | | - Gilberto Kac
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
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13
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Song P, Adeloye D, Li S, Zhao D, Ye X, Pan Q, Qiu Y, Zhang R, Rudan I. The prevalence of vitamin A deficiency and its public health significance in children in low- and middle-income countries: A systematic review and modelling analysis. J Glob Health 2023; 13:04084. [PMID: 37565390 PMCID: PMC10416138 DOI: 10.7189/jogh.13.04084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
Background Vitamin A deficiency (VAD) is widely recognised as a major public health concern in low- and middle-income countries (LMICs). Despite various interventions implemented in many countries, a lack of reliable data is hindering progress. We aimed to consolidate available data and quantify estimates of the prevalence of VAD among children ≤18 years in LMICs. Methods We searched PubMed, Medline and Embase for studies reported the prevalence of VAD or marginal (m)VAD among children. A multilevel mixed-effects meta-regression approach was applied to establish the regression models for VAD and mVAD prevalence. The total numbers of children affected by VAD and mVAD in LMICs in 2019 were separately calculated from the estimated age- and socio-demographic index (SDI)-specific prevalence with their corresponding United Nations Population Division populations projections. We estimated areas of significant public health concern in 165 LMICs using the lower confidence interval (CI) of VAD prevalence. Results A total of 116 articles from 40 LMICs were retained. In 2019, VAD and mVAD affected 333.95 million (95% CI = 253.00-433.74) and 556.13 million (95% CI = 388.83-767.94) children and adolescents in 165 LMICs, respectively, corresponding to a prevalence of 14.73% (95% CI = 11.16-19.14) and 24.54% (95% CI = 17.15-33.88). The prevalence of both VAD and mVAD was the highest in children aged 0-5 years at 19.53% (95% CI = 15.03-24.91) and 28.22% (95% CI = 20.00-38.24), respectively, with both steadily decreasing to 10.09% (95% CI = 7.44-13.50) and 20.76% (95% CI = 14.16-29.50) in adolescents aged 13-18 years. The prevalence of VAD was significantly higher in the low SDI region at 29.67% (95% CI = 22.67-37.53) compared to 5.17% (95% CI = 3.14-8.43) estimated in the high-middle SDI region. 68 of the 165 LMICs (41.21%) were classified as areas of moderate to severe VAD public health significance. Conclusions VAD continues to pose a significant public health concern in many low-income settings. Development in LMICs is a crucial factor for VAD, with a disproportionately higher burden in low SDI regions. Registration This study protocol was registered with PROSPERO, CRD42020220654.
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Affiliation(s)
- Peige Song
- School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Davies Adeloye
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | - Shuting Li
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Dong Zhao
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Xinxin Ye
- College of Education, Zhejiang University, Hangzhou, Zhejiang, China
| | - Qing Pan
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yiwen Qiu
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ronghua Zhang
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Igor Rudan
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
- Algebra University, Zagreb, Croatia
| | - Global Health Epidemiology Research Group (GHERG)
- School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, Zhejiang, China
- College of Education, Zhejiang University, Hangzhou, Zhejiang, China
- Algebra University, Zagreb, Croatia
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14
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Marek S, Forbes G, Avery RA, Zanganeh T, Davidson S, DeCarlo E, Kumar P, Hammersmith K. Potential blindness from nutritional xerophthalmia in autistic patients. J AAPOS 2023; 27:198.e1-198.e4. [PMID: 37453663 DOI: 10.1016/j.jaapos.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Vitamin A is vital to retinal rod function and epithelial cell differentiation. Although uncommon in the developed world, vitamin A deficiency (VAD) secondary to poor diets or gastrointestinal disease has been reported and can lead to xerophthalmia, which is characterized by night blindness and a spectrum of ocular surface changes. Patients with autism spectrum disorder have been shown to have restrictive diets secondary to sensory issues leading to rejection of foods except for those of certain color or texture. METHODS We present a case series of 6 pediatric patients with autism who developed varying degrees of xerophthalmia due to VAD, which resulted from restrictive eating. RESULTS All patients presented with a history of eye irritation that was not relieved by antibiotic or allergy eye drops. Further questioning revealed they had restrictive diets consisting of only or mostly white and tan foods, and serum vitamin A testing confirmed severe VAD. Most stages of xerophthalmia were completely reversed with vitamin A supplementation, but in 2 patients more advanced xerophthalmia resulted in irreversible blindness and ocular damage. CONCLUSIONS Both pediatricians and pediatric eye care providers must be vigilant for VAD as an etiology of eye irritation, photophobia, or new-onset visual impairment in autistic children. A review of the child's diet must be implemented as a standard part of routine history taken in this vulnerable population. Early identification and vitamin A supplementation can prevent irreversible ocular compromise and vision loss.
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Affiliation(s)
- Samantha Marek
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Robert A Avery
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Emily DeCarlo
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Priyanka Kumar
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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15
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Thapa R, Addo EK, Ruit S, Bernstein PS. Assessment of Skin Carotenoid Measurement as a Means to Detect Vitamin A Deficiency in Children and Pregnant Women of Nepal. J Nutr 2023; 153:1211-1219. [PMID: 36780945 PMCID: PMC10356995 DOI: 10.1016/j.tjnut.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/04/2023] [Accepted: 02/08/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Vitamin A deficiency (VAD) is an ongoing public health concern among children and pregnant women in Nepal despite robust national efforts to screen and treat this vision- and life-threatening condition. OBJECTIVES This study aimed to evaluate skin carotenoid scores measured using the Veggie Meter as a rapid, noninvasive screening tool for VAD in Nepali children and pregnant women. METHODS This comparative cross-sectional study enrolled 164 pregnant women and 168 children (aged 8 to 12 y) from public hospitals in three distinct outlying ecological regions of Nepal (Terai, Hill, and Mountain). The primary outcome assessed whether skin carotenoid status could be a biomarker for VAD. We determined skin carotenoid scores using the Veggie Meter and compared them with serum retinol and total carotenoid concentrations assessed by HPLC. Correlation analysis was used to determine bivariate associations between serum retinol and total carotenoid concentrations, and the Veggie Meter assessed skin carotenoid status. Receiver operating characteristics curves were determined, and a P value <0.05 was considered statistically significant. RESULTS We found that 8.5% of pregnant women and 13.0% of children in this study had severe VAD (serum retinol < 200 ng/mL). There were significant correlations between skin carotenoid scores with serum retinol and total carotenoid concentrations among pregnant women and children (r = 0.253-0.530, P ≤ 0.001). The Veggie Meter detected severe VAD with 57.1% sensitivity and 82.7% specificity in pregnant women and 61.9% sensitivity and 75.9% specificity in children. CONCLUSIONS Although sensitivity and specificity were moderate for detecting VAD with the Veggie Meter, skin carotenoid assessment using this rapid, noninvasive portable device could still be valuable for high-risk VAD screening in Nepal and similar developing countries with limited access to laboratory measurement of serum vitamin A concentrations.
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Affiliation(s)
- Raba Thapa
- Department of Ophthalmology, Tilganga Institute of Ophthalmology, Kathmandu, Nepal.
| | - Emmanuel K Addo
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT, United States; Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, United States.
| | - Sanduk Ruit
- Department of Ophthalmology, Tilganga Institute of Ophthalmology, Kathmandu, Nepal.
| | - Paul S Bernstein
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT, United States; Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, United States.
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16
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Gannon BM, Sombié OO, Zeba AN, Nama GM, Bekele TH, Woldeyohannes M, van Stuijvenberg ME, Dhansay MA, Urio EM, Kaliwile C, Chileshe J, Kalungwana N, Davis CR, Grahn M, Tanumihardjo SA. Comparison of Total Body Vitamin A Stores Using Individual versus Population 13C-Natural Abundance of Serum Retinol in Preschool Children and Women Residing in 6 Diverse African Countries. J Nutr 2023; 153:949-957. [PMID: 36822237 PMCID: PMC10367224 DOI: 10.1016/j.tjnut.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/27/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Stable isotope techniques using 13C to assess vitamin A (VA) dietary sources, absorption, and total body VA stores (TBSs) require determination of baseline 13C abundance. 13C-natural abundance is approximately 1.1% total carbon, but varies with foods consumed, supplements taken, and food fortification with synthetic retinyl palmitate. OBJECTIVES We determined 13C variation from purified serum retinol and the resulting impact on TBSs using pooled data from preschool children in Burkina Faso, Cameroon, Ethiopia, South Africa, Tanzania, and Zambia and Zambian women. METHODS Seven studies included children (n = 639; 56 ± 25 mo; 48% female) and one in women (n = 138; 29 ± 8.5 y). Serum retinol 13C-natural abundance was determined using GC-C-IRMS. TBSs were available in 7 studies that employed retinol isotope dilution (RID). Serum CRP and α1-acid-glycoprotein (AGP) were available from 6 studies in children. Multivariate mixed models assessed the impact of covariates on retinol 13C. Spearman correlations and Bland-Altman analysis compared serum and milk retinol 13C and evaluated the impact of using study- or global-retinol 13C estimates on calculated TBSs. RESULTS 13C-natural abundance (%, median [Q1, Q3]) differed among countries (low: Zambia, 1.0744 [1.0736, 1.0753]; high: South Africa, 1.0773 [1.0769, 1.0779]) and was associated with TBSs, CRP, and AGP in children and with TBSs in women. 13C-enrichment from serum and milk retinol were correlated (r = 0.52; P = 0.0001). RID in children and women using study and global estimates had low mean bias (range, -3.7% to 2.2%), but larger 95% limits of agreement (range, -23% to 37%). CONCLUSIONS 13C-natural abundance is different among human cohorts in Africa. Collecting this information in subgroups is recommended for surveys using RID. When TBSs are needed on individuals in clinical applications, baseline 13C measures are important and should be measured in all enrolled subjects.
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Affiliation(s)
- Bryan M Gannon
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, United States.
| | - Olivier O Sombié
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Augustin N Zeba
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | | | | | | | - Martha E van Stuijvenberg
- Non-Communicable Diseases Research Unit, South African Medical Research Council; Division of Human Nutrition, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Muhammad A Dhansay
- Division of Human Nutrition, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa; Burden of Disease Research Unit, South African Medical Research Council, Cape Town, Western Cape, South Africa; Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| | | | - Chisela Kaliwile
- National Food and Nutrition Commission (NFNC), Public Health and Community Nutrition Unit, Lusaka, Zambia
| | | | | | - Christopher R Davis
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Michael Grahn
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Sherry A Tanumihardjo
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, United States.
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17
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Tang K, Eilerts H, Imohe A, Adams KP, Sandalinas F, Moloney G, Joy E, Hasman A. Evaluating equity dimensions of infant and child vitamin A supplementation programmes using Demographic and Health Surveys from 49 countries. BMJ Open 2023; 13:e062387. [PMID: 36918231 PMCID: PMC10016247 DOI: 10.1136/bmjopen-2022-062387] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVES Vitamin A deficiency affects an estimated 29% of all children under 5 years of age in low/middle-income countries, contributing to child mortality and exacerbating severity of infections. Biannual vitamin A supplementation (VAS) for children aged 6-59 months can be a low-cost intervention to meet vitamin A needs. This study aimed to present a framework for evaluating the equity dimensions of national VAS programmes according to determinants known to affect child nutrition and assist programming by highlighting geographical variation in coverage. METHODS We used open-source data from the Demographic and Health Survey for 49 countries to identify differences in VAS coverage between subpopulations characterised by various immediate, underlying and enabling determinants of vitamin A status and geographically. This included recent consumption of vitamin A-rich foods, access to health systems and services, administrative region of the country, place of residence (rural vs urban), socioeconomic position, caregiver educational attainment and caregiver empowerment. RESULTS Children who did not recently consume vitamin A-rich foods and who had poorer access to health systems and services were less likely to receive VAS in most countries despite potentially having a greater vitamin A need. Differences in coverage were also observed when disaggregated by administrative regions (88% of countries) and urban versus rural residence (35% of countries). Differences in vitamin A coverage between subpopulations characterised by other determinants of vitamin A status varied considerably between countries. CONCLUSION VAS programmes are unable to reach all eligible infants and children, and subpopulation differences in VAS coverage characterised by various determinants of vitamin A status suggest that VAS programmes may not be operating equitably in many countries.
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Affiliation(s)
- Kevin Tang
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Programme Division, UNICEF, New York City, New York, USA
| | - Hallie Eilerts
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Annette Imohe
- Programme Division, UNICEF, New York City, New York, USA
| | - Katherine P Adams
- Institute for Global Nutrition, University of California Davis, Davis, California, USA
| | - Fanny Sandalinas
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Edward Joy
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Andreas Hasman
- Programme Division, UNICEF, New York City, New York, USA
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Sigh S, Roos N, Chhoun C, Laillou A, Wieringa FT. Ready-to-Use Therapeutic Foods Fail to Improve Vitamin A and Iron Status Meaningfully during Treatment for Severe Acute Malnutrition in 6-59-Month-old Cambodian Children. Nutrients 2023; 15:nu15040905. [PMID: 36839263 PMCID: PMC9961841 DOI: 10.3390/nu15040905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023] Open
Abstract
Severe acute malnutrition (SAM) remains a global health concern. Studies on the impact of ready-to-use therapeutic foods (RUTFs) on micronutrient status during SAM treatment are almost nonexistent. The objective was to investigate the impact of RUTFs on the iron and vitamin A status of 6-59-month-old children receiving SAM treatment. Biomarkers of vitamin A status (retinol-binding protein, RBP), iron status (ferritin and soluble transferrin receptor, sTfR), and inflammation (C-reactive protein, CRP, and alpha-1 acid glycoprotein, AGP) were collected at admission and discharge (week 8) during an RUTF effectiveness trial. Vitamin A deficiency was defined as RBP <0.70 µmol/L, low body iron as body iron (BI) <0 mg/kg and deficient iron stores as ferritin <12 µg/L. Data were available for 110 and 75 children at admission and discharge, respectively. There was no significant difference in haemoglobin, ferritin, sTfR, BI or RBP concentrations between admission and discharge. At discharge, BI was 0.2 mg/kg lower, and there was a tendency towards a slightly lower RBP concentration, but the prevalence of vitamin A deficiency was low at admission and discharge (6% and 3%, respectively). The small impact of both RUTFs on improving vitamin A and iron status during SAM treatment calls for further research on the bioavailability of micronutrients to enhance the effectiveness of SAM treatment on micronutrient status.
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Affiliation(s)
- Sanne Sigh
- Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Rolighedsvej 26, 1958 Frederiksberg C, Denmark
- Department of Fisheries Post-Harvest Technologies and Quality Control, Fisheries Administration, 186 Preah Norodom Boulevard, Phnom Penh 12101, Cambodia
- Correspondence: ; Tel.: +855-(0)95-201-308
| | - Nanna Roos
- Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Rolighedsvej 26, 1958 Frederiksberg C, Denmark
| | - Chamnan Chhoun
- Department of Fisheries Post-Harvest Technologies and Quality Control, Fisheries Administration, 186 Preah Norodom Boulevard, Phnom Penh 12101, Cambodia
| | - Arnaud Laillou
- Nutrition Section, UNICEF West and Central Africa Region, Dakar 29720, Senegal
| | - Frank T. Wieringa
- UMR QualiSud, Institut de Recherche Pour le Développement (IRD), 34394 Montpellier, France
- Qualisud, University of Montpellier, Avignon University, CIRAD, Institut Agro, IRD, Université de la Réunion, 34394 Montpellier, France
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Sachdev HS, Reddy GB, Pullakhandam R, Ghosh S, Rajkumar H, Kurpad AV. Flawed analyses and historical data inflate vitamin A deficiency in India to misdirect policy. Eur J Clin Nutr 2023; 77:138-139. [PMID: 35590098 DOI: 10.1038/s41430-022-01164-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/06/2022] [Accepted: 05/06/2022] [Indexed: 01/28/2023]
Affiliation(s)
| | - G Bhanuprakash Reddy
- ICMR-National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India
| | - Raghu Pullakhandam
- ICMR-National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India
| | | | - Hemalatha Rajkumar
- ICMR-National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India
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Arlappa N. Vitamin A supplementation policy: A shift from universal to geographical targeted approach in India considered detrimental to health and nutritional status of under 5 years children. Eur J Clin Nutr 2023; 77:1-6. [PMID: 35347255 PMCID: PMC8959797 DOI: 10.1038/s41430-022-01122-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 03/03/2022] [Accepted: 03/11/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Nimmathota Arlappa
- Scientist-F, Division of Public Health Nutrition, ICMR-National Institute of Nutrition, Hyderabad, India.
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21
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Singh P, Nigam A. The time is not right for a change to the Vitamin A Supplementation Programme for Children in India. Eur J Clin Nutr 2023; 77:142-144. [PMID: 36180588 DOI: 10.1038/s41430-022-01210-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Padam Singh
- Indian Council of Medical Research (ICMR), New Delhi, India.
| | - Arun Nigam
- Institute of Applied Statistics and Development Studies, Lucknow, India
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22
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Abstract
Respiratory tract infections are common illnesses in children, causing significant morbidity and negatively affecting their health. Vitamin A protects against infections and maintains epithelial integrity. The goal of this study was to determine the correlation between vitamin A deficiency and recurrent respiratory tract infections (RRTIs). Participants in this cross-sectional study were divided into 3 groups: RRTIs (including patients with history of RRTIs presenting with respiratory tract infection symptoms), RTI (including patients without history of RRTIs presenting with respiratory tract infection symptoms), and control (including children who came for a routine health checkup without a history of RRTIs or respiratory tract infection symptoms). The vitamin A assay was performed using high-performance liquid chromatography. The study included 550 children aged 6.64 ± 2.61 years. The RRTIs group included 150 children (27.3%), the RTI group included 300 children (54.5%), and the control group included 100 children (18.2%). Subclinical vitamin A deficiency and vitamin A deficiency affected 3.1% and 1.3% of subjects, respectively. Subclinical vitamin A deficiency and vitamin A deficiency were higher in children with RRTIs than in those with RTI (8% vs 1.3%, P = .001 and 4% vs 0.3%, P = .006). Additionally, children with RRTIs had significantly higher rates of subclinical vitamin A deficiency and vitamin A deficiency than those in the control group, which had 1% subclinical vitamin A deficiency (P = .017) and no cases of vitamin A deficiency (P = .043). The RRTIs group had higher rates of otitis media (27.3%), sinusitis (20%), and pneumonia (4.7%) than the RTI group (P = .002). Vitamin A insufficiency was associated with RRTIs in children.
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Affiliation(s)
- Ashraf Abdelkader
- Department of Pediatrics, Faculty of Medicine (Boys), Al-Azhar University, Cairo, Egypt
- Scientific Research and Continuous Medical Education Unit, Al Ansari Specialist Hospital, Yanbu, Saudi Arabia
- *Correspondence: Ashraf Abdelkader, Faculty of Medicine for Boys, Al-Azhar University, Al mokhaym Aldaem street, Nasr City, Cairo 11751, Egypt (E-mail: )
| | - Ashraf A. Wahba
- Department of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Mohamed El-tonsy
- Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | | | - Mohamed Shams Eldin
- Department of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Haselow NJ, Joshi V, Bayo PN, Murye JW, Shaban SN, Abebe KT, Kassim I, Shiweredo T, Vinathan H, Jaiswal CP, Miluwa KA, Ategbo EA, Ndiaye B, Ayoya MA. A Review of Vitamin A Supplementation in South Sudan: Successes, Challenges, and Opportunities for the Way Forward. Glob Health Sci Pract 2022; 10:GHSP-D-21-00660. [PMID: 36332070 PMCID: PMC9242605 DOI: 10.9745/ghsp-d-21-00660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 04/05/2022] [Indexed: 11/17/2022]
Abstract
Although South Sudan's vitamin A supplementation program has demonstrated success, vitamin A supplementation remains a critical public health need for young children. How can South Sudan best maintain high vitamin A supplementation coverage for the short to medium term while planning a more sustainable delivery approach for the longer term? Aim: To identify vitamin A supplementation (VAS) trends in South Sudan and provide insights to refocus VAS programming vis a vis polio eradication campaigns recently phased out while access to health care, land, food, and markets remain challenging. Method: Review of data from survey and coverage reports; review of policy and program documents; key informant responses; general literature search. Results: Vitamin A deficiency (VAD) is likely a severe public health problem among preschool-aged children in South Sudan based on a high under-5 mortality rate (96.2 deaths/1,000 live births) and high levels of undernutrition, infections, and food insecurity. Vitamin A capsules, with deworming tablets (VASD), have been delivered to preschool-aged children during national immunization days (NIDs) for the past decade. Although areas of South Sudan and certain populations continue to have low VAS coverage, when comparing national VAS coverage (reported in the last 6 months) between 2010 and August 2019, a large improvement is noted from 4% to 76%. In 2021, VAS coverage was more than 90% at the national level during 2 stand-alone distribution campaigns. Deworming coverage trends generally mimicked VAS coverage. VAS is provided to postpartum mothers who deliver at health facilities (approximately 12%–25%), but coverage data are not available. Conclusion: Twice-yearly VAS should remain a key lifesaving intervention to address VAD, but alternative delivery strategies will be needed. Conducting events, such as child health days, supported by promotional activities or community-based VASD distribution activities for the youngest children and those missed during campaigns, should be considered. For the long term, a hybrid approach targeting underserved areas with mass distribution events while integrating VASD into community-based programs such as quarterly screening for wasting should be tested further and gradually scaled up everywhere as this has the potential to sustainably reach all vulnerable children twice yearly.
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Affiliation(s)
| | - Vandana Joshi
- UNICEF South Sudan, Juba, The Republic of South Sudan.
| | | | - Jesca W Murye
- UNICEF South Sudan, Juba, The Republic of South Sudan
| | | | | | | | | | - Hari Vinathan
- UNICEF Lao People's Democratic Republic, Vientiane, Lao People's Democratic Republic
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Shrestha S, Thapa S, Garner P, Caws M, Gurung SC, Fox T, Kirubakaran R, Pokhrel KN. Is routine Vitamin A supplementation still justified for children in Nepal? Trial synthesis findings applied to Nepal national mortality estimates. PLoS One 2022; 17:e0268507. [PMID: 35584136 PMCID: PMC9116662 DOI: 10.1371/journal.pone.0268507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/03/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The World Health Organization has recommended Vitamin A supplementation for children in low- and middle-income countries for many years to reduce child mortality. Nepal still practices routine Vitamin A supplementation. We examined the potential current impact of these programs using national data in Nepal combined with an update of the mortality effect estimate from a meta-analysis of randomized controlled trials. METHODS We used the 2017 Cochrane review as a template for an updated meta-analysis. We conducted fresh searches, re-applied the inclusion criteria, re-extracted the data for mortality and constructed a summary of findings table using GRADE. We applied the best estimate of the effect obtained from the trials to the national statistics of the country to estimate the impact of supplementation on under-five mortality in Nepal. RESULTS The effect estimates from well-concealed trials gave a 9% reduction in mortality (Risk Ratio: 0.91, 95% CI 0.85 to 0.97, 6 trials; 1,046,829 participants; low certainty evidence). The funnel plot suggested publication bias, and a meta-analysis of trials published since 2000 gave a smaller effect estimate (Risk Ratio: 0.96, 95% CI 0.89 to 1.03, 2 trials, 1,007,587 participants), with the DEVTA trial contributing 55.1 per cent to this estimate. Applying the estimate from well-concealed trials to Nepal's under-five mortality rate, there may be a reduction in mortality, and this is small from 28 to 25 per 1000 live births; 3 fewer deaths (95% CI 1 to 4 fewer) for every 1000 children supplemented. CONCLUSIONS Vitamin A supplementation may only result in a quantitatively unimportant reduction in child mortality. Stopping blanket supplementation seems reasonable given these data.
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Affiliation(s)
- Samjhana Shrestha
- Birat Nepal Medical Trust (BNMT), READ-It Project, Kathmandu, Nepal
- Centre for Evidence Synthesis in Global Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Saki Thapa
- Birat Nepal Medical Trust (BNMT), READ-It Project, Kathmandu, Nepal
| | - Paul Garner
- Centre for Evidence Synthesis in Global Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Maxine Caws
- Birat Nepal Medical Trust (BNMT), READ-It Project, Kathmandu, Nepal
- Department of Clinical Sciences, Center for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Suman Chandra Gurung
- Birat Nepal Medical Trust (BNMT), READ-It Project, Kathmandu, Nepal
- Department of Clinical Sciences, Center for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Tilly Fox
- Centre for Evidence Synthesis in Global Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Richard Kirubakaran
- Prof BV Moses Centre for Evidence-Informed Healthcare and Health Policy, Vellore, India
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Mao D, Chen J, Wang R, Hu Y, Li M, Li W, Yang L. [Vitamin A nutrition status of Chinese urban adults aged 18 to 60 years old in 2015]. Wei Sheng Yan Jiu 2022; 51:381-385. [PMID: 35718898 DOI: 10.19813/j.cnki.weishengyanjiu.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To investigate the vitamin A nutritional status and its related influencing factors of Chinese 18-60 urban adults by analyzing serum retinol level in 2015. METHODS Serum samples of 42 people, half male and half female, were randomly selected in each point, from the 302 monitoring sites of Chinese adult chronic diseases and nutrition surveillance in 2015. The serum retinol levels were determined by high pressure liquid chromatography(HPLC). RESULTS A total of 2571 serum samples were detected. The serum retinol level of Chinese urban adults of 18-60 years old was 1.98(1.56-2.53)μmol/L, the deficiency rate was 0.25%, and the marginal deficiency rate was 4.45%. The serum retinol level of male was 2.19(1.75-2.78)μmol/L, the deficiency rate was 0.05%, and the marginal deficiency rate was 2.48%; The serum retinol level of female was 1.80(1.42-2.25)μmol/L, the deficiency rate was 0.46%, and the marginal deficiency rate was 6.51%. The significant differences in serum retinol was observed deficiency rate and marginal deficiency rate between males and females(P<0.01), the nutritional status of males was better than the females. The deficiency rate and marginal deficiency rate of 18-29 years old were the highest, which were 0.34% and 5.81% respectively. The deficiency rate and marginal deficiency rate of over 50 years old were the lowest, which were 0.15% and 2.60% respectively. The vitamin A deficiency rate and marginal deficiency rate of people with body mass index(BMI)<18.5 were 0.95% and 7.24%, 0.33% and 5.85% for BMI=18.5-23.9, 0.13% and 3.27% for BMI=24.0-27.9, respectively. The differences of vitamin A deficiency rate and marginal deficiency rate among different BMI were significant. CONCLUSION The vitamin A nutritional status of urban adults in China is good, the vitamin A deficiency rate is very low, and the incidence of vitamin A deficiency is also low. It is basically not a public health problem according the WHO standard.
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Affiliation(s)
- Deqian Mao
- NHC Key Laboratory of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Jing Chen
- NHC Key Laboratory of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Rui Wang
- NHC Key Laboratory of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Yichun Hu
- NHC Key Laboratory of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Min Li
- NHC Key Laboratory of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Weidong Li
- NHC Key Laboratory of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Lichen Yang
- NHC Key Laboratory of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
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Song A, Mousa HM, Soifer M, Perez VL. Recognizing vitamin A deficiency: special considerations in low-prevalence areas. Curr Opin Pediatr 2022; 34:241-247. [PMID: 35125379 PMCID: PMC8891082 DOI: 10.1097/mop.0000000000001110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Although vitamin A deficiency (VAD) is rare in well resourced countries, there is a growing trend of VAD in at-risk pediatric populations. Early diagnosis is critically important to prevent its associated morbidity and mortality. This review highlights key lessons for evaluation, diagnosis, and management of children with xerophthalmia in the United States. It synthesizes the latest findings from the literature on the pathophysiology, epidemiology, risk factors, evaluation, and management of VAD in low-prevalence areas. RECENT FINDINGS Vitamin A is crucial for maintaining the functional integrity of the eye, immune system, skin, and mucous membranes. Despite the scarcity of VAD in developed countries, there are increasing reports of VAD in at-risk children, including those with autism spectrum disorder and gastrointestinal conditions. There is a broad range of manifestations of VAD, posing a diagnostic challenge. Familiarity with the variable presentations of VAD and having a high index of suspicion in at-risk populations can aid in its early diagnosis. Systemic vitamin A supplementation and a multidisciplinary approach are important components of the management of VAD. SUMMARY Even in well resourced countries, VAD should remain on the differential in patients with risk factors who present with relevant signs and symptoms. Early diagnosis and appropriate involvement of a multidisciplinary care team can help prevent morbidity and mortality associated with VAD.
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Affiliation(s)
- Ailin Song
- Duke University School of Medicine, Durham, NC, USA
| | - Hazem M Mousa
- Foster Center for Ocular Immunology, Duke Eye Institute, 2351 Erwin Road, Durham, NC, USA
- Department of Ophthalmology, Duke University Medical Center, 2351 Erwin Road, Durham, NC, USA
| | - Matias Soifer
- Foster Center for Ocular Immunology, Duke Eye Institute, 2351 Erwin Road, Durham, NC, USA
- Department of Ophthalmology, Duke University Medical Center, 2351 Erwin Road, Durham, NC, USA
| | - Victor L Perez
- Foster Center for Ocular Immunology, Duke Eye Institute, 2351 Erwin Road, Durham, NC, USA
- Department of Ophthalmology, Duke University Medical Center, 2351 Erwin Road, Durham, NC, USA
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Imdad A, Mayo-Wilson E, Haykal MR, Regan A, Sidhu J, Smith A, Bhutta ZA. Vitamin A supplementation for preventing morbidity and mortality in children from six months to five years of age. Cochrane Database Syst Rev 2022; 3:CD008524. [PMID: 35294044 PMCID: PMC8925277 DOI: 10.1002/14651858.cd008524.pub4] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Vitamin A deficiency (VAD) is a major public health problem in low- and middle-income countries, affecting 190 million children under five years of age and leading to many adverse health consequences, including death. Based on prior evidence and a previous version of this review, the World Health Organization has continued to recommend vitamin A supplementation (VAS) for children aged 6 to 59 months. The last version of this review was published in 2017, and this is an updated version of that review. OBJECTIVES To assess the effects of vitamin A supplementation (VAS) for preventing morbidity and mortality in children aged six months to five years. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, six other databases, and two trials registers up to March 2021. We also checked reference lists and contacted relevant organisations and researchers to identify additional studies. SELECTION CRITERIA Randomised controlled trials (RCTs) and cluster-RCTs evaluating the effect of synthetic VAS in children aged six months to five years living in the community. We excluded studies involving children in hospital and children with disease or infection. We also excluded studies evaluating the effects of food fortification, consumption of vitamin A rich foods, or beta-carotene supplementation. DATA COLLECTION AND ANALYSIS For this update, two review authors independently assessed studies for inclusion resolving discrepancies by discussion. We performed meta-analyses for outcomes, including all-cause and cause-specific mortality, disease, vision, and side effects. We used the GRADE approach to assess the quality of the evidence. MAIN RESULTS The updated search identified no new RCTs. We identified 47 studies, involving approximately 1,223,856 children. Studies were set in 19 countries: 30 (63%) in Asia, 16 of these in India; 8 (17%) in Africa; 7 (15%) in Latin America, and 2 (4%) in Australia. About one-third of the studies were in urban/periurban settings, and half were in rural settings; the remaining studies did not clearly report settings. Most studies included equal numbers of girls and boys and lasted about one year. The mean age of the children was about 33 months. The included studies were at variable overall risk of bias; however, evidence for the primary outcome was at low risk of bias. A meta-analysis for all-cause mortality included 19 trials (1,202,382 children). At longest follow-up, there was a 12% observed reduction in the risk of all-cause mortality for VAS compared with control using a fixed-effect model (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.83 to 0.93; high-certainty evidence). Nine trials reported mortality due to diarrhoea and showed a 12% overall reduction for VAS (RR 0.88, 95% CI 0.79 to 0.98; 1,098,538 children; high-certainty evidence). There was no evidence of a difference for VAS on mortality due to measles (RR 0.88, 95% CI 0.69 to 1.11; 6 studies, 1,088,261 children; low-certainty evidence), respiratory disease (RR 0.98, 95% CI 0.86 to 1.12; 9 studies, 1,098,538 children; low-certainty evidence), and meningitis. VAS reduced the incidence of diarrhoea (RR 0.85, 95% CI 0.82 to 0.87; 15 studies, 77,946 children; low-certainty evidence), measles (RR 0.50, 95% CI 0.37 to 0.67; 6 studies, 19,566 children; moderate-certainty evidence), Bitot's spots (RR 0.42, 95% CI 0.33 to 0.53; 5 studies, 1,063,278 children; moderate-certainty evidence), night blindness (RR 0.32, 95% CI 0.21 to 0.50; 2 studies, 22,972 children; moderate-certainty evidence), and VAD (RR 0.71, 95% CI 0.65 to 0.78; 4 studies, 2262 children, moderate-certainty evidence). However, there was no evidence of a difference on incidence of respiratory disease (RR 0.99, 95% CI 0.92 to 1.06; 11 studies, 27,540 children; low-certainty evidence) or hospitalisations due to diarrhoea or pneumonia. There was an increased risk of vomiting within the first 48 hours of VAS (RR 1.97, 95% CI 1.44 to 2.69; 4 studies, 10,541 children; moderate-certainty evidence). AUTHORS' CONCLUSIONS This update identified no new eligible studies and the conclusions remain the same. VAS is associated with a clinically meaningful reduction in morbidity and mortality in children. Further placebo-controlled trials of VAS in children between six months and five years of age would not change the conclusions of this review, although studies that compare different doses and delivery mechanisms are needed. In populations with documented VAD, it would be unethical to conduct placebo-controlled trials.
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Affiliation(s)
- Aamer Imdad
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Evan Mayo-Wilson
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Maya R Haykal
- College of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Allison Regan
- College of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Jasleen Sidhu
- College of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Abigail Smith
- Health Sciences Library, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
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Thomas T, Sachdev HS, Ghosh S, Kapil U, Kurpad AV. Association of Vitamin A Status With Under-Five Mortality in India. Indian Pediatr 2022; 59:206-209. [PMID: 34553692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To re-estimate the survival benefit from Vitamin A supplementation (VAS) in India using meta-analysis and to correlate mortality and vitamin A deficiency (VAD) in children aged 6 month to 5 year. METHODS Pooled risk ratio (fixed effects model) for mortality reduction with VAS was calculated from available Indian studies. Computed mortality rates in 6 months to 5 years children in Indian states were regressed on VAD prevalence estimates of the states. RESULTS There was no reduction in risk of all-cause mortality with VAS (RR=0.96; 95% CI: 0.89, 1.03). When regressing mortality on VAD in high or low VAD prevalence states, the regression coefficients were discordant. CONCLUSION No survival benefit was observed for VAS in India from the available literature. The targeting of VAS programs should be given serious consideration.
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Affiliation(s)
- Tinku Thomas
- Department of Biostatistics, St John's Medical College, St. John's National Academy of Health Sciences, Bengaluru, Karnataka
| | | | - Santu Ghosh
- Department of Biostatistics, St John's Medical College, St. John's National Academy of Health Sciences, Bengaluru, Karnataka
| | - Umesh Kapil
- Institute of Liver and Biliary Sciences, New Delhi
| | - Anura V Kurpad
- Department of Physiology, St. John's Medical College, St. John's National Academy of Health Sciences, Bengaluru, Karnataka. Correspondence to: Dr AV Kurpad, Department of Physiology, St. John's Medical College, St. John's National Academy of Health Sciences, Bengaluru 560 034, Karnataka.
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Patwari AK. Do We Need To Roll Back Universal Vitamin A Supplementation In India? Indian Pediatr 2022; 59:189-190. [PMID: 35315346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Ashok K Patwari
- Former Research Professor, Boston University School of Public Health, Boston, USA. Correspondence to: N53W17480, Ridgeline Tr, Menomonee Falls, WI-53051, USA.
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Kebede A, Jirström M, Worku A, Alemu K, Berhane HY, Turner C, Ekström EC, Berhane Y. Residential Food Environment, Household Wealth and Maternal Education Association to Preschoolers' Consumption of Plant-Based Vitamin A-Rich Foods: The EAT Addis Survey in Addis Ababa. Nutrients 2022; 14:296. [PMID: 35057477 PMCID: PMC8778225 DOI: 10.3390/nu14020296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/03/2022] [Accepted: 01/07/2022] [Indexed: 11/29/2022] Open
Abstract
Vitamin A deficiency is common among preschoolers in low-income settings and a serious public health concern due to its association to increased morbidity and mortality. The limited consumption of vitamin A-rich food is contributing to the problem. Many factors may influence children's diet, including residential food environment, household wealth, and maternal education. However, very few studies in low-income settings have examined the relationship of these factors to children's diet together. This study aimed to assess the importance of residential food availability of three plant-based groups of vitamin A-rich foods, household wealth, and maternal education for preschoolers' consumption of plant-based vitamin A-rich foods in Addis Ababa. A multistage sampling procedure was used to enroll 5467 households with under-five children and 233 residential food environments with 2568 vendors. Data were analyzed using a multilevel binary logistic regression model. Overall, 36% (95% CI: 34.26, 36.95) of the study children reportedly consumed at least one plant-based vitamin A-rich food group in the 24-h dietary recall period. The odds of consuming any plant-based vitamin A-rich food were significantly higher among children whose mothers had a higher education level (AOR: 2.55; 95% CI: 2.01, 3.25), those living in the highest wealth quintile households (AOR: 2.37; 95% CI: 1.92, 2.93), and in residentials where vitamin A-rich fruits were available (AOR: 1.20; 95% CI: 1.02, 1.41). Further research in residential food environment is necessary to understand the purchasing habits, affordability, and desirability of plant-based vitamin A-rich foods to widen strategic options to improve its consumption among preschoolers in low-income and low-education communities.
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Affiliation(s)
- Adane Kebede
- Department of Health System and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Magnus Jirström
- Department of Human Geography, Lund University, 223 62 Lund, Sweden;
| | - Alemayehu Worku
- School of Public Health, College of Health Science, Addis Ababa University, Addis Ababa 1176, Ethiopia;
| | - Kassahun Alemu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia;
| | - Hanna Y. Berhane
- Department of Nutrition and Behavioral Sciences, Addis Continental Institute of Public Health, Addis Ababa 26751/1000, Ethiopia;
- Department of Women’s and Children Health, Uppsala University, 751 85 Uppsala, Sweden; (E.-C.E.); (Y.B.)
| | - Christopher Turner
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK;
| | - Eva-Charlotte Ekström
- Department of Women’s and Children Health, Uppsala University, 751 85 Uppsala, Sweden; (E.-C.E.); (Y.B.)
| | - Yemane Berhane
- Department of Women’s and Children Health, Uppsala University, 751 85 Uppsala, Sweden; (E.-C.E.); (Y.B.)
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa 26751/1000, Ethiopia
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Liu R, Wu H, Chen Y, Xiong F, Zhao J, Sun H, Li Y, He F. Prevalence of vitamin A and vitamin D deficiency in hospitalized neonates in Xi'an, China. Asia Pac J Clin Nutr 2022; 31:275-281. [PMID: 35766563 DOI: 10.6133/apjcn.202206_31(2).0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVES To investigate the prevalence of vitamin A and vitamin D deficiency and the associated factors in hospitalized neonates in Xi'an, China. METHODS AND STUDY DESIGN A total of 524 hospitalized neonates were collected in this study. Serum vitamin A and D concentrations were detected in neonates within two weeks of birth. RESULTS Serum vitamin A and D concentrations of hospitalized neonates were 0.55±0.21 μmol/L and 42.0±20.6 nmol/L, respectively. They were greater in full-term neonates than in preterm neonates, greater in rural neonates than in urban, and greater in single than in twin (all p<0.001). The prevalence of vitamin A and D deficiency were 14.9% and 33.0%, the prevalence of marginal vitamin A deficiency was 64.7%, and vitamin D insufficiency was 35.1%. Neonatal serum vitamin A and D concentrations were all positively correlated with birth weight and gestational age. Neonatal serum vitamin D concentration was also positively correlated with maternal serum vitamin D concentration. Additionally, neonatal vitamin A concentration was positively correlated with neonatal serum vitamin D concentration. CONCLUSIONS Vitamin A and vitamin D statuses are compromised in hospitalized neonates in Xi'an, especially in premature neonates, low birth weight neonates, twins, and those born in urban areas. Individualized supplementation with vitamin A and vitamin D in neonates should be a clinical consideration.
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Affiliation(s)
- Ruiping Liu
- Department of Clinical Nutrition, Xi'an Children's Hospital, the Affiliated Children's Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Haibin Wu
- Shaanxi Institute of Pediatric Diseases, Xi'an Children's Hospital, the Affiliated Children's Hospital of Xi'an Jiaotong University, Xi'an, China.
| | - Yang Chen
- Department of Clinical Nutrition, Xi'an Children's Hospital, the Affiliated Children's Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Fengmei Xiong
- Department of Pharmacy, Xi'an Children's Hospital, the Affiliated Children's Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jiangang Zhao
- Department of Neonatology, Xi'an Children's Hospital, the Affiliated Children's Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Huan Sun
- Neonatal Intensive Care Unit, Xi'an Children's Hospital, the Affiliated Children's Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yuanyuan Li
- Department of Clinical Nutrition, Xi'an Children's Hospital, the Affiliated Children's Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Fangyuan He
- Department of Clinical Nutrition, Xi'an Children's Hospital, the Affiliated Children's Hospital of Xi'an Jiaotong University, Xi'an, China
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Diouf JBN, Sougou NM. Vitamin A Supplementation in Children in Guédiawaye Health District, Senegal. Indian Pediatr 2021; 58:1094-1095. [PMID: 34837369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
To assess the coverage rate of routine vitamin A supplementa tion, a descriptive study was carried out in the Guédiawaye Health District. The coverage rate for vitamin A supplementation was 48.6%. Age over 24 months, uneducated father, maternal age over 25, and lack of disease-related knowledge were factors associated with delayed vitamin A supplementation.
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Affiliation(s)
- Jean Baptiste Niokhor Diouf
- Pediatrics Department of the Hospital Center Roi Baudouin of Guédiawaye, University of Cheikh Anta Diop, Dakar, Senegal.
| | - Ndèye Marième Sougou
- Department of Public Health, Institut de Santé et Development (ISED), University of Cheikh Anta Diop, Dakar, Senegal
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De la Cruz-Góngora V, Salinas-Rodríguez A, Flores-Aldana M, Villalpando S. Etiology of Anemia in Older Mexican Adults: The Role of Hepcidin, Vitamin A and Vitamin D. Nutrients 2021; 13:3814. [PMID: 34836070 PMCID: PMC8622982 DOI: 10.3390/nu13113814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 12/18/2022] Open
Abstract
Anemia in older adults is a growing public health issue in Mexico; however, its etiology remains largely unknown. Vitamin A deficiency (VAD) and vitamin D deficiency (VDD) have been implicated in the development of anemia, though by different mechanisms. The aim of this study is to analyze the etiology of anemia and anemia-related factors in older Mexican adults. This is a cross-sectional study of 803 older adults from the southern region of Mexico in 2015. The anemia etiologies analyzed were chronic kidney disease (CKD), nutritional deficiencies (ND), anemia of inflammation (AI), anemia of multiple causes (AMC) and unexplained anemia (UEA). VAD was considered to be s-retinol ≤ 20 μg/dL, and VDD if 25(OH)D < 50 nmol/L. IL-6 and hepcidin were also measured. Multinomial regression models were generated and adjusted for confounders. Anemia was present in 35.7% of OA, independent of sex. UEA, CKD, AI and ND were confirmed in 45%, 29.3%, 14.6% and 7% of older adults with anemia, respectively. Hepcidin and log IL-6 were associated with AI (p < 0.05) and CKD (p < 0.001). VAD was associated with AI (p < 0.001), and VDD with ND and AMC (p < 0.05). Log-IL6 was associated with UEA (p < 0.001). In conclusion, anemia in older adults has an inflammatory component. VAD was associated to AI and VDD with ND and AMC.
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Affiliation(s)
- Vanessa De la Cruz-Góngora
- Center for Evaluation and Survey Research, Instituto Nacional de Salud Pública (National Institute of Public Health), Cuernavaca 62100, Mexico;
| | - Aarón Salinas-Rodríguez
- Center for Evaluation and Survey Research, Instituto Nacional de Salud Pública (National Institute of Public Health), Cuernavaca 62100, Mexico;
| | - Mario Flores-Aldana
- Center for Nutrition and Health Research, Instituto Nacional de Salud Pública (National Institute of Public Health), Cuernavaca 62100, Mexico; (M.F.-A.); (S.V.)
| | - Salvador Villalpando
- Center for Nutrition and Health Research, Instituto Nacional de Salud Pública (National Institute of Public Health), Cuernavaca 62100, Mexico; (M.F.-A.); (S.V.)
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Govender L, Pillay K, Siwela M, Modi AT, Mabhaudhi T. Assessment of the Nutritional Status of Four Selected Rural Communities in KwaZulu-Natal, South Africa. Nutrients 2021; 13:2920. [PMID: 34578797 PMCID: PMC8465248 DOI: 10.3390/nu13092920] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/26/2021] [Accepted: 08/19/2021] [Indexed: 11/17/2022] Open
Abstract
Under- and over-nutrition co-exist as the double burden of malnutrition that poses a public health concern in countries of the developing regions, including South Africa (SA). Vulnerable groups such as pregnant women and children under five years are the most affected by malnutrition, especially in rural areas. Major contributing factors of malnutrition include food and nutrition insecurity, poverty, and unhealthy lifestyles. The current study aimed to assess the nutritional status, using selected anthropometric indices and dietary intake methods (repeated 24 h recall and food frequency), of four rural communities in KwaZulu-Natal (SA). Purposive sampling generated a sample of 50 households each in three rural areas: Swayimane, Tugela Ferry, and Umbumbulu and 21 households at Fountain Hill Estate. The Estimated Average Requirement cut-point method was used to assess the prevalence of inadequate nutrient intake. Stunting (30.8%; n = 12) and overweight (15.4%; n = 6) were prevalent in children under five years, whilst obesity was highly prevalent among adult females (39.1%; n = 81), especially those aged 16-35 years. There was a high intake of carbohydrates and a low intake of fibre and micronutrients, including vitamin A, thus, confirming the need for a food-based approach to address malnutrition and micronutrient deficiencies, particularly vitamin A deficiency.
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Affiliation(s)
- Laurencia Govender
- Dietetics and Human Nutrition, School of Agricultural, Earth and Environmental Sciences, University of KwaZulu-Natal, Private Bag X01, Scottsville 3209, Pietermaritzburg 3201, South Africa; (K.P.); (M.S.)
| | - Kirthee Pillay
- Dietetics and Human Nutrition, School of Agricultural, Earth and Environmental Sciences, University of KwaZulu-Natal, Private Bag X01, Scottsville 3209, Pietermaritzburg 3201, South Africa; (K.P.); (M.S.)
| | - Muthulisi Siwela
- Dietetics and Human Nutrition, School of Agricultural, Earth and Environmental Sciences, University of KwaZulu-Natal, Private Bag X01, Scottsville 3209, Pietermaritzburg 3201, South Africa; (K.P.); (M.S.)
| | - Albert Thembinkosi Modi
- Centre for Transformative Agricultural and Food Systems, School of Agricultural, Earth and Environmental Sciences, University of KwaZulu-Natal, Private Bag X01, Scottsville 3209, Pietermaritzburg 3201, South Africa; (A.T.M.); (T.M.)
| | - Tafadzwanashe Mabhaudhi
- Centre for Transformative Agricultural and Food Systems, School of Agricultural, Earth and Environmental Sciences, University of KwaZulu-Natal, Private Bag X01, Scottsville 3209, Pietermaritzburg 3201, South Africa; (A.T.M.); (T.M.)
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de Juras AR, Hsu WC, Hu SC. Prevalence and Determinants of the Co-Occurrence of Overweight or Obesity and Micronutrient Deficiencies among Adults in the Philippines: Results from a National Representative Survey. Nutrients 2021; 13:2339. [PMID: 34371849 PMCID: PMC8308505 DOI: 10.3390/nu13072339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 01/20/2023] Open
Abstract
The double burden of malnutrition (DBM) affects many low- and middle-income countries. However, few studies have examined DBM at the individual level, or undernutrition and overnutrition co-occurring within the same person. This study aims to investigate the prevalence and determinants of DBM among adults in the Philippines. Data from the 2013 National Nutrition Survey were used. The sample size in the analysis was 17,010 adults aged ≥20 years old, after excluding pregnant and lactating women. DBM was defined as the co-occurrence of overweight/obesity and anemia (definition #1), overweight/obesity and anemia or vitamin A deficiency (definition #2), and overweight/obesity and anemia or vitamin A deficiency or iodine insufficiency (definition #3). Anthropometric measurements and biochemical markers were used for DBM assessment. Data were analyzed using descriptive statistics, the chi-square test, and logistic regression by R software. Results showed that definition #3 is the predominant type of DBM (7.0%) in the general population, whereas the prevalence of DBM has increased to 23.7% in overweight/obese persons. Sex, age, educational attainment, marital status, household size, wealth quintile, and smoking status were the determinants of DBM. This study revealed that Filipino adults experience malnutrition critically and must be addressed through food and nutrition interventions.
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Affiliation(s)
- Aileen R. de Juras
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan City 701, Taiwan; (A.R.d.J.); (W.-C.H.)
- Institute of Human Nutrition and Food, College of Human Ecology, University of the Philippines Los Baños, Laguna 4031, Philippines
| | - Wan-Chen Hsu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan City 701, Taiwan; (A.R.d.J.); (W.-C.H.)
| | - Susan C. Hu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan City 701, Taiwan; (A.R.d.J.); (W.-C.H.)
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Ernawati F, Syauqy A, Arifin AY, Soekatri MYE, Sandjaja S. Micronutrient Deficiencies and Stunting Were Associated with Socioeconomic Status in Indonesian Children Aged 6-59 Months. Nutrients 2021; 13:nu13061802. [PMID: 34073270 PMCID: PMC8228349 DOI: 10.3390/nu13061802] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/20/2021] [Accepted: 05/20/2021] [Indexed: 01/21/2023] Open
Abstract
Micronutrient deficiencies and stunting are known as a significant problem in most developing countries, including Indonesia. The objective of this study was to analyze the association between micronutrient deficiencies and stunting with socioeconomic status (SES) among Indonesian children aged 6–59 months. This cross-sectional study was part of the South East Asian Nutrition Surveys (SEANUTS). A total of 1008 Indonesian children were included in the study. Anemia, iron deficiency, vitamin A deficiency, vitamin D deficiency, and stunting were identified in this study. Structured questionnaires were used to measure SES. Differences between micronutrient parameters and anthropometric indicators with the SES groups were tested using one-way ANOVA with post-hoc test after adjusted for age, area resident (rural and urban), and sex. The highest prevalence of anemia, stunting, and severe stunting were found to be most significant in the lowest SES group at 45.6%, 29.3%, and 54.5%, respectively. Children from the lowest SES group had significantly lower means of Hb, ferritin, retinol, and HAZ. Severely stunted children had a significantly lower mean of Hb concentration compared to stunted and normal height children. Micronutrient deficiencies, except vitamin D, and stunting, were associated with low SES among Indonesian children aged 6–59 months.
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Affiliation(s)
- Fitrah Ernawati
- Center of Research and Development for Biomedical and Basic Technology of Health, National Institute of Health Research and Development, Jakarta 10560, Indonesia; (F.E.); (A.Y.A.)
| | - Ahmad Syauqy
- Department of Nutrition Science, Faculty of Medicine, Diponegoro University, Jawa Tengah 50275, Indonesia
- Center of Nutrition Research (CENURE), Diponegoro University, Jawa Tengah 50275, Indonesia
- Correspondence: ; Tel./Fax: +62-24-76402881
| | - Aya Yuriestia Arifin
- Center of Research and Development for Biomedical and Basic Technology of Health, National Institute of Health Research and Development, Jakarta 10560, Indonesia; (F.E.); (A.Y.A.)
| | - Moesijanti Y. E. Soekatri
- Nutrition Department, Health Polytechnic Ministry of Health of Jakarta II, Jakarta 12120, Indonesia;
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Suzuki M, Wang T, Garretto D, Isasi CR, Cardoso WV, Greally JM, Quadro L. Disproportionate Vitamin A Deficiency in Women of Specific Ethnicities Linked to Differences in Allele Frequencies of Vitamin A-Related Polymorphisms. Nutrients 2021; 13:nu13061743. [PMID: 34063790 PMCID: PMC8223783 DOI: 10.3390/nu13061743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background: While the current national prevalence rate of vitamin A deficiency (VAD) is estimated to be less than 1%, it is suggested that it varies between different ethnic groups and races within the U.S. We assessed the prevalence of VAD in pregnant women of different ethnic groups and tested these prevalence rates for associations with the vitamin A-related single nucleotide polymorphism (SNP) allele frequencies in each ethnic group. Methods: We analyzed two independent datasets of serum retinol levels with self-reported ethnicities and the differences of allele frequencies of the SNPs associated with vitamin A metabolism between groups in publicly available datasets. Results: Non-Hispanic Black and Hispanic pregnant women showed high VAD prevalence in both datasets. Interestingly, the VAD prevalence for Hispanic pregnant women significantly differed between datasets (p = 1.973 × 10−10, 95%CI 0.04–0.22). Alleles known to confer the risk of low serum retinol (rs10882272 C and rs738409 G) showed higher frequencies in the race/ethnicity groups with more VAD. Moreover, minor allele frequencies of a set of 39 previously reported SNPs associated with vitamin A metabolism were significantly different between the populations of different ancestries than those of randomly selected SNPs (p = 0.030). Conclusions: Our analysis confirmed that VAD prevalence varies between different ethnic groups/races and may be causally associated with genetic variants conferring risk for low retinol levels. Assessing genetic variant information prior to performing an effective nutrient supplementation program will help us plan more effective food-based interventions.
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Affiliation(s)
- Masako Suzuki
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Tao Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Diana Garretto
- Department of Obstetrics and Gynecology and Women's Health, Stony Brook University Medical Center, Stony Brook, NY 11794, USA
| | - Carmen R Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Wellington V Cardoso
- Columbia Center for Human Development, Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - John M Greally
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Loredana Quadro
- Department of Food Science and Rutgers Center for Lipid Research, and New Jersey Institute for Food, Nutrition, and Health, Rutgers University, New Brunswick, NJ 08901, USA
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Williams AM, Tanumihardjo SA, Rhodes EC, Mapango C, Kazembe B, Phiri F, Kang'ombe DD, Sheftel J, Orchardson V, Tripp K, Suchdev PS. Vitamin A deficiency has declined in Malawi, but with evidence of elevated vitamin A in children. Am J Clin Nutr 2021; 113:854-864. [PMID: 33751046 PMCID: PMC8023849 DOI: 10.1093/ajcn/nqab004] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/04/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Reduction of vitamin A deficiency (VAD) in Malawi coincided with introduction of vitamin A-fortified staple foods, alongside continued biannual high-dose vitamin A supplementation (VAS). OBJECTIVE We describe coverage of vitamin A interventions and vitamin A status in the 2015-2016 Malawi Micronutrient Survey. METHODS Food samples and biospecimens were collected within a representative household survey across 105 clusters. Retinol was measured using ultraviolet excitation fluorescence (sugar) and photometric determination (oil). Preschool children (PSC, aged 6-59 mo, n = 1102), school-age children (SAC, aged 5-14 y, n = 758), nonpregnant women (n = 752), and men (n = 219) were initially assessed for vitamin A status using retinol binding protein (RBP) and modified relative dose response (MRDR). Randomly selected fasted MRDR participants (n = 247) and nonfasted women and children (n = 293) were later assessed for serum retinol, retinyl esters, and carotenoids. Analyses accounted for complex survey design. RESULTS We tested sugar and oil samples from 71.8% and 70.5% of the households (n = 2,112), respectively. All of the oil samples and all but one of the sugar samples had detectable vitamin A. National mean retinol sugar and oil contents were 6.1 ± 0.7 mg/kg and 6.6 ± 1.4 mg/kg, respectively. Receipt of VAS in the previous 6 mo was reported by 68.0% of PSC. VAD prevalence (RBP equivalent to <0.7µmol retinol/L) was 3.6% in PSC, and <1% in other groups. One woman and no children had MRDR ≥0.060 indicating VAD. Among fasted PSC and SAC, 18.0% (95% CI: 6.4, 29.6) and 18.8% (7.2, 30.5) had >5% of total serum vitamin A as retinyl esters, and 1.7% (0.0, 4.1) and 4.9% (0.0, 10.2) had >10% of total serum vitamin A as retinyl esters. Serum carotenoids indicated recent intake of vitamin A-rich fruits and vegetables. CONCLUSIONS Near elimination of VAD in Malawi is a public health success story, but elevated levels of vitamin A among children suggests that vitamin A interventions may need modification.
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Affiliation(s)
- Anne M Williams
- McKing Consulting Corporation, Atlanta, GA USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Division of Nutrition, Physical Activity and Obesity, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Sherry A Tanumihardjo
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Elizabeth C Rhodes
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Carine Mapango
- Division of Nutrition, Physical Activity and Obesity, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Benson Kazembe
- United Nations Children's Fund, UNICEF Malawi, Lilongwe, Malawi
| | - Felix Phiri
- Department of Nutrition, HIV and AIDS, Ministry of Health, Lilongwe, Malawi
| | | | - Jesse Sheftel
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Violet Orchardson
- United States Agency for International Development, USAID, Malawi, Lilongwe, Malawi
| | - Katie Tripp
- Division of Nutrition, Physical Activity and Obesity, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Parminder S Suchdev
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Division of Nutrition, Physical Activity and Obesity, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
- Department of Pediatrics and Emory Global Health Institute, Emory University, Atlanta, GA, USA
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Likoswe BH, Joy EJM, Sandalinas F, Filteau S, Maleta K, Phuka JC. Re-Defining the Population-Specific Cut-Off Mark for Vitamin A Deficiency in Pre-School Children of Malawi. Nutrients 2021; 13:849. [PMID: 33807563 PMCID: PMC8000145 DOI: 10.3390/nu13030849] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/23/2021] [Accepted: 03/02/2021] [Indexed: 11/23/2022] Open
Abstract
Retinol Binding Protein (RBP) is responsible for the transport of serum retinol (SR) to target tissue in the body. Since RBP is relatively easy and cheap to measure, it is widely used in national Micronutrient Surveys (MNS) as a proxy for SR to determine vitamin A status. By regressing RBP concentration against SR concentration measured in a subset of the survey population, one can define a population-specific threshold concentration of RBP that indicates vitamin A deficiency (VAD). However, the relationship between RBP and SR concentrations is affected by various factors including inflammation. This study, therefore, aimed to re-define the population-specific cut-off for VAD by examining the influence of inflammation on RBP and SR, among pre-school children (PSC) from the 2015-16 Malawi MNS. The initial association between RBP and SR concentrations was poor, and this remained the case despite applying various methods to correct for inflammation. The World Health Organization (WHO) recommends the threshold of 0.7 µmol/L to define VAD for SR concentrations. Applying this threshold to the RBP concentrations gave a VAD prevalence of 24%, which reduced to 10% after inflammation adjustments following methods developed by the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA). Further research is required to identify why SR and RBP were poorly associated in this population. Future MNS will need to account for the effect of inflammation on RBP to measure the prevalence of VAD in Malawi.
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Affiliation(s)
- Blessings H. Likoswe
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi;
| | - Edward J. M. Joy
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (E.J.M.J.); (F.S.); (S.F.)
| | - Fanny Sandalinas
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (E.J.M.J.); (F.S.); (S.F.)
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (E.J.M.J.); (F.S.); (S.F.)
| | - Kenneth Maleta
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi;
| | - John C. Phuka
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi;
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Ahmad SM, Huda MN, Raqib R, Qadri F, Alam MJ, Afsar MNA, Peerson JM, Tanumihardjo SA, Stephensen CB. High-Dose Neonatal Vitamin A Supplementation to Bangladeshi Infants Increases the Percentage of CCR9-Positive Treg Cells in Infants with Lower Birthweight in Early Infancy, and Decreases Plasma sCD14 Concentration and the Prevalence of Vitamin A Deficiency at Two Years of Age. J Nutr 2020; 150:3005-3012. [PMID: 32939553 PMCID: PMC7675026 DOI: 10.1093/jn/nxaa260] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/08/2020] [Accepted: 08/04/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Vitamin A (VA) stores are low in early infancy and may impair development of the immune system. OBJECTIVE This study determined if neonatal VA supplementation (VAS) affects the following: 1) development of regulatory T (Treg) cells; 2) chemokine receptor 9 (CCR9) expression, which directs mucosal targeting of immune cells; and 3) systemic endotoxin exposure as indicated by changed plasma concentrations of soluble CD14 (sCD14). Secondarily, VA status, growth, and systemic inflammation were investigated. METHODS In total, 306 Bangladeshi infants were randomly assigned to receive 50,000 IU VA or placebo (PL) within 48 h of birth, and immune function was assessed at 6 wk, 15 wk, and 2 y. Primary outcomes included the following: 1) peripheral blood Treg cells; 2) percentage of Treg, T, and B cells expressing CCR9; and 3) plasma sCD14. Secondary outcomes included the following: 4) VA status measured using the modified relative dose-response (MRDR) test and plasma retinol; 5) infant growth; and 6) plasma C-reactive protein (CRP). Statistical analysis identified group differences and interactions with sex and birthweight. RESULTS VAS increased (P = 0.004) the percentage of CCR9+ Treg cells (13.2 ± 1.37%) relative to PL (9.17 ± 1.15%) in children below the median birthweight but had the opposite effect (P = 0.04) in those with higher birthweight (VA, 9.13 ± 0.89; PL, 12.1 ± 1.31%) at 6 and 15 wk (values are combined mean ± SE). VAS decreased (P = 0.003) plasma sCD14 (1.56 ± 0.025 mg/L) relative to PL (1.67 ± 0.032 mg/L) and decreased (P = 0.034) the prevalence of VA deficiency (2.3%) relative to PL (9.2%) at 2 y. CONCLUSIONS Neonatal VAS enhanced mucosal targeting of Treg cells in low-birthweight infants. The decreased systemic exposure to endotoxin and improved VA status at 2 y may have been due to VA-mediated improvements in gut development resulting in improved barrier function and nutrient absorption. This trial was registered at clinicaltrials.gov as NCT01583972 and NCT02027610.
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Affiliation(s)
- Shaikh M Ahmad
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
| | - M Nazmul Huda
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
- USDA Western Human Nutrition Research Center at University of California, Davis, CA, USA
- Nutrition Department, University of California, Davis, CA, USA
| | - Rubhana Raqib
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
| | - Firdausi Qadri
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
| | - Md Jahangir Alam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
| | - Md Nure Alam Afsar
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
| | - Janet M Peerson
- USDA Western Human Nutrition Research Center at University of California, Davis, CA, USA
| | - Sherry A Tanumihardjo
- University of Wisconsin–Madison, Department of Nutritional Sciences, Madison, WI, USA
| | - Charles B Stephensen
- USDA Western Human Nutrition Research Center at University of California, Davis, CA, USA
- Nutrition Department, University of California, Davis, CA, USA
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Aserese AD, Atenafu A, Sisay M, Sorrie MB, Yirdaw BW, Zegeye MK. Adequate vitamin A rich food consumption and associated factors among lactating mothers visiting child immunization and post-natal clinic at health institutions in Gondar Town, Northwest Ethiopia. PLoS One 2020; 15:e0239308. [PMID: 32956396 PMCID: PMC7508326 DOI: 10.1371/journal.pone.0239308] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 09/03/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Vitamin A deficiency is highly prevalent in low-income countries and is a major public health problem worldwide. Lactating mothers are the most vulnerable population group to vitamin A deficiency. Despite this, there is limited study on vitamin A-rich food consumption by lactating mothers in Ethiopia. Therefore, this study aimed to assess adequate vitamin A rich food consumption and associated factors among lactating mothers visiting child immunization and postnatal care centers in health institutions of Gondar Town. METHODS An Institution-based cross-sectional study design was employed at a health institution in Gondar Town from February to March 2019, and included 631 study participants. Simple random sampling followed by a systematic sampling technique was used to select participants. The data were collected using the Helen Keller International Food Frequency Questionnaire, entered using Epi-Info 7 statistical software and exported to STATA version 14 for analysis. A multivariable logistic regression analysis was used to identify factors associated with the outcome variable and variables with p-value <0.05 were considered as statistically significant. RESULT A total of 624 lactating mothers participated in the study giving a response rate of 98.89%. The study shows adequate consumption of vitamin A-rich food was 38.94% (95% CI: 35%- 43%). Predictors such as attending college diploma and above (AOR = 2.26, 95% CI; 1.02-4.99), having household family size ≤ 3 (AOR = 4.04, 95% CI; 1.60-10.17), being in higher economic class (AOR = 1.93, 95% CI; 1.18-3.14), having dietary diversity score of ≥ 5 (AOR = 1.59, 95% CI; 1.09-2.32) and meal frequency of ≥ 4 (AOR = 1.64, 95% CI; 1.09-2.32) were statistically significant. CONCLUSION AND RECOMMENDATION The majority of respondents had inadequate consumption of foods rich in vitamin A. Educational status, family size, wealth index, dietary diversity, and meal frequency were found to be factors that affect adequate consumption of vitamin A-rich foods. Encouraging and educating lactating mothers to consume foods rich in vitamin A is crucial.
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Golonka RM, Xiao X, Abokor AA, Joe B, Vijay-Kumar M. Altered nutrient status reprograms host inflammation and metabolic health via gut microbiota. J Nutr Biochem 2020; 80:108360. [PMID: 32163821 PMCID: PMC7242157 DOI: 10.1016/j.jnutbio.2020.108360] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/07/2020] [Accepted: 02/08/2020] [Indexed: 02/07/2023]
Abstract
The metabolism of macro- and micronutrients is a complex and highly regulated biological process. An imbalance in the metabolites and their signaling networks can lead to nonresolving inflammation and consequently to the development of chronic inflammatory-associated diseases. Therefore, identifying the accumulated metabolites and altered pathways during inflammatory disorders would not only serve as "real-time" markers but also help in the development of nutritional therapeutics. In this review, we explore recent research that has delved into elucidating the effects of carbohydrate/calorie restriction, protein malnutrition, lipid emulsions and micronutrient deficiencies on metabolic health and inflammation. Moreover, we describe the integrated stress response in terms of amino acid starvation and lipemia and how this modulates new age diseases such as inflammatory bowel disease and atherosclerosis. Lastly, we explain the latest research on metaflammation and inflammaging. This review focuses on multiple signaling pathways, including, but not limited to, the FGF21-β-hydroxybutryate-NLRP3 axis, the GCN2-eIF2α-ATF4 pathway, the von Hippel-Lindau/hypoxia-inducible transcription factor pathway and the TMAO-PERK-FoxO1 axis. Additionally, throughout the review, we explain how the gut microbiota responds to altered nutrient status and also how antimicrobial peptides generated from nutrient-based signaling pathways can modulate the gut microbiota. Collectively, it must be emphasized that metabolic starvation and inflammation are strongly regulated by both environmental (i.e., nutrition, gut microbiome) and nonenvironmental (i.e., genetics) factors, which can influence the susceptibility to inflammatory disorders.
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Affiliation(s)
- Rachel M Golonka
- UT Microbiome Consortium, Department of Physiology and Pharmacology, The University of Toledo College of Medicine and Life Sciences, Toledo, OH 43614
| | - Xia Xiao
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Ahmed A Abokor
- UT Microbiome Consortium, Department of Physiology and Pharmacology, The University of Toledo College of Medicine and Life Sciences, Toledo, OH 43614
| | - Bina Joe
- UT Microbiome Consortium, Department of Physiology and Pharmacology, The University of Toledo College of Medicine and Life Sciences, Toledo, OH 43614
| | - Matam Vijay-Kumar
- UT Microbiome Consortium, Department of Physiology and Pharmacology, The University of Toledo College of Medicine and Life Sciences, Toledo, OH 43614.
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Ssentongo P, Ba DM, Ssentongo AE, Fronterre C, Whalen A, Yang Y, Ericson JE, Chinchilli VM. Association of vitamin A deficiency with early childhood stunting in Uganda: A population-based cross-sectional study. PLoS One 2020; 15:e0233615. [PMID: 32470055 PMCID: PMC7259702 DOI: 10.1371/journal.pone.0233615] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 05/10/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Despite the high prevalence of childhood protein-energy malnutrition and vitamin A deficiency in sub-Saharan Africa, their association has not been explored in this region. A better understanding of the epidemiologic link could help define effective preventive strategies. We aimed to explore the association of vitamin A deficiency (VAD) with stunting, wasting, and underweight among preschool children in Uganda. METHOD We analyzed a population-based, cross-sectional data of 4,765 children aged 6-59 months who participated in 2016 Demographic and Health Surveys conducted in Uganda. We utilized generalized linear mixed-effects models with logit link function, adjusting for potential confounders to estimate associations between VAD and stunting, wasting, and underweight. RESULTS The prevalence of VAD was 8.9% (95% CI: 8.1% to 9.6%, n = 424). Twenty-seven percent were stunted (95% CI: 26.1% to 28.6, n = 1302), 4% wasted (95% CI: 3.6% to 4.7%, n = 196), and 17% underweight (95% CI: 16.0% to 18.2%, n = 813). After adjusting for household factors (e.g., wealth index, education and working status of parents, owning land for agriculture, livestock, herds, or farm animals), vitamin A supplementation, and community factors (e.g., population density, crop growing season lengths, place of residence), children with VAD had 43% higher odds of stunted growth than those without VAD (adjusted odds ratio, 1.43 (95% CI: 1.08 to 1.89, p = 0.01). No association was observed between VAD and wasting or underweight. CONCLUSION Vitamin A deficiency was associated with higher odds of stunting, and the association was independent of the individual, household, and community-level variables.
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Affiliation(s)
- Paddy Ssentongo
- Center for Neural Engineering, The Pennsylvania State University, University Park, State College, PA, United States of America
- Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, State College, PA, United States of America
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, United States of America
| | - Djibril M. Ba
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, United States of America
- Center for Applied Studies in Health Economics, The Pennsylvania State University College of Medicine, Hershey, PA, United States of America
| | - Anna E. Ssentongo
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, United States of America
| | - Claudio Fronterre
- Centre for Health Informatics, Computing and Statistics, Lancaster University, Lancaster, United Kingdom
| | - Andrew Whalen
- Center for Neural Engineering, The Pennsylvania State University, University Park, State College, PA, United States of America
- Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, State College, PA, United States of America
| | - Yanxu Yang
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, United States of America
| | - Jessica E. Ericson
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, United States of America
- Department of Pediatrics, The Pennsylvania State University College of Medicine, Hershey, PA, United States of America
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, United States of America
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Petry N, Nizamov F, Woodruff BA, Ishmakova R, Komilov J, Wegmüller R, Wirth JP, Arifdjanova D, Guo S, Rohner F. Risk Factors for Anemia and Micronutrient Deficiencies among Women of Reproductive Age-The Impact of the Wheat Flour Fortification Program in Uzbekistan. Nutrients 2020; 12:E714. [PMID: 32156021 PMCID: PMC7146397 DOI: 10.3390/nu12030714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 11/17/2022] Open
Abstract
Food fortification can be effective in reducing the prevalence of anemia and micronutrient deficiencies. This study assessed risk factors for-and the impact of the wheat flour program in Uzbekistan on-anemia, and iron and folate deficiency (FD) in non-pregnant women (NPW) of reproductive age. National data were analyzed for risk factors using multivariable regression. Additional iron intake from fortified flour was not associated with iron deficiency (ID) and did not result in a significantly different prevalence of anemia regardless of the levels, whereas women with additional folic acid intake had a lower relative risk (RR) of FD (RR: 0.67 [95% CI: 0.53, 0.85]). RR for anemia was greater in women with ID (RR: 4.7; 95% CI: 3.5, 6.5) and vitamin A insufficiency (VAI; RR 1.5; 95% CI: 1.3, 1.9). VAI (RR: 1.4 [95% CI: 1.3, 1.6]) and breastfeeding (RR: 1.1 [95% CI: 0.99, 1.2]) were associated with increased risk of ID, while being underweight reduced the risk (RR: 0.74 [95% CI: 0.58, 0.96]). Breastfeeding (RR: 1.2 [95% CI: 1.1, 1.4]) and inflammation (RR: 1.2 [95% CI: 1.0, 1.3]) increased risk of FD. FD results indicate that the fortification program had potential for impact, but requires higher coverage of adequately fortified wheat flour and a more bioavailable iron fortificant.
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Affiliation(s)
- Nicolai Petry
- GroundWork, 7306 Fläsch, Switzerland; (B.A.W.); (R.W.); (J.P.W.); (F.R.)
| | | | | | | | | | - Rita Wegmüller
- GroundWork, 7306 Fläsch, Switzerland; (B.A.W.); (R.W.); (J.P.W.); (F.R.)
| | - James P. Wirth
- GroundWork, 7306 Fläsch, Switzerland; (B.A.W.); (R.W.); (J.P.W.); (F.R.)
| | | | - Sufang Guo
- UNICEF, Tashkent 100029, Uzbekistan; (F.N.); (D.A.); (S.G.)
| | - Fabian Rohner
- GroundWork, 7306 Fläsch, Switzerland; (B.A.W.); (R.W.); (J.P.W.); (F.R.)
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Sahile Z, Yilma D, Tezera R, Bezu T, Haileselassie W, Seifu B, Ali JH. Prevalence of Vitamin A Deficiency among Preschool Children in Ethiopia: A Systematic Review and Meta-Analysis. Biomed Res Int 2020; 2020:8032894. [PMID: 32258145 PMCID: PMC7073500 DOI: 10.1155/2020/8032894] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/31/2020] [Accepted: 02/13/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Vitamin A deficiency is a major nutritional concern in lower-income countries. The aim of this systematic review and meta-analysis was to show the magnitude of vitamin A deficiency among preschoolers in Ethiopia. OBJECTIVE The present study was aimed at synthesizing qualitatively and quantitatively the existing literature on the prevalence of VAD in preschool children in Ethiopia. METHODS Studies were searched through the search engine of Google Scholar, Hinari, MEDLINE/PubMed, Cochrane Library, and Africa-Wide Information. Searching was made using the keywords/MeSH of vitamin A deficiency, xerophthalmia, night blindness, Bitot's spot, retinol, children, and Ethiopia. Data were analyzed and compared with the WHO threshold criteria to declare a public health problem. Heterogeneity among studies was assessed using a Cochran Q test and I 2 statistics. A random-effects model with 95% confidence interval was used for prevalence estimations. RESULTS Of the 13 studies included in clinical analysis, 12 of them reported the prevalence of night blindness and/or Bitot's spot among preschool children in Ethiopia which was above WHO cutoff point for the public health problem 1% and 0.5%, respectively. The prevalence of night blindness significantly decreased from moderate public health problem 4.2% (95% CI: 2.8%-5.7%) in a period from 1990 to 2004 to mild public health problem 0.8% (95% CI: 0.6%-1.0%) in a period from 2005 to 2019. Furthermore, statistically insignificant reduction was observed in the prevalence of Bitot's spot in a period from 1990 to 2004, 2.2% (95% CI: 1.3%-3.2%) to 1.8% (95% CI: 1.2%-2.3%) in a period from 2005 to 2019. Among 8 studies on subclinical vitamin A deficiency, 7 of them indicated a severe public health problem (>20%). The prevalence of subclinical vitamin A deficiency decreased from 55.7% (95% CI: 39.8%-71.6%) in a period from 1990 to 2004 to 28.3% (95% CI: 9.8%-46.7%) in a period from 2005 to 2019, but not statistically significant. CONCLUSIONS Despite the reduced proportion of night blindness and Bitot's spot, still both clinical and subclinical vitamin A deficiencies remain a public health problem in Ethiopia requiring strengthen intervention through the newly initiated health extension program.
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Affiliation(s)
- Zekariyas Sahile
- Ambo University, College of Medicine and Health Science, Department of Public Health, P.O. Box 19 Ambo, Ethiopia
| | - Delelegn Yilma
- Ambo University, College of Medicine and Health Science, Department of Public Health, P.O. Box 19 Ambo, Ethiopia
| | - Robel Tezera
- Addis Ababa University, College of Health Science, Department of Medical Radiological Technology, P.O. Box 11950 Addis Ababa, Ethiopia
| | - Tadu Bezu
- Kotebe Metropolitan University, Menelik II Health Science and College of Medicine, Addis Ababa, Ethiopia
| | - Werissaw Haileselassie
- Addis Ababa University, College of Health Sciences, School of Public Health, P.O. Box 11950 Addis Ababa, Ethiopia
| | - Benyam Seifu
- Ambo University, College of Medicine and Health Science, Department of Midwifery, P.O. Box 19 Ambo, Ethiopia
| | - Jemal Haidar Ali
- Addis Ababa University, College of Health Science, School of Public Health, P.O. Box 27285 1000 Addis Ababa, Ethiopia
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Panda L, Nayak S, Das T. Tribal Odisha Eye Disease Study Report # 6. Opportunistic screening of vitamin A deficiency through School Sight Program in tribal Odisha (India). Indian J Ophthalmol 2020; 68:351-355. [PMID: 31957725 PMCID: PMC7003593 DOI: 10.4103/ijo.ijo_1154_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/12/2019] [Accepted: 09/21/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose To explore the possibility of vitamin A deficiency (VAD) detection through School Sight Program (SSP) in a tribal district of Odisha, India. Methods In a cross-sectional observational study, we tracked school children with ocular signs/symptoms of VAD to their villages. The ophthalmologist examined their under-5 siblings and other under-5 children in the village. Information pertaining to family belief and practices of food, water, sanitation, and the socioeconomic status of the family were collected. Results The ocular features of VAD were detected in 207 of 4801 (4.3%) examined children. This included 70 children (mean age 11 ± 2.6 years) detected in the school, 22 siblings (mean age 3.2 ± 1.2 years) of these children detected at their home, and 115 children (mean age 3 ± 1.5 years) detected in their habitat. The average family size was 5.8 ± 2.02 and the birth order of the child with VAD was 2.3 ± 1.25. Most parents were farmer, living in asbestos-roofed house, depended on public underground water, and practiced open-air defecation. The distribution of VAD in 207 children was conjunctival xerosis (X1A = 207; 100% of VAD and 4.3% of all children), Bitot's spot (X1B = 169; 81.6% of VAD and 3.5% of all children), corneal scar (XS = 3; 1.4% of VAD and 0.06% of all children), and night blindness (XN = 35; 16.9% of VAD and 0.72% of all children). Conclusion An opportunistic screening for detection of VAD through a SSP could be cost-effective and complement the existing strategy.
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Affiliation(s)
- Lapam Panda
- Indian Oil Centre for Rural Eye Care, L V Prasad Eye Institute, Bhubaneswar, India
| | - Suryasmita Nayak
- Indian Oil Centre for Rural Eye Care, L V Prasad Eye Institute, Bhubaneswar, India
| | - Taraprasad Das
- Indian Oil Centre for Rural Eye Care, L V Prasad Eye Institute, Bhubaneswar, India
- Indian Oil Centre for Rural Eye Care, L V Prasad Eye Institute, Bhubaneswar; Srimati Kanuri Shantamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Pena G, Kuang B, Cowled P, Howell S, Dawson J, Philpot R, Fitridge R. Micronutrient Status in Diabetic Patients with Foot Ulcers. Adv Wound Care (New Rochelle) 2020; 9:9-15. [PMID: 31871826 PMCID: PMC6918841 DOI: 10.1089/wound.2019.0973] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/15/2019] [Indexed: 12/16/2022] Open
Abstract
Objective: To explore the prevalence of micronutrient deficiencies in patients with diabetic foot ulcers and correlate this with foot disease severity and other clinical factors. Approach: Prospective cohort study of diabetic patients with foot ulcers seen in multidisciplinary foot clinics across Adelaide or admitted to the Vascular Surgery Unit at the Royal Adelaide Hospital between February 2017 and September 2018. A total of 131 patients were included in the study. Plasma serum levels of vitamins A, C, D, and E, copper, zinc, and ferritin were measured. Demographic and clinical data, including BMI, smoking status, duration of diabetes, HbA1c, and WIfI score, were obtained. Results: The most prevalent nutritional deficiency found was vitamin D affecting 55.7% of patients. Suboptimal levels of vitamin C affected 73% of patients, comprising marginal levels in 22.2% and deficient levels in 50.8%. Zinc deficiency, vitamin A deficiency, and low ferritin levels were present in 26.9%, 10.9%, and 5.9% of patients, respectively. There was no correlation between BMI, grip strength, duration of diabetes, HbA1c, or smoking status with micronutrient deficiency. Increased severity of diabetic foot disease was associated with lower vitamin C levels (p = 0.02). Innovation: This study has demonstrated that the deficiency of micronutrients, especially vitamin D, vitamin C, zinc, and vitamin A, is common in diabetic patients with foot ulcers. Conclusions: The prevalence of micronutrient deficiency is high in a diabetic population with foot ulcers/wounds. Special concerns regarding the high prevalence of vitamin C and zinc deficiency, given their roles in wound healing. Although further research needs to be performed to determine the clinical implications of our findings, micronutrient deficiency should be considered in diabetic patients with foot wounds.
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Affiliation(s)
- Guilherme Pena
- Department of Vascular and Endovascular Surgery, Royal Adelaide Hospital, Adelaide, Australia
- Discipline of Surgery, The University of Adelaide, Adelaide, Australia
| | - Beatrice Kuang
- Department of Vascular and Endovascular Surgery, Royal Adelaide Hospital, Adelaide, Australia
- Discipline of Surgery, The University of Adelaide, Adelaide, Australia
| | - Prue Cowled
- Discipline of Surgery, The University of Adelaide, Adelaide, Australia
| | - Stuart Howell
- Data Management and Analysis Centre, School of Population Health, The University of Adelaide, Adelaide, Australia
| | - Joseph Dawson
- Department of Vascular and Endovascular Surgery, Royal Adelaide Hospital, Adelaide, Australia
- Discipline of Surgery, The University of Adelaide, Adelaide, Australia
| | - Ross Philpot
- Department of Infectious Disease, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Robert Fitridge
- Department of Vascular and Endovascular Surgery, Royal Adelaide Hospital, Adelaide, Australia
- Discipline of Surgery, The University of Adelaide, Adelaide, Australia
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Abstract
The aim of this study was to investigate possible associations of nutrient intake on glaucoma in subjects of Japanese descent living in Los Angeles, CA.In this cross-sectional study, 581 Japanese American participants in Los Angeles underwent an interview, fundus photography, comprehensive physical, and blood examinations, along with determining the body mass index status and any confounding factors. CDSketch was used to measure the cup-disc ratio and rim width of each fundus in the retinal photographs. A multivariate logistic regression test with adjustment for confounding factors was used to assess the association between glaucoma and nutrient intake.A total of 61 of 581 participants were diagnosed with glaucoma in this study. Multivariate logistic regression analysis showed that a high intake of iron (odds ratio [OR]: 1.303, P = .004), low intake of vitamin A (OR: 0.365, P = .019), and vegetable fat (OR: 0.957, P = .004) were associated with an increased risk of glaucoma.Current findings showed that high iron intake and low vitamin A and vegetable fat intake appeared to be associated with an increased risk of glaucoma in subjects of Japanese descent living in the Los Angeles populations.
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Affiliation(s)
- Muhammad Yoserizal
- Department of Ophthalmology and Visual Science
- Jakarta Eye Centre, Jakarta, Indonesia
| | | | - Masayasu Yoneda
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Haruya Ohno
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Kazuhiro Kobuke
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Reo Kawano
- Center for Integrated Medical Research, Hiroshima University Hospital, Hiroshima, Japan
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Petry N, Jallow B, Sawo Y, Darboe MK, Barrow S, Sarr A, Ceesay PO, Fofana MN, Prentice AM, Wegmüller R, Rohner F, Phall MC, Wirth JP. Micronutrient Deficiencies, Nutritional Status and the Determinants of Anemia in Children 0-59 Months of Age and Non-Pregnant Women of Reproductive Age in The Gambia. Nutrients 2019; 11:E2275. [PMID: 31547543 PMCID: PMC6835426 DOI: 10.3390/nu11102275] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/12/2019] [Accepted: 09/18/2019] [Indexed: 11/16/2022] Open
Abstract
Data on micronutrient deficiency prevalence, nutrition status, and risk factors of anemia in The Gambia is scanty. To fill this data gap, a nationally representative cross-sectional survey was conducted on 1354 children (0-59 months), 1703 non-pregnant women (NPW; 15-49 years), and 158 pregnant women (PW). The survey assessed the prevalence of under and overnutrition, anemia, iron deficiency (ID), iron deficiency anemia (IDA), vitamin A deficiency (VAD), and urinary iodine concentration (UIC). Multivariate analysis was used to assess risk factors of anemia. Among children, prevalence of anemia, ID, IDA, and VAD was 50.4%, 59.0%, 38.2%, and 18.3%, respectively. Nearly 40% of anemia was attributable to ID. Prevalence of stunting, underweight, wasting, and small head circumference was 15.7%, 10.6%, 5.8%, and 7.4%, respectively. Among NPW, prevalence of anemia, ID, IDA and VAD was 50.9%, 41.4%, 28.0% and 1.8%, respectively. Anemia was significantly associated with ID and vitamin A insufficiency. Median UIC in NPW and PW was 143.1 µg/L and 113.5 ug/L, respectively. Overall, 18.3% of NPW were overweight, 11.1% obese, and 15.4% underweight. Anemia is mainly caused by ID and poses a severe public health problem. To tackle both anemia and ID, programs such as fortification or supplementation should be intensified.
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Affiliation(s)
| | | | | | - Momodou K Darboe
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, Banjul, The Gambia.
| | - Samba Barrow
- Gambia Bureau of Statistics, Banjul, The Gambia.
| | | | | | | | - Andrew M Prentice
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, Banjul, The Gambia.
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Tanumihardjo SA, Kaliwile C, Boy E, Dhansay MA, van Stuijvenberg ME. Overlapping vitamin A interventions in the United States, Guatemala, Zambia, and South Africa: case studies. Ann N Y Acad Sci 2019; 1446:102-116. [PMID: 30265402 PMCID: PMC7999526 DOI: 10.1111/nyas.13965] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/01/2018] [Accepted: 08/15/2018] [Indexed: 01/12/2023]
Abstract
Vitamin A (VA) deficiency is a serious public health problem, especially in preschool children who are at risk of increased mortality. In order to address this problem, the World Health Organization recommends periodic high-dose supplementation to children 6-59 months of age in areas of highest risk. Originally, supplementation was meant as a short-term solution until more sustainable interventions could be adopted. Currently, many countries are fortifying commercialized common staple and snack foods with retinyl palmitate. However, in some countries, overlapping programs may lead to excessive intakes. Our review uses case studies in the United States, Guatemala, Zambia, and South Africa to illustrate the potential for excessive intakes in some groups. For example, direct liver analysis from 27 U.S. adult cadavers revealed 33% prevalence of hypervitaminosis A (defined as ≥1 μmol/g liver). In 133 Zambian children, 59% were diagnosed with hypervitaminosis A using a retinol isotope dilution, and 16% had ≥5% total serum VA as retinyl esters, a measure of intoxication. In 40 South African children who frequently consumed liver, 72.5% had ≥5% total serum VA as retinyl esters. All four countries have mandatory fortified foods and a high percentage of supplement users or targeted supplementation to preschool children.
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Affiliation(s)
| | | | | | - Muhammad A. Dhansay
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
| | - Martha E. van Stuijvenberg
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
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