Vitamin A deficiency and anemia among children 12-71 months old in Honduras

Vitamin A deficiency (VAD) and iron deficiency anemia (IDA) have been recognised as public health problems in Honduras for over 30 years. This paper, based on the 1996 National Micronutrient Survey on 1 678 children 12-71 months of age, presents the results for vitamin A status and anemia prevalence, as well as the level of vitamin A in sugar at the household level. The results showed that 14 percent of the children were subclinically vitamin A deficient (plasma retinol < 20 ug/dL) and 32 percent were at risk of VAD (plasma retinol 20-30 ug/dL). These data indicate that VAD is a moderate public health problem in Honduras. Logistic regression analysis showed that children 12-23 months old living in areas other than the rural south of the country were at greatest risk of subclinical VAD. Infection, indicated by an elevated alpha-1-acid-glycoprotein level, increased the risk of subclinical VAD more than three-fold. Children from households that obtained water from a river, stream, or lake were at twice the risk of subclinical VAD compared to other children. That same double risk was found for children from a household with an outside toilet. VAD can be controlled by fortifying sugar. Retinol levels in sugar at the household level were about 50 percent of those mandated by Honduran law. There appears to be a significant leakage of unfortified sugar into the market. This is particularly true in the rural north, where 33 percent of samples contained no retinol. Overall 30 percent of children were anemic (Hb < 11g/dL). Logistic regression analysis showed that children whose fathers lived with them but who had not attended at least grade 4 of primary school were at 33 percent greater risk of being anemic. Infection and being underweight increased the risk of being anemic by 51 percent and 21 percent respectively. Many of the anemic children had not been given iron supplements, suggesting health care providers may not be aware that anemia is widespread among young children and/or know how to diagnose it (AU)

Vitamin A deficiency in Latin America and the Caribbean: An overview

Vitamin A deficiency (VAD) has been known to exist in Latin America and the Caribbean since the mid-1960s; however, except for pioneering work by the Institute of Nutrition of Central America and Panama/Pan American Health Organization on sugar fortification in Central America, there was little interest in controlling it because of the low frequency of clinical findings. More recently, implicatons of the effect of subclinical VAD on child health and survival has generated increased interest in assessing the problem and a greater commitment to controlling it. The information available by mid-1997 on the magnitude VAD in countries of the region was extensively reviewed. Internationally accepted methods and cutoff points for prevalence estimations were used to compile information from relevant dietary, biochemical, and clinical studies carried out between 1985 and 1997 in samples of at least 100 individuals. VAD in the region of Latin America and the Caribbean is mostly subclinical. The national prevalence of subclinical VAD (serum retinol <20 ug/d) in children under 5 years of age ranges between 6 percent in Panama and 36 percent in El Salvador. The problem is severe in five countries, moderate in six, and mild in four. There are no recent data from Chile, Haiti, Paraguay, Uruguay, Venezuela, and the English-speaking Caribbean. The population affected amounts to about 14.5 million children under 5 years of age (25 percent of that age group). Schoolchildren and adult women may also have significant VAD. Actions currently implemented to control VAD include (a) universal or targeted supplementation; with sustained high coverage rates through national immunization day in some countries; (b) sugar fortification, which is well established in El Salvador, Guatemala and Honduras ( a significant effect has been documented in Guatemala and Honduras and is under negotiation in Bolivia, Columbia, Costa Rica (to be resumed), Equador, Nicaragua and Peru; and (c) limited dietary diversification activities.(AU)

Vitamin A, E and carotenoid status in Jamaica children with sickle cell disease

Nutritional deficiencies would appear to be an important determinant of morbidity in homozygous sickle cell (SS) disease. This is evidenced by the growth and development deficits which are observed in children with SS disease. In a study of the nutritional status of Jamaican children with SS disease aged 3 to 6 years, serum samples from blood taken after an overnight fast in the SS children and children of the same age with normal haemoglobin (AA) were collected. Micro-nutrient analyses of these serum samples for vitamin A (retinol) and vitamins E (alpha and gamma tocopherol) and the carotenoids, beta-carotene and lycopene were carried out using high performance liquid chromatography (HPLC). The results suggest that in children with SS disease several of the micro-nutrients which are essential for maintaining optimal antioxidant status are found in decreased amounts in serum. The confirmation of these micronutrients deficiencies in SS children provide the basis fo further exploration of their interrelationshipo with the growth and development deficits in this population. (AU)

Serum carotenoid concentrations and their reproducibility in children in Belize

Suggestions that carotenoid-containing foods are beneficial in maintaining health have led to several studies of circulating carotenoid concentrations of adults. Because few data are available for children, we report serum carotenoid concentrations of 493 children in Belize. Carotenoid concentrations were determined as part of a survey of vitamin A status of children, most between 65 and 89 mo of age. Reproducibility was tested by collecting a second blood samples 2 wk after the first collection from a subset of children (n = 23) who consumed their habiitual diet with no treatment during the interim. Predominant serum carotenoids were lutein/zeaxanthin and beta-carotene, which accounted for 26 percent and 24 percent of median total carotenoids, respectively. The three provitamin A carotenoids, alpha- and beta-carotene and beta-cryptoaxnthin, constituted 51 percent od median total carotenoid concentrations. Partial correlations of each carotenoid with fasting retinol concentrations indicated that beta-carotene had the highest correlation. Concordance correlation coefficients (rc) for fasting carotenoid concentrati9ons determined 2 wk apart were > or = 0.89 for lycopene, beta-cryptoxanthin, and alpha- and beta-catotene. The rc for lutein/zeaxanthin and total carotenoids was lower, 0.59 and 0.68, respectively, because of higher lutein/zeaxanthin concentrations at the second sampling than at the first. The reproducibility of the concentrations suggest both that individuals have characteristic profiles and that serum carotenoid concentrations can be measured randomly over > or =2 wk without significant bias. (au)

Vitamin A deficiency in Latin America and the Caribbean: an overview

Vitamin A deficiency (VAD) has been known to exist in Latin America and the Caribbean since the mid-1960's; however, except for pioneering work by the Institute of Nutrition of Central America and Panama/Pan American Health Organization on sugar fortification in Central America, there was little interest in controlling it because of the low frequency of clinical findings. More recently, implications of the effect of subclinical VAD on child health and survival has generated increased interest in assessing the problem and a greater commitment to controlling it. The information available by mid-1997 on the magnitude of VAD in countries of the Region was extensively reviewed. Internationally accepted methods and cutoff points for prevalence estimations were used to compile information from relevant dietary, biochemical, and clinical studies carried out between 1985 and 1997 in samples of at least 100 individuals. VAD in the Region of Latin America and the Caribbean is mostly subclinical. The national prevalence of subclinical VAD (serum retinol < 20 mole g/dl) in children under 5 years of age ranges between 6 percent in Panama and 36 percent in El Salvador. The problem is severe in five countries, moderate in six, and mild in four. There are no recent data from Chile, Haiti, Paraguay, Uruguay, Venezuela, and the English-speaking Caribbean. The population affected amounts to about 14.5 million children under 5 years of age (25 percent of that age group). Schoolchildren and adult women may also have significant VAD. Actions currently implemented to control VAD include (a) universal or targeted supplementation, with sustained high coverage rates through national immunization days in some countries; (b) sugar fortification, which is well established in El Salvador, Guatemala, and Honduras (a significant effect has been documented in Guatemala and Honduras) and is under negotiation in Bolivia, Colombia, Costa Rica (to be resumed), Ecuador, Nicaragua, and Peru; and (c) limited dietary diversification activities (AU)