Vitamin A and iron status of children before and after treatment of uncomplicated severe acute malnutrition.

BACKGROUND & AIMS: Treatment of children with uncomplicated severe acute malnutrition (SAM) is based on ready-to-use therapeutic foods (RUTF) and aims for quick regain of lost body tissues while providing sufficient micronutrients to restore diminished body stores. Little evidence exists on the success of the treatment to establish normal micronutrient status. We aimed to assess the changes in vitamin A and iron status of children treated for SAM with RUTF, and explore the effect of a reduced RUTF dose. METHODS: We collected blood samples from children 6-59 months old with SAM included in a randomised trial at admission to and discharge from treatment and analysed haemoglobin (Hb) and serum concentrations of retinol binding protein (RBP), ferritin (SF), soluble transferrin receptor (sTfR), C-reactive protein (CRP) and α1-acid glycoprotein (AGP). SF, sTfR and RBP were adjusted for inflammation (CRP and AGP) prior to analysis using internal regression coefficients. Vitamin A deficiency (VAD) was defined as RBP < 0.7 µmol/l, anaemia as Hb < 110 g/l, storage iron deficiency (sID) as SF < 12 µg/l, tissue iron deficiency (tID) as sTfR > 8.3 mg/l and iron deficiency anaemia (IDA) as both anaemia and sID. Linear and logistic mixed models were fitted including research team and study site as random effects and adjusting for sex, age and outcome at admission. RESULTS: Children included in the study (n = 801) were on average 13 months of age at admission to treatment and the median treatment duration was 56 days [IQR: 35; 91] in both arms. Vitamin A and iron status markers did not differ between trial arms at admission or at discharge. Only Hb was 1.7 g/l lower (95% CI -0.3, 3.7; p = 0.088) in the reduced dose arm compared to the standard dose, at recovery. Mean concentrations of all biomarkers improved from admission to discharge: Hb increased by 12% or 11.6 g/l (95% CI 10.2, 13.0), RBP increased by 13% or 0.12 µmol/l (95% CI 0.09, 0.15), SF increased by 36% or 4.4 µg/l (95% CI 3.1, 5.7) and sTfR decreased by 16% or 1.5 mg/l (95% CI 1.0, 1.9). However, at discharge, micronutrient deficiencies were still common, as 9% had VAD, 55% had anaemia, 35% had sID, 41% had tID and 21% had IDA. CONCLUSION: Reduced dose of RUTF did not result in poorer vitamin A and iron status of children. Only haemoglobin seemed slightly lower at recovery among children treated with the reduced dose. While improvement was observed, the vitamin A and iron status remained sub-optimal among children treated successfully for SAM with RUTF. There is a need to reconsider RUTF fortification levels or test other potential strategies in order to fully restore the micronutrient status of children treated for SAM.

Strategies to achieve adequate vitamin A intake for young children: options for Cameroon.

Meeting children's vitamin A (VA) needs remains a policy priority. Doing so efficiently is a fiscal imperative and protecting at-risk children during policy transitions is a moral imperative. Using the Micronutrient Intervention Modeling tool and data for Cameroon, we predict the impacts and costs of alternative VA intervention programs, identify the least-cost strategy for meeting targets nationally, and compare it to a business-as-usual (BAU) strategy over 10 years. BAU programs effectively cover ∼12.8 million (m) child-years (CY) and cost ∼$30.1 m; ∼US$2.34 per CY effectively covered. Improving the VA-fortified oil program, implementing a VA-fortified bouillon cube program, and periodic VA supplements (VAS) in the North macroregion for 3 years effectively cover ∼13.1 m CY at a cost of ∼US$9.5 m, or ∼US$0.71 per CY effectively covered. The tool then identifies a sequence of subnational policy choices leading from the BAU toward the more efficient strategy, while addressing VA-attributable mortality concerns. By year 4, fortification programs are predicted to eliminate inadequate VA intake in the South and Cities macroregions, but not the North, where VAS should continue until additional delivery platforms are implemented. This modeling approach offers a concrete example of the strategic use of data to follow the Global Alliance for VA framework and do so efficiently.

The change in retinoic acid receptor signaling induced by prenatal marginal vitamin A deficiency and its effects on learning and memory.

This study investigated the prenatal marginal vitamin A deficiency (mVAD)-related impairment in learning and memory and the interactions between RARα, Src and NR1. Learning and memory were assessed in adult rats that were exposed to prenatal mVAD with Morris water maze. The average escape time was longer in mVAD rats, and they passed the hidden platform fewer times during the memory retention test than normal vitamin A intake (VAN) rats. The mRNA and protein levels of RARα, Src and NR1 in mVAD rats were significantly lower than those in VAN rats. RARα and Src, but not NR1, were in the same protein complex. RA treatment-induced increase in RARα, Src and NR1 expressions in mVAD neurons was much lower than that in VAN neurons. Overexpression of RARα gene in VAN neurons induced an increase in RARα, Src and NR1 expressions, while silencing of RARα gene induced a decrease in expressions of RARα and Src, but not that of of NR1. In mVAD neurons, however, overexpression of RARα did not induce an increase in NR1 expression, while silencing of RARα gene had no effect on Src and NR1 expressions. Furthermore, inhibition of Src was associated with a decrease in NR1 expression but not that of RARα. Prenatal mVAD was associated with impaired learning and memory in adult rats. It is possible that mVAD-related decrease in RARα led to a decrease in Src expression, which in turn down-regulated NR1 expression and Ca2+ influx and eventually caused learning and memory deficits.

An Animal-Source Food Supplement Increases Micronutrient Intakes and Iron Status among Reproductive-Age Women in Rural Vietnam.

Background: Few studies have examined the impact of local animal-source foods (ASFs) on the nutritional status of reproductive-age women in developing countries.Objective: We hypothesized that a midmorning snack of local ASF for 6 mo would reduce dietary micronutrient deficiencies [usual intake less than the estimated average requirement (EAR)] and improve blood biomarkers of iron, zinc, and vitamins A and B-12 status among nonpregnant, reproductive-age women in rural Vietnam.Methods: One hundred seventeen women, 18-30 y old, were randomly assigned to receive either an ASF (mean: 144 kcal, 8.9 mg Fe, 2.7 mg Zn, 1050 µg retinoic acid equivalent vitamin A, and 5.5 µg vitamin B-12) or a control snack (mean: 150 kcal, 2.0 mg Fe, 0.9 mg Zn, 0 µg retinoic acid equivalent vitamin A, and 0 µg vitamin B-12) 5 d/wk for 6 mo. Usual nutrient intakes were estimated by repeated 24-h dietary recalls. Blood samples were collected at baseline and 3 and 6 mo. Because of the relation between nutritional status and inflammation, serum C-reactive protein, α-1-acid-glycoprotein, and urinary tract infections (UTIs) were also monitored.Results: Eighty-nine women (47 in the ASF group and 42 controls) completed the study. In the ASF group, intakes of iron and vitamins A and B-12 below the EAR were eliminated, and the prevalence of a low zinc intake was reduced to 9.6% compared with 64.7% in controls (P < 0.001). At 6 mo, a modest increase (P < 0.05) in hemoglobin and iron status occurred in the ASF group compared with the control group, but plasma zinc, retinol, and serum vitamin B-12 concentrations did not differ. UTI relative risk was 3.9 (P < 0.05) among women assigned to the ASF group who had a low whole-body iron status at baseline.Conclusions: Adding a small amount of locally produced ASF to the diets of reproductive-age Vietnamese women improved micronutrient intakes and iron status. However, the increased UTI incidence in women in the ASF group with initially lower iron stores warrants further investigation.

Promotion of Orange-Fleshed Sweet Potato Increased Vitamin A Intakes and Reduced the Odds of Low Retinol-Binding Protein among Postpartum Kenyan Women.

Background: Orange-fleshed sweet potato (OFSP) improves vitamin A (VA) status of young children; research with pregnant and lactating women is limited.Objective: We examined the effectiveness of the Mama SASHA (Sweetpotato Action for Security and Health in Africa) program to improve nutrition knowledge, diets, and nutritional status of pregnant and lactating women (PLW) in Western Kenya.Methods: Eight health facilities were allocated to the Mama SASHA intervention or comparison arms. PLW in intervention facilities received enhanced nutrition counseling at health clinics, were linked with community-based maternal support groups, and received vouchers for OFSP vine cuttings. Control PLW received clinic-based nutrition counseling only. A total of 505 women in early and midpregnancy, attending their first antenatal care visit, and with no previous engagement in project activities were enrolled from the 8 facilities. Nutrition and health-seeking knowledge, food security, dietary patterns, and anthropometric measurements were collected at 4 time points at ≤9 mo postpartum. VA intakes were assessed with multipass 24-h recalls in a subsample of 206 mothers at 8-10 mo postpartum. VA status was assessed by using serum retinol-binding protein (RBP). Impacts were estimated with multilevel mixed models adjusted for clustering and differences at enrollment.Results: At enrollment, 22.9% of women had RBP <1.17 µmol/L. By 9 mo postpartum, intervention women had significantly higher intakes of VA [adjusted difference = 297.0 retinol activity equivalent (RAE) units; 95% CI: 82, 513 RAE units; P = 0.01; n = 206], greater consumption of VA-rich fruit and vegetables in the previous 7 d (difference-in-difference estimate: 0.40 d; 95% CI: 0.23, 0.56 d; P < 0.01), and a 45% reduction in the odds of RBP <1.17 µmol/L (OR: 0.55; 95% CI: 0.33, 0.92; P = 0.01).Conclusion: Promotion of OFSP to PLW through health services is a feasible strategy to improve women's nutrition knowledge, VA intakes, and maternal RBP.

Impact of Multi-Micronutrient Fortified Rice on Hemoglobin, Iron and Vitamin A Status of Cambodian Schoolchildren: a Double-Blind Cluster-Randomized Controlled Trial.

In Cambodia, micronutrient deficiencies remain a critical public health problem. Our objective was to evaluate the impact of multi-micronutrient fortified rice (MMFR) formulations, distributed through a World Food Program school-meals program (WFP-SMP), on the hemoglobin concentrations and iron and vitamin A (VA) status of Cambodian schoolchildren. The FORISCA-UltraRice+NutriRice study was a double-blind, cluster-randomized, placebo-controlled trial. Sixteen schools participating in WFP-SMP were randomly assigned to receive extrusion-fortified rice (UltraRice Original, UltraRice New (URN), or NutriRice) or unfortified rice (placebo) six days a week for six months. Four additional schools not participating in WFP-SMP were randomly selected as controls. A total of 2440 schoolchildren (6-16 years old) participated in the biochemical study. Hemoglobin, iron status, estimated using inflammation-adjusted ferritin and transferrin receptors concentrations, and VA status, assessed using inflammation-adjusted retinol-binding protein concentration, were measured at the baseline, as well as at three and six months. Baseline prevalence of anemia, depleted iron stores, tissue iron deficiency, marginal VA status and VA deficiency were 15.6%, 1.4%, 51.0%, 7.9%, and 0.7%, respectively. The strongest risk factors for anemia were hemoglobinopathy, VA deficiency, and depleted iron stores (all p < 0.01). After six months, children receiving NutriRice and URN had 4 and 5 times less risk of low VA status, respectively, in comparison to the placebo group. Hemoglobin significantly increased (+0.8 g/L) after three months for the URN group in comparison to the placebo group; however, this difference was no longer significant after six months, except for children without inflammation. MMFR containing VA effectively improved the VA status of schoolchildren. The impact on hemoglobin and iron status was limited, partly by sub-clinical inflammation. MMFR combined with non-nutritional approaches addressing anemia and inflammation should be further investigated.

The Influence of Iron and Zinc Supplementation on the Bioavailability of Provitamin A Carotenoids from Papaya Following Consumption of a Vitamin A-Deficient Diet.

Iron deficiency anemia, zinc and vitamin A deficiencies are serious public health problems in Cameroon, as in many developing countries. Local vegetables which are sources of provitamin A carotenoids (PACs) can be used to improve vitamin A intakes. However, traditional meals are often unable to cover zinc and iron needs. The aim of this study was to determine the bioavailability of 3 PACs (α-carotene, ß-carotene, and ß-cryptoxanthin) in young men, who were fed with a vitamin A-free diet and received iron and zinc supplementation. Twelve healthy participants were divided into three groups and were supplemented with elemental iron (20 mg of iron fumarate), 20 mg of zinc sulfate or iron+zinc (20 mg of iron in the morning and 20 mg of zinc in the evening) for 11 d. They were given a vitamin A- and PAC-free diet from the 6th to the 11th day, followed by a test meal containing 0.55 kg of freshly peeled papaya as a source of PACs. Blood samples were collected four times successively on the 11th day (the test meal day), at T0 (just after the test meal), after 2 h (T2), after 4 h (T4) and after 7 h (T7). Ultracentrifugation was used to isolate serum chylomicrons. Retinol appearance and PAC postprandial concentrations were determined. The supplementation with zinc, iron and iron+zinc influenced the chylomicron appearance of retinol and PACs differently as reflected by retention times and maximum absorption peaks. Iron led to highest retinol levels in the chylomicron. Zinc and iron+zinc supplements were best for optimal intact appearance of α-carotene, ß-carotene and ß-cryptoxanthin respectively. Supplementation with iron led to the greatest bioavailability of PACs from papaya and its conversion to retinol.

Vitamin A and retinol-binding protein deficiency among chronic liver disease patients.

OBJECTIVE: Vitamin A deficiency (VAD) is associated with the progression of chronic liver disease (CLD). The aim in this study was to assess levels of serum retinol and retinol-binding protein (RBP) as well as liver vitamin A stores in the presence of liver cirrhosis and hepatocellular carcinoma. METHODS: We ascertained the serum retinol and RBP levels of randomly selected CLD patients divided into two groups, one given 1500 UI (n = 89) and the other receiving 2500 UI (n = 89) doses of retinyl palmitate for the relative dose response test. Blood samples were collected in a fasting state and 5 and 7 h after supplementation. RESULTS: The prevalence of VAD was 62.4%. There was a progressive drop in serum retinol (P < 0.001) and RBP (P = 0.002) according to the severity of the liver disease, and a greater prevalence of severe VAD was noted in cirrhosis Child & Pugh C (52.8%). Fifty percent of the patients presented a low availability of RBP relative to retinol concentration, and there was no peak in RBP levels regardless of the dose of retinyl palmitate administered. CONCLUSIONS: Our findings suggest serum retinol and RBP are relevant as indicators of vitamin A nutritional status in the presence of CLD. Liver vitamin A store cannot be evaluated using the RDR test because CLD causes a reduction in RBP synthesis and interferes with the mobilization of endogenous vitamin A. Considering how the patients already showed a drop in RBP relative to retinol concentrations, it is reasonable to assume vitamin A supplementation may trigger harmful effects in CLD patients.

Estimating the impact of vitamin A-fortified vegetable oil in Bangladesh in the absence of dietary assessment data.

OBJECTIVE: Vitamin A deficiency is a serious health problem in Bangladesh. The 2011-12 Bangladesh Micronutrient Survey found 76·8% of children of pre-school age were vitamin A deficient. In the absence of nationally representative, individual dietary assessment data, we use an alternative--household income and expenditure survey data--to estimate the potential impact of the introduction of vitamin A-fortified vegetable oil in Bangladesh. DESIGN: Items in the household income and expenditure survey were matched to food composition tables to estimate households' usual vitamin A intakes. Then, assuming (i) the intra-household distribution of food is in direct proportion to household members' share of the household's total adult male consumption equivalents, (ii) all vegetable oil that is made from other-than mustard seed and that is purchased is fortifiable and (iii) oil fortification standards are implemented, we modelled the additional vitamin A intake due to the new fortification initiative. SETTING: Nationwide in Bangladesh. SUBJECTS: A weighted sample of 12,240 households comprised of 55,580 individuals. RESULTS: Ninety-nine per cent of the Bangladesh population consumes vegetable oil. The quantities consumed are sufficiently large and, varying little by socio-economic status, are able to provide an important, large-scale impact. At full implementation, vegetable oil fortification will reduce the number of persons with inadequate vitamin A intake from 115 million to 86 million and decrease the prevalence of inadequate vitamin A intake from 80% to 60%. CONCLUSIONS: Vegetable oil is an ideal fortification vehicle in Bangladesh. Its fortification with vitamin A is an important public health intervention.

Double-blind cluster randomised controlled trial of wheat flour chapatti fortified with micronutrients on the status of vitamin A and iron in school-aged children in rural Bangladesh.

Food fortification is a cost-effective and sustainable strategy to prevent or correct micronutrient deficiencies. A double-blind cluster (bari) randomised controlled trial was conducted in a rural community in Bangladesh to evaluate the impact of consumption of chapatti made of micronutrient-fortified wheat flour for 6 months by school-aged children on their vitamin A, haemoglobin and iron status. A total of 43 baris (group of households) were randomly selected. The baris were randomly assigned to either intervention or control group. The intervention group received wheat flour fortified with added micronutrients (including 66 mg hydrogen-reduced elemental iron and 3030 µg retinol equivalent as retinyl palmitate per kilogram of flour), while the control group received wheat flour without added micronutrients. A total of 352 children were enrolled in the trial, 203 in the intervention group and 149 in the control group. Analyses were carried out on children who completed the study (191 in the intervention group and 143 in the control group). Micronutrient-fortified wheat flour chapatti significantly increased serum retinol concentration at 6 months by 0.12 µmol L(-1) [95% confidence interval (CI): 0.06, 0.19; P < 0.01]. The odds of vitamin A deficiency was significantly lower for children in the intervention group at 3 months [odds ratio (OR) = 0.26; 95% confidence interval (CI): 0.07, 0.89; P < 0.05] and 6 months (OR = 0.21; 95% CI: 0.06, 0.68; P < 0.01). No demonstrable effect of fortified chapatti consumption on iron status, haemoglobin levels or anaemia was observed. Consumption of fortified chapattis demonstrated a significant improvement in the vitamin A status, but not in iron, haemoglobin or anaemia status.

Flocos desidratados de abóbora na prevenção da carência de vitamina A em pré-escolares de uma creche / Dehydrated pumpkin flakes for preventing vitamin A deficiency in preschoolers attending a daycare

OBJETIVO: Esta pesquisa teve como objetivo avaliar a eficácia de flocos desidratados de abóbora na elevação dos níveis séricos de retinol e a resposta relativa à dose em pré-escolares. MÉTODOS: A ingestão de vitamina A foi avaliada por meio de inquérito dietético. Os flocos foram analisados quanto às características microbiológicas e ao conteúdo de carotenoides. As crianças estudadas receberam diariamente 6g do produto no almoço, durante 90 dias. Elas foram submetidas ao teste de resposta relativa à dose no início e no final do estudo. Amostras de sangue foram colhidas em jejum, para análise do retinol sérico por espectro-fotometria, no início do estudo, aos 30 dias de consumo e aos 90 dias. RESULTADOS: Quanto às análises microbiológicas, os flocos encontravam-se adequados para consumo. O nível médio de retinol sérico nas crianças aumentou de M=1,438, DP=0,45µmol/L (tempo 0) para M=1,659, DP=0,51µmol/L (30 dias) e M=1,928, DP=0,70µmol/L (90 dias). No início do estudo, 18,5% das crianças apresentavam níveis de retinol sérico abaixo do ponto de corte de 1,05µmol/L, proporção que caiu para 7,6% depois de 30 dias e para 0% após 90 dias. No final do período de estudo (90 dias) nenhuma criança apresentou resposta relativa à dose positiva. CONCLUSÃO: Os flocos de abóbora são eficazes na elevação do retinol sérico e na reserva hepática da vitamina em pré-escolares.

OBJECTIVE: This study assessed the effectiveness of dehydrated pumpkin flakes for elevating serum retinol and the relative dose response in preschoolers. METHODS: Vitamin A intake was determined by dietary survey. The flakes were analyzed microbiologically and for carotenoid content. The children were then given 6 grams of flakes per day during lunch for 90 days. The relative dose response essay was done at baseline and end of intervention. Fasting blood samples were collected at baseline, 30 and 90 days to determine serum retinol levels by spectrophotometry. RESULTS: Microbiological analyses showed that the flakes were suitable for consumption. The mean serum retinol level of the children increased from M=1.438 (SD=0.45µmol/L) at baseline to M=1.659 (SD=0.51µmol/L) at 30 days and M=1.928 (SD=0.70µmol/L) at 90 days. At the beginning of the study, 18.5% of the children had serum retinol levels below 1.05µmol/L. This percentage dropped to 7.6% after 30 days and 0% after 90 days. At the end of the study period (90 days), no child had a positive relative dose response. CONCLUSION: Pumpkin flakes efficiently increase serum retinol levels and hepatic vitamin A reserves in preschoolers.

Estado nutricio de vitamina A en preescolares con padecimientos oculares / Nutritional status of vitamin A in preschoolers with ocular diseases

El propósito del estudio fue evaluar el estado nutricio de vitamina A en preescolares con padecimientos oculares que acuden al Hospital Civil de Guadalajara. En estudio transversal analítico se incluyeron por conveniencia 100 sujetos (24-71 meses) con padecimiento ocular. El consumo de vitamina A (VA), energía y macro nutrimentos se estimó con una encuesta dietética de recordatorio de 24 horas (EDR-24h). Mediante cromatografía líquida de alta presión (HPLC) se determinó la concentración sérica de retinol y se realizó una citología de impresión conjuntival (CIC) por un patólogo entrenado en la técnica. Se estimaron los índices talla/edad y peso/talla (Puntaje z) y se utilizaron las pruebas de ANOVA, U de Mann Whitney y de correlación de Spearman. Fueron niñas 44,1 por ciento y varones 55.9 por ciento. Los padecimientos oculares más frecuentes fueron: estrabismo (41,9 por ciento), conjuntivitis (19,4 por ciento) y padecimientos congénitos (17,2 por ciento). Según la EDR-24 h el consumo de vitamina A fue de 374 µg/día ± 706; la concentración de Retinol sérico 30 µg/dL ± 7,6 y CIC fue normal en 75,6 por ciento. Sólo 3.2 por ciento a 3,5 por ciento presentaron deficiencia de VA (concentración de retinol y CIC). No hubo asociación entre padecimientos oculares y deficiencia de VA. Hubo correlación positiva entre consumo de vitamina A e índice peso/talla (r = 0,244). En conclusión, la mayoría de los preescolares cubrió la ingestión recomendada de vitamina A, la deficiencia de esta vitamina fue baja y no se asoció a padecimientos oculares.

SUMMARY The purpose was to evaluate the nutritional status of vitamin A in preschool children with ocular diseases attending to the Hospital Civil of Guadalajara. In a cross sectional design 100 preschool children between 24 and 71 mo of age with ocular diseases were included. Vitamin A intake was evaluated by 24 h dietetic recall, plasma Retinol concentration by high pressure liquid chromatography (HPLC); and, conjunctiva impression cytology (CIC) was carried out by a trained pathologist. ANOVA and U Mann Whitney tests, and also Spearman correlations were estimated. There were 44.1 percent females and 55,9 percent males. Strabismus was the most common disease (41,9 percent), conjunctivitis (19,4 percent), and congenital diseases (17,2 percent). The mean intake of Vitamin A was 374 µg/d ± 706 and the serum concentration of retinol was of 30 µg/dL ± 7,6; CIC was normal in 75,6 percent. The percentage of vitamin A deficiency was 3,2 percent according to the serum concentration of Retinol and 3,5 percent to the CIC criteria. It was not association between the nutritional status of vitamin A and ocular diseases. A positive correlation between vitamin A intake and weight/height index (r = 0,244) was found. In conclusion, most preschool children covered the dietary reference intake recommendation of vitamin A; deficiency of this vitamin was lower and, it was not associated to ocular diseases.

Effects of vitamin A, vitamin A plus iron and multiple micronutrient-fortified seasoning powder on preschool children in a suburb of Chongqing, China.

Preschool children in developing countries are likely to have multiple, concurrent micronutrient deficiencies. This study was designed to evaluate the effectiveness of different combinations of nutritional fortified diet to improve the blood levels of iron, vitamin A and other essential micronutrients in the preschool population of Banan District of Chongqing, China. From December 2005 to June 2006, a total of 226 2-6 y old preschool children were recruited from three nurseries in the area, and they were randomly assigned to three different fortified diet groups for 6 mo. Group I was fortified with vitamin A; groups II and III were fortified with vitamin A plus iron and vitamin A plus iron, thiamine, riboflavin, folic acid, niacinamide, zinc and calcium, respectively. Subjects' weight and height were measured for assessing the children's growth and development. Blood samples were taken at the beginning and the end of the 6-mo study period for measuring serum levels of micronutrients. Group III with the multiple micronutrient fortified diet was the most effective to improve the serum level of retinol from [media (P25, P75): 1.06 (0.89, 1.32)] micromol/L to 1.29 (1.04, 1.39) micromol/L (p<0.05) and retinol binding protein from 17.0 (12.6, 25.6) mg/L to 31.6 (24.4, 44.0) mg/L (p<0.05) and to mobilize the stored iron in the liver (p<0.05). In addition, the three groups' hemoglobin levels were elevated from 117.0 (109.0, 124.1) g/L, 114.0 (109.2, 119.7) g/L and 115.0 (109.5, 122.7) g/L to 125.7 (119.2, 133.1) g/L, 126.5 (122.2, 135.9) g/L and 125.1 (119.8, 131.6) g/L over the 6 mo of intervention period, but there were no difference among the three groups (p>0.05). Nevertheless, unexpected results were obtained when comparing the effects on growth status among the different supplement groups. Our study has demonstrated that a multiple micronutrient fortified diet for 6 mo is more effective to improve the levels of hemoglobin, serum retinol, and RBP as well as to facilitate the mobilization of iron storage in preschool children.

Carotenóides como alternativa contra a hipovitaminose A / Carotenoids as an alternative against hypovitaminosis A

A hipovitaminose A acarreta xeroftalmia, cegueira e morte em milhares de crianças no mundo e constitui um dos principais problemas nutricionais de populações de países em desenvolvimento, incluído o Brasil. Embora haja grande disponibilidade de frutas e verduras, fontes de carotenóides no Brasil, a hipovitaminose A constitui um grave problema de saúde pública. A falta de informação da população, no que diz respeito às fontes alimentares e aos fatores que interferem na biodisponibilidade dos carotenóides, citados na literatura, com a "mnemônica" SLAMENGHI são possíveis causas associadas a esta contradição. Os atuais fatores de conversão de carotenóides em retinol são superiores aos antigos fatores, o que pressupõe uma efetividade ainda menor na conversão dos carotenóides na forma ativa da vitamina A e coloca em questão a utilização destes no combate à hipovitaminose A. Esta revisão tem como objetivo relatar o que vem sendo abordado acerca do tema biodisponibilidade e fontes de carotenóides, para possibilitar um melhor posicionamento na utilização dos carotenóides no combate à hipovitaminose A.

Aceitabilidade de flocos desidratados de abóbora / Dehydrated pumpkin flakes acceptability

OBJETIVO: Avaliar a aceitabilidade de flocos desidratados de abóbora, uma vez que tal produto pode constituir uma alternativa no combate à hipovitaminose A. MÉTODOS: Os flocos foram avaliados quanto às características microbiológicas, por meio das análises de coliformes a 45ºC, Escherichia coli, Staphylococcus aureus, Salmonela sp, contagem de bolores e leveduras, e características físico-químicas, por meio da análise de umidade, proteínas, lipídios, cinzas, fibra alimentar, carboidratos, carotenóides, estabilidade ao longo do tempo de armazenamento e aceitabilidade dos flocos adicionados ao feijão e ao pirão de 188 adultos e 67 crianças, respectivamente. RESULTADOS: Os flocos estavam adequados quanto às características microbiológicas e físico-químicas e os percentuais de aceitação de 95,21 por cento para os adultos e 95,52 por cento para as crianças. CONCLUSAO: Os flocos desidratados de abóbora podem ser utilizados em larga escala para o estudo do efeito deste produto no combate à hipovitaminose A.

Red palm oil as a source of vitamin A for mothers and children: impact of a pilot project in Burkina Faso.

OBJECTIVE: To demonstrate the effectiveness of the commercial introduction of red palm oil (RPO) as a source of vitamin A (VA) for mothers and children in a non-consuming area, as a dietary diversification strategy. DESIGN: A pre-post intervention design (no control area) was used to assess changes in VA intake and status over a 24-month pilot project. SETTING AND SUBJECTS: The pilot project involved RPO promotion in 10 villages and an urban area in east-central Burkina Faso, targeting approximately 10 000 women and children aged <5 years. A random sample of 210 mother-child (12-36-months-old) pairs was selected in seven out of the 11 pilot sites for the evaluation. RESULTS: After 24 months, RPO was reportedly consumed by nearly 45% of mothers and children in the previous week. VA intake increased from 235+/-23 microg retinol activity equivalents (RAE) to 655+/-144 microg RAE in mothers (41 to 120% of safe intake level), and from 164+/-14 microg RAE to 514+/-77 microg RAE in children (36 to 97%). Rates of serum retinol <0.70 micromol l(-1) decreased from 61.8+/-8.0% to 28.2+/-11.0% in mothers, and from 84.5+/-6.4% to 66.9+/-11.2% in children. Those with a lower initial concentration of serum retinol showed a higher serum retinol response adjusted for VA intake. CONCLUSIONS: Commercial distribution of RPO was effective in reducing VA deficiency in the pilot sites. While it is promising as part of a national strategy, additional public health and food-based measures are needed to control VA malnutrition, which remained high in the RPO project area.

[The use of alimentary antioxidants in diet therapy of geriatric patients during the period of the surgical treatment]. / Ispol'zovanie alimentarnykh antioksidantov v dietoterapii geriatricheskikh bol'nykh v period khirurgicheskogo lecheniia.

Analysis of actual feeding of 277 geriatric patients suffering from urology disease. The patients had a combined deficient of vitamin A, vitamin C, vitamin of the B group, beta-capotene and mineral substances. Diets 1a, 1, 5, 7, 9, 15 could not provide daily needs for antioxidant nutrients. Antioxidant and antiinflammatory effects of the dietary supplement containing natural antioxidants in 122 oncourology patients after operation was indicated. So there was reason to fortify diets of patients with antioxidant dietary supplement during the period of surgical treatment.

Carotenoid-rich bananas: a potential food source for alleviating vitamin A deficiency.

This review article points out that bananas are an important food for many people in the world. Thus, banana cultivars rich in provitamin A carotenoids may offer a potential food source for alleviating vitamin A deficiency, particularly in developing countries. Many factors are associated with the presently known food sources of vitamin A that limit their effectiveness in improving vitamin A status. Acceptable carotenoid-rich banana cultivars have been identified in Micronesia, and some carotenoid-rich bananas have been identified elsewhere. Bananas are an ideal food for young children and families for many regions of the world, because of their sweetness, texture, portion size, familiarity, availability, convenience, versatility, and cost. Foods containing high levels of carotenoids have been shown to protect against chronic disease, including certain cancers, cardiovascular disease, and diabetes. Because the coloration of the edible flesh of the banana appears to be a good indicator of likely carotenoid content, it may be possible to develop a simple method for selecting carotenoid-rich banana cultivars in the community. Research is needed on the identification of carotenoid-rich cultivars, targeting those areas of the world where bananas are a major staple food; investigating factors affecting production, consumption, and acceptability; and determining the impact that carotenoid-rich bananas may have on improving vitamin A status. Based on these results, interventions should be undertaken for initiating or increasing homestead and commercial production.

[Pre-cooked corn flour intake and its contribution of iron and vitamin A in low income preschoolers]. / Consumo de harina de maíz precocida y su aporte de hierro y vitamina A en preescolares de bajos recursos económicos.

The objective of this study was to determine whether the addition of iron and vitamin A (VA) to corn flour, supplied through a national enrichment program since 1993, allows preschoolers to achieve an adequate intake of these nutrients. Data from the assessment of 196 children (4-6 year old) from Valencia, Venezuela is presented, including socio-demographic, anthropometric, anemia, VA deficiency (by conjunctival impression cytology (CIC) and serum retinol), and food intake. 92% of the children lived in poverty. 12% were below the norm for weight-for-height. 13% had anemia, 9% had VA deficiency according to CIC, and 0.5% according to serum retinol (< 0.70 mumol/L), 30% were at risk of VA deficiency (0.70-1.05 mmol/L). 17%, 37%, and 5% of the sample had an insufficient intake (< 80% of RDA) of energy, iron, and VA, respectively. When excluding from the analysis the amount of iron and VA from corn flour enrichment, an additional 38% and 10% of the sample showed deficient intakes of each nutrient, respectively. According to the weight-for-height indicator, iron intake was significantly lower in undernourished children (p < 0.05) than in those normal or above the norm; this was not so for VA. It is concluded that iron enrichment contributes to the improvement of the intake of this nutrient but is not enough to provide an adequate amount of it; and that the addition of VA does not seem to have an important effect on the diet of this age group.