Global patterns in vision loss burden due to vitamin A deficiency from 1990 to 2017.

OBJECTIVE: To investigate the vision loss burden due to vitamin A deficiency (VAD) at the global, regional and national levels by year, age, sex and socio-economic status using prevalence and years lived with disability (YLD). DESIGN: International, retrospective, comparative burden-of-disease study. SETTING: Prevalence and YLD data were extracted from the Global Burden of Disease (GBD) Study 2017. The association of age-standardised YLD rates and human development index (HDI) was tested by Pearson correlation and linear regression analyses. The Gini coefficient and concentration index (CI) were calculated to demonstrate the trends in between-country inequality in vision loss burden due to VAD. PARTICIPANTS: All participants met the GBD inclusion criteria. RESULTS: The age-standardised prevalence rate increased by 9·2 %, while the age-standardised YLD rates rose by 10·8 % from 1990 to 2017. Notably, the vision loss burden caused by VAD showed a declining trend since 2014. The vision loss burden was more concentrated in the post-neonatal age group and decreased with increasing age. The age-standardised YLD rates were inversely correlated with HDI (r = -0·2417, P = 0·0084). The CI and Gini coefficients indicated that socio-economic-related and between-country inequality declined from 2000 to 2017. VAD was the eighth leading cause of the age-standardised prevalence rate and ninth leading cause of age-standardised YLD rate among fifteen causes of vision loss in 2017. CONCLUSION: VAD has become one of the significant leading causes of vision loss globally. Efforts to control vision impairment related to VAD are needed, especially for children in countries with lower socio-economic status.

Diagnosis of night blindness through standardized interview and electroretinography.

INTRODUCTION: Objective: To compare the diagnosis of NB through the use of the standardized interview of the World Health Organization/Pan American Health Organization (WHO/PAHO) with electroretinography, and also to evaluate the association of these diagnoses with serum concentrations of retinol in class III obesity individuals. Methods: Adult patients of both genders, in the 20-60 age group, with BMI ≥ 40 kg/m² were studied. NB was diagnosed through electroretinography and the standardized interview validated by the WHO/PAHO. Serum level of retinol was quantified by the HPLC-UV method, and VAD was diagnosed when levels were <1.05 µmol /L, and severity was also evaluated. Statistical analysis was carried out through the Statistical Package for the Social Sciences, version 21.0 (p < 0.05). Results: Mean BMI was 44.9  11.8 kg/m², and a negative correlation was found in serum levels of retinol (p= 0.01). The prevalence of VAD, according to the serum concentrations of retinol, was 14%, and of this percentage 23.3% had NB according to the standardized interview, and 22.0% according to electroretinography. NB diagnosed by both methods showed an association with VAD according to the serum concentrations of retinol. Of these individuals with NB, according to the standardized interview, 6.9% showed severe VAD, 10.3% moderate VAD and 82.8% marginal VAD. Conclusion: The standardized interview for the diagnosis of NB can be a good strategy to evaluate the nutritional status of vitamin A, and it is a simple, non-invasive and low-cost method.

INTRODUCCIÓN: Objetivo: Comparar el diagnóstico de NB mediante el uso de la entrevista estandarizada de la Organización Mundial de la Salud/Organización Panamericana de la Salud (OMS/OPS) con electrorretinografía, y también evaluar la asociación de estos diagnósticos con las concentraciones séricas de retinol en la clase III personas obesas. Métodos: se estudiaron pacientes adultos de ambos sexos, en el grupo de 20 a 60 años de edad, con un IMC ≥ 40 kg/m². La NB se diagnosticó mediante electrorretinografía y la entrevista estandarizada validada por la OMS/OPS. El nivel sérico de retinol se cuantificó mediante el método HPLC-UV, y el DVA se diagnosticó cuando los niveles eran <1.05 µmol / L, y también se evaluó la gravedad. El análisis estadístico se realizó a través del Paquete Estadístico para las Ciencias Sociales, versión 21.0 (p <0.05). Resultados: IMC promedio fue de 44.9 ± 11.8 kg / m², y se encontró una correlación negativa en los niveles séricos de retinol (p = 0.01). La prevalencia de DVA, según las concentraciones séricas de retinol, fue del 14%, y de este porcentaje, el 23,3% tenía NB de acuerdo con la entrevista estandarizada y el 22,0% según la electrorretinografía. La NB diagnosticada por ambos métodos mostró una asociación con VAD según las concentraciones séricas de retinol. De estos individuos con NB, según la entrevista estandarizada, el 6,9% mostró VAD grave, el 10,3% de VAD moderado y el 82,8% de VAD marginal. Conclusión: la entrevista estandarizada para el diagnóstico de NB puede ser una buena estrategia para evaluar el estado nutricional de la vitamina A, y es un método simple, no invasivo y de bajo costo.

Relative Contributions of Malaria, Inflammation, and Deficiencies of Iron and Vitamin A to the Burden of Anemia during Low and High Malaria Seasons in Rural Zambian Children.

OBJECTIVE: To estimate the burden of anemia attributable to malaria, inflammation, and deficiency of iron or vitamin A during low and high malaria seasons among Zambian children. STUDY DESIGN: From a cohort of children (n = 820), 4-8 years of age participating in a randomized controlled trial of pro-vitamin A, we estimated attributable fractions for anemia (hemoglobin of <110 or 115 g/L, by age) owing to current malaria or inflammation (C-reactive protein of >5 mg/L, or α-1 acid glycoprotein of >1 g/L, or both), and current or prior iron deficiency (ID; defined as low ferritin [<12 or 15 µg/L for age <5 or >5 years] or functional ID [soluble transferrin receptor of >8.3 mg/L] or both) and vitamin A deficiency (retinol of <0.7 µmol/L), during low and high malaria seasons, using multivariate logistic regression. Serum ferritin, soluble transferrin receptor, and retinol were adjusted for inflammation. RESULTS: The burden of anemia independently associated with current malaria, inflammation, ID, and vitamin A deficiency in the low malaria season were 12% (P < .001), 6% (P = .005), 14% (P = .001), and 2% (P = .07), respectively, and 32% (P < .001), 15% (P < .001), 10% (P = .06), and 2% (P = .06), respectively, in the high malaria season. In both seasons, functional ID was independently associated with more anemia (approximately 11%) than low ferritin (approximately 4%). Anemia and ID in the low malaria season, accounted for 20% (P < .001) and 4% (P = .095) of the anemia in the subsequent high malaria season. CONCLUSIONS: Anemia in this population is strongly linked to malaria, inflammation, and functional ID, and to a lesser extent, low iron stores. Integrated control strategies are needed.

Soil-Transmitted Helminthiasis and Vitamin A Deficiency: Two Problems, One Policy.

Vitamin A deficiency (VAD) and soil-transmitted helminthiasis (STH) represent two widely prevalent and often overlapping global health problems. Approximately 75% of countries with moderate or severe VAD are coendemic for STH. We reviewed the literature on the complex relationship between STH and VAD. Treatment for STH significantly increases provitamin A (e.g., ß-carotene) levels but is associated with minimal increases in preformed vitamin A (retinol). Interpretation of the data is complicated by variations in STH infection intensity and limitations of vitamin A biomarkers. Despite these challenges, increased coordination of STH and VAD interventions represents an important public health opportunity.

Assessment of indicators of vitamin A status in non-cirrhotic chronic hepatitis C patients.

Subjects with chronic liver disease are susceptible to hypovitaminosis A due to several factors. Therefore, identifying patients with vitamin deficiency and a requirement for vitamin supplementation is important. Most studies assessing vitamin A in the context of hepatic disorders are conducted using cirrhotic patients. A cross-sectional study was conducted in 43 non-cirrhotic patients with chronic hepatitis C to evaluate markers of vitamin A status represented by serum retinol, liver retinol, and serum retinol-binding protein levels. We also performed the relative dose-response test, which provides an indirect estimate of hepatic vitamin A reserves. These vitamin A indicators were assessed according to the stage of liver fibrosis using the METAVIR score and the body mass index. The sample study was predominantly composed of male subjects (63%) with mild liver fibrosis (F1). The relative dose-response test was <20% in all subjects, indicating vitamin A sufficiency. Overweight or obese patients had higher serum retinol levels than those with a normal body mass index (2.6 and 1.9 µmol/L, respectively; P<0.01). Subjects with moderate liver fibrosis (F2) showed lower levels of serum retinol (1.9 vs 2.5 µmol/L, P=0.01) and retinol-binding protein levels compared with those with mild fibrosis (F1) (46.3 vs 67.7 µg/mL, P<0.01). These results suggested an effect of being overweight on serum retinol levels. Furthermore, more advanced stages of liver fibrosis were related to a decrease in serum vitamin A levels.

Assessment of indicators of vitamin A status in non-cirrhotic chronic hepatitis C patients

Subjects with chronic liver disease are susceptible to hypovitaminosis A due to several factors. Therefore, identifying patients with vitamin deficiency and a requirement for vitamin supplementation is important. Most studies assessing vitamin A in the context of hepatic disorders are conducted using cirrhotic patients. A cross-sectional study was conducted in 43 non-cirrhotic patients with chronic hepatitis C to evaluate markers of vitamin A status represented by serum retinol, liver retinol, and serum retinol-binding protein levels. We also performed the relative dose-response test, which provides an indirect estimate of hepatic vitamin A reserves. These vitamin A indicators were assessed according to the stage of liver fibrosis using the METAVIR score and the body mass index. The sample study was predominantly composed of male subjects (63%) with mild liver fibrosis (F1). The relative dose-response test was <20% in all subjects, indicating vitamin A sufficiency. Overweight or obese patients had higher serum retinol levels than those with a normal body mass index (2.6 and 1.9 µmol/L, respectively; P<0.01). Subjects with moderate liver fibrosis (F2) showed lower levels of serum retinol (1.9 vs 2.5 µmol/L, P=0.01) and retinol-binding protein levels compared with those with mild fibrosis (F1) (46.3 vs 67.7 µg/mL, P<0.01). These results suggested an effect of being overweight on serum retinol levels. Furthermore, more advanced stages of liver fibrosis were related to a decrease in serum vitamin A levels.

Global distribution and disease burden related to micronutrient deficiencies.

Micronutrients are vitamins and minerals that are essential for human life and health. Deficiencies in these micronutrients are common because of poor quality diets and frequent infectious diseases in low- and middle-income countries. The high prevalence of deficiencies and their important adverse consequences on mortality, morbidity and disability result in a substantial disease burden. In particular, deficiencies of vitamin A and zinc increase the risk of child mortality, and zinc deficiency increases infectious morbidity and reduces linear growth as well. Deficiencies of iodine and iron are significant primarily for their effects on development and cognition and consequent disabilities. Programs targeting each of these micronutrients are underway and, particularly for vitamin A and iodine, have some success. Greater efforts to address these and the full set of micronutrients are needed to reduce their global burden of diseases.

Assessment of the relative dose-response test as indicators of hepatic vitamin A stores in various stages of chronic liver disease.

Hepatic vitamin A stores should be the best early indicator of vitamin A status because more than 90% of total body vitamin A is stored in the liver. The objective of the present study was to evaluate the hepatic vitamin A stores in all stages of chronic liver disease (CLD), including chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma (HCC). One hundred forty-four patients (age 55.34 ± 9.38 years) were evaluated in a cross-sectional study. Vitamin A nutrition status was analyzed by serum retinol levels and relative dose-response (RDR) method. Patients with cholestasis were excluded from the sample group. Biochemical, clinical, and anthropometric evaluations were performed. Vitamin A deficiency (VAD) was detected in 51.4% of all patients. Patients with adequate levels of serum retinol presented adequate liver vitamin A reserves; in contrast, nearly half the patients with low serum retinol levels presented adequate levels of retinol in the liver, although none of the patients with hepatitis had this condition. Therefore, the effectiveness of the RDR method for evaluating vitamin A nutrition status was limited in patients with cirrhosis and HCC, perhaps due to the advanced age of these patients, since those in the chronic hepatitis group, who were younger, responded adequately to the test. Thus, the RDR method should be modified when applied to later stages of CLD, considering the time and dose of retinyl palmitate supplementation, as VAD may be a risk factor for the progression of the disease.

The double burden of malnutrition and cardiometabolic risk widens the gender and socio-economic health gap: a study among adults in Burkina Faso (West Africa).

OBJECTIVE: To document the double burden of malnutrition and cardiometabolic risk factors (CMRF) in adults and its occurrence according to different sociodemographic parameters. DESIGN: Population-based cross-sectional observational study. We first randomly selected 330 households stratified by tertile of the income levels proxy as low, middle and high income. SETTING: Northern district of Ouagadougou, the capital city of Burkina Faso. SUBJECTS: In each income stratum, 110 individuals aged 25-60 years and who had lived permanently in Ouagadougou for at least 6 months were randomly selected, followed with collection of anthropometric, socio-economic and clinical data, and blood samples. RESULTS: The overall obesity/overweight prevalence was 24.2 % and it was twice as high in women as in men (34.1 % v. 15.5 %, P < 0.001). Hypertension, hyperglycaemia and low HDL cholesterol prevalence was 21.9 %, 22.3 % and 30.0 %, respectively, without gender difference. The prevalence of the metabolic syndrome was 10.3 %. Iron depletion and vitamin A deficiency affected 15.7 % and 25.7 % of participants, respectively, with higher rates in women. Coexistence of at least one nutritional deficiency and one CMRF was observed in 23.5 % of participants, and this 'double burden' was significantly higher in women than in men (30.4 % v. 16.1 %, P = 0.008) and in the low income group. CONCLUSIONS: CMRF are becoming a leading nutritional problem in adults of Ouagadougou, while nutritional deficiencies persist. The double nutritional burden exacerbates health inequities and calls for action addressing both malnutrition and nutrition-related chronic diseases.

Thriving public-private partnership to fortify cooking oil in the West African Economic and Monetary Union (UEMOA) to control vitamin A deficiency: Faire Tache d'Huile en Afrique de l'Ouest.

BACKGROUND: In sub-Saharan Africa, more than 42% of children are at risk for vitamin A deficiency, and control of vitamin A deficiency will prevent more than 600,000 child deaths annually. In the West African Economic and Monetary Union (UEMOA), an estimated 54.3% of preschool-age children are vitamin A deficient and 13% of pregnant women have night blindness. OBJECTIVE: To project the achievements of this West African coalition. METHODS: This article documents the achievements, challenges, and lessons learned associated with the development of a public-private partnership to fortify vegetable oil in West Africa through project reports and industry assessments. RESULTS: National-level food consumption surveys identified cooking oil as a key vehicle for vitamin A. Stakeholders therefore advocated for the production of fortified vegetable oil at large scale, supported industrial assessments, and reinforced the capacity of cooking oil industries to implement vitamin A fortification through effective coordination of public and private partnerships tied with standards, regulations, and social marketing. Strong alliances for food fortification were established at the regional and national levels. Stakeholders also developed policies, adopted directives, built capacity, implemented social marketing, and monitored quality enforcement systems to sustain fortification for maximum public health impact. The synergy created resulted from the unique and complementary core competencies of all the partners under effective coordination. The initiative began with the 8 UEMOA member countries and now includes all 15 countries of the Economic Community of West African States (ECOWAS), plus Cameroon, Tanzania, and Mozambique, forming a sub-Saharan Africa-wide initiative on food fortification. All members of the Professional Association of Cooking Oil Industries of the West African Economic and Monetary Union (AIFO-UEMOA) now fortify edible oil with vitamin A. Through multisector cooperation, an estimated 70% of the population has access to vitamin A-fortified edible oil in participating countries. CONCLUSIONS: Sustainable fortification of cooking oil is now a reality in all UEMOA countries.

Relationship of homestead food production with night blindness among children below 5 years of age in Bangladesh.

OBJECTIVE: To examine the relationship between homestead food production and night blindness among pre-school children in rural Bangladesh in the presence of a national vitamin A supplementation programme. DESIGN: A cross-sectional study. SETTING: A population-based sample of six rural divisions of Bangladesh assessed in the Bangladesh Nutrition Surveillance Project 2001-2005. SUBJECTS: A total of 158 898 children aged 12-59 months. RESULTS: The prevalence rates of night blindness in children among those who did and did not receive vitamin A capsules in the last 6 months were 0·07 % and 0·13 %, respectively. Given the known effect of vitamin A supplementation on night blindness, the analysis was stratified by children's receipt of vitamin A capsules in the last 6 months. Among children who did not receive vitamin A capsules in the last 6 months, the lack of a home garden was associated with increased odds of night blindness (OR = 3·16, 95 % CI 1·76, 5·68; P = 0·0001). Among children who received vitamin A capsules in the last 6 months, the lack of a home garden was not associated with night blindness (OR = 1·28, 95 % CI 0·71, 2·31; P = 0·4). CONCLUSIONS: Homestead food production confers a protective effect against night blindness among pre-school children who missed vitamin A supplementation in rural Bangladesh.

Microphthalmia and anophthalmia in Chuuk State, Federated States of Micronesia.

Microphthalmia ('small eye') and anophthalmia ('no eye') are rare congenital defects of eye development. Previous studies utilizing a variety of methodologies have estimated their combined incidence at anywhere from 4 to 30 cases per 100,000 live births. In Chuuk, Federated States of Micronesia, there have been 42 cases detected since 1988, yielding an estimated incidence of 140 cases per 100,000. A number of putative genetic and environmental causes have previously been associated with microphthalmia and anophthalmia, including vitamin A deficiency. To date, it is unclear which of these factors may play a role in the alarmingly high rates observed in Chuuk. The Chuuk Division of Public Health has proposed a study to explore these potential causes, which will hopefully shed light on the prevention of these rare but debilitating conditions.

Assessment of the relationship of vitamin D with serum antioxidant vitamins E and A and their deficiencies in Iranian pregnant women.

OBJECTIVE: To assess the relationship between vitamin D and serum antioxidant vitamins E and A, and their deficiencies in pregnant women. METHODS: This cross-sectional study was carried out in the maternity clinic of Naghavi Specialists and Subspecialities Polyclinic, affiliated to Kashan University of Medical Sciences Kashan, Iran between April 2008 and August 2009. One hundred and forty-seven pregnant women were recruited. Vitamin D, A, and E status were assessed using serum at 5-9 months of pregnancy. The prevalence of vitamin deficiency was reported using defined cutoff values. Correlations between vitamin D and vitamins A and E were reported. Data were compared using the analysis of variance and coefficient correlation linear Pearson's. The relative difference between the groups were considered statistically significant (p<0.05). RESULTS: Serum concentrations of vitamin D were 7.2 +/- 2.31, 17.72 +/- 5 and 33.05 +/- 0.94 ug/ml, for vitamin E 2.15 +/- 1.3 and 8.07+/- 2.3 ug/ml, and for vitamin A 0.16+/- 0.05 and 0.46+/-0.13. We used the defined cutoff values in determining vitamins D, A, and E deficiency. The prevalence of vitamin D deficiency was 95.8%, vitamin A was 7%, and vitamin E was 58.6%. The correlation coefficient between serum vitamin D and vitamin E shows an inverse relationship (r=0.24, p=0.004). CONCLUSION: Extent vitamins D, A, and E deficiency among pregnant women is a major public health problem in Kashan, Iran.

Lipid-soluble vitamins A, D, and E in HIV-infected pregnant women in Tanzania.

BACKGROUND/OBJECTIVES: There is limited published research examining lipid-soluble vitamins in human immunodeficiency virus (HIV)-infected pregnant women, particularly in resource-limited settings. SUBJECTS/METHODS: This is an observational analysis of 1078 HIV-infected pregnant women enrolled in a trial of vitamin supplementation in Tanzania. Baseline data on sociodemographic and anthropometric characteristics, clinical signs and symptoms, and laboratory parameters were used to identify correlates of low plasma vitamin A (<0.7 micromol/l), vitamin D (<80 nmol/l) and vitamin E (<9.7 micromol/l) status. Binomial regression was used to estimate risk ratios and 95% confidence intervals. RESULTS: Approximately 35, 39 and 51% of the women had low levels of vitamins A, D and E, respectively. Severe anemia (hemoglobin <85 g/l; P<0.01), plasma vitamin E (P=0.02), selenium (P=0.01) and vitamin D (P=0.02) concentrations were significant correlates of low vitamin A status in multivariate models. Erythrocyte Sedimentation Rate (ESR) was independently related to low vitamin A status in a nonlinear manner (P=0.01). The correlates of low vitamin D status were CD8 cell count (P=0.01), high ESR (ESR >81 mm/h; P<0.01), gestational age at enrollment (nonlinear; P=0.03) and plasma vitamins A (P=0.02) and E (P=0.01). For low vitamin E status, the correlates were money spent on food per household per day (P<0.01), plasma vitamin A concentration (nonlinear; P<0.01) and a gestational age <16 weeks at enrollment (P<0.01). CONCLUSIONS: Low concentrations of lipid-soluble vitamins are widely prevalent among HIV-infected women in Tanzania and are correlated with other nutritional insufficiencies. Identifying HIV-infected persons at greater risk of poor nutritional status and infections may help inform design and implementation of appropriate interventions.

Indonesian women of childbearing age are at greater risk of clinical vitamin A deficiency in families that spend more on rice and less on fruits/vegetables and animal-based foods.

Clinical vitamin A deficiency is characterized by night blindness and greater morbidity and mortality. The aim of this study was to examine the relationships between household food expenditures and night blindness among nonpregnant women of childbearing age among families in the slums of Jakarta, Indonesia. In a cross-sectional study of 42 974 households in the Indonesian Nutrition Surveillance System, 1998 to 2003, night blindness was assessed in nonpregnant women. Food expenditures were divided into 5 major categories as follows: plant-based foods (fruits and vegetables), animal-based foods, eggs, other nongrain foods, and grain foods (primarily rice), calculated as percentage of total weekly per capita food expenditure, and expressed in quintiles. The proportion of households with night blindness in nonpregnant women was 0.72%. Plant-based food, animal-based food, and eggs were associated with reduced odds of night blindness (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.33-0.67; P < .0001, and OR, 0.47; 95% CI, 0.29-0.76; P = .002; OR, 0.62; 95% CI, 0.44-0.85; P = .004), respectively, among families in the highest compared with the lowest quintile, adjusting for potential confounders. Grain food expenditures were associated with increased odds of night blindness among nonpregnant women (OR, 2.80; 95% CI, 1.86-4.22; P < .0001) among families in the highest compared with the lowest quintile, adjusting for potential confounders. This study suggests that nonpregnant women are at greater risk of clinical vitamin A deficiency where families spend more on rice and less on animal and plant-based foods, a situation that is more typical when food prices are high.

Estimating the burden of disease attributable to vitamin A deficiency in South Africa in 2000.

OBJECTIVES: To estimate the burden of disease attributable to vitamin A deficiency in children aged 0 - 4 years and pregnant women aged 15 - 49 years in South Africa in 2000. DESIGN: The framework adopted for the most recent World Health Organization comparative risk assessment (CRA) methodology was followed. Population-attributable fractions were calculated from South African Vitamin A Consultative Group (SAVACG) survey data on the prevalence of vitamin A deficiency in children and the relative risks of associated health problems, applied to revised burden of disease estimates for South Africa in the year 2000. Small community studies were used to derive the prevalence in pregnant women. Monte Carlo simulation-modelling techniques were used for the uncertainty analysis. SETTING: South Africa. SUBJECTS: Children under 5 years and pregnant women 15 - 49 years. OUTCOME MEASURES: Direct sequelae of vitamin A deficiency, including disability-adjusted life years (DALYs), as well as mortality associated with measles, diarrhoeal diseases and other infections, and mortality and DALYs associated with malaria in children and all-cause maternal mortality. RESULTS: One-third of children aged 0 - 4 years and 1 - 6% of pregnant women were vitamin A-deficient. Of deaths among young children aged 0 - 4 years in 2000, about 28% of those resulting from diarrhoeal diseases, 23% of those from measles, and 21% of those from malaria were attributed to vitamin A deficiency, accounting for some 3,000 deaths. Overall, about 110,467 ( 95% uncertainty interval 86,388 - 136,009) healthy years of life lost, or between 0.5% and 0.8% of all DALYs in South Africa in 2000 were attributable to vitamin A deficiency. CONCLUSIONS: The vitamin A supplementation programme for children and the recent food fortification programme introduced in South Africa in 2003 should prevent future morbidity and mortality related to vitamin A deficiency. Monitoring the effectiveness of these interventions is strongly recommended.

Biochemical assessment of vitamin A in schoolchildren from a rural community.

OBJECTIVE: To investigate the prevalence of vitamin A deficiency among schoolchildren from a rural area in the Distrito Federal, Brazil, and to correlate this with rates of anemia and malnutrition. METHODS: From a total of 179 students, the study recruited 155 schoolchildren (5 to 18 years), whose parents gave permission for blood tests. Plasma retinol concentration was assayed by high resolution liquid chromatography, and levels of plasma vitamin A lower than 20 microg/dL were defined as abnormal or deficient in vitamin A. Hemoglobin was measured by an automated cell counter, and anemia was defined as serum concentrations of less than 11.5 and 12.0 g/dL for children and adolescents, respectively. Nutritional status was assessed using z scores for weight/height, height/age and body mass index percentiles. RESULTS: The results indicated that 33.55% of the schoolchildren tested had a vitamin A deficiency, with a prevalence of 35.44% among children (5-9 years) and 31.58% among adolescents (10-18 years). No correlation was observed between the prevalence of vitamin A deficiency and prevalence rates of anemia or malnutrition. Both sexes and all ages were homogeneous for vitamin A deficiency. CONCLUSIONS: The elevated prevalence of vitamin A deficiency among the children and adolescents attending this rural school identify a public health problem in the region. These results indicate that age groups from 5 years onwards should be included in those at risk of hypovitaminosis A and that they should be included in public policies aimed at combating hypovitaminosis A.

Avaliação bioquímica de vitamina A em escolares de uma comunidade rural / Biochemical assessment of vitamin A in schoolchildren from a rural community

OBJETIVO: Investigar a prevalência de deficiência de vitamina A em escolares de área rural do Distrito Federal e correlacionar com índices de anemia e desnutrição. MÉTODOS: Do total de 179 alunos, o estudo incluiu 155 escolares (5 a 18 anos), cujos pais autorizaram a participação na coleta de sangue. A concentração de retinol plasmático foi determinada por cromatografia líquida de alta resolução, e os níveis plasmáticos de vitamina A inferior a 20 µg/dL foram considerados como inadequação ou deficiência de vitamina A. A hemoglobina foi dosada em contador de células automatizado, e a anemia foi caracterizada para crianças e adolescentes com valor sérico menor que 11,5 e 12,0 g/dL, respectivamente. O estado nutricional foi avaliado com o índice escore z para peso/altura, altura/idade e percentil do índice de massa corporal. RESULTADOS: Os resultados mostraram que 33,55 por cento dos escolares pesquisados apresentavam deficiência de vitamina A, com prevalência de 35,44 por cento entre crianças (5-9 anos) e de 31,58 por cento entre adolescentes (10-18 anos). Não foi encontrada correlação entre a prevalência de deficiência de vitamina A e prevalência de anemia ou desnutrição. A deficiência de vitamina A foi homogênea entre as idades e gêneros. CONCLUSÕES: A elevada prevalência de deficiência de vitamina A em crianças e adolescentes desta escola rural estudada identifica um problema de saúde pública na região. Esses resultados apontam para a necessidade de inclusão de faixas etárias maiores de 5 anos no grupo de risco de hipovitaminose A e sua inserção nas políticas públicas de combate à hipovitaminose A.

OBJECTIVE: To investigate the prevalence of vitamin A deficiency among schoolchildren from a rural area in the Distrito Federal, Brazil, and to correlate this with rates of anemia and malnutrition. METHODS: From a total of 179 students, the study recruited 155 schoolchildren (5 to 18 years), whose parents gave permission for blood tests. Plasma retinol concentration was assayed by high resolution liquid chromatography, and levels of plasma vitamin A lower than 20 µg/dL were defined as abnormal or deficient in vitamin A. Hemoglobin was measured by an automated cell counter, and anemia was defined as serum concentrations of less than 11.5 and 12.0 g/dL for children and adolescents, respectively. Nutritional status was assessed using z scores for weight/height, height/age and body mass index percentiles. RESULTS: The results indicated that 33.55 percent of the schoolchildren tested had a vitamin A deficiency, with a prevalence of 35.44 percent among children (5-9 years) and 31.58 percent among adolescents (10-18 years). No correlation was observed between the prevalence of vitamin A deficiency and prevalence rates of anemia or malnutrition. Both sexes and all ages were homogeneous for vitamin A deficiency. CONCLUSIONS: The elevated prevalence of vitamin A deficiency among the children and adolescents attending this rural school identify a public health problem in the region. These results indicate that age groups from 5 years onwards should be included in those at risk of hypovitaminosis A and that they should be included in public policies aimed at combating hypovitaminosis A.