Vitamin A status and its relationship with serum zinc concentrations among pregnant women who have previously undergone Roux-en-Y gastric bypass.

OBJECTIVE: To evaluate vitamin A status and its relationship with serum zinc concentrations among pregnant women who had previously undergone Roux-en-Y gastric bypass (RYGB), correlating these measures with anthropometric maternal characteristics and perinatal outcomes. METHODS: An analytical prospective longitudinal study was conducted at a clinic in Rio de Janeiro, Brazil, between March 3, 2008, and March 30, 2012, among women with singleton pregnancies who had previously undergone RYGB. Participants received daily oral supplementation with 5000 IU retinol and 15 mg zinc. Variables assessed included vitamin A status (serum retinol and ß-carotene; gestational night blindness), serum zinc concentration, maternal anthropometry, complications during pregnancy, and perinatal outcomes. RESULTS: Overall, 30 women participated. In all trimesters, more than 60% had inadequate serum levels of retinol or ß-carotene. Night blindness was reported by 17 (57%) women in each trimester. Only 6 (20%) women had zinc inadequacy in the first and third trimesters. No significant association was observed between serum retinol or zinc and maternal anthropometry and birth weight. Vitamin A deficiency was associated with urinary tract infection (first trimester, P=0.020) and dumping syndrome (third trimester, P=0.013). CONCLUSION: Despite RYGB and nutritional deficiencies (especially of vitamin A and zinc) increasing risks during pregnancy, there was no apparent fetal compromise when considering the analysis of birth weight and length of pregnancy at birth.

Determinants of gestational night blindness in pregnant women from Rio de Janeiro, Brazil.

OBJECTIVE: To describe the prevalence and determinants of gestational night blindness in pregnant women receiving care in a hospital in Rio de Janeiro, Brazil. DESIGN: Cross-sectional study of pregnant and postpartum women receiving care in a public hospital in Rio de Janeiro from 1999 to 2001 (group I; n 225) or from 2005 to 2008 (group II; n 381). Night blindness was identified through a standardized and validated interview (WHO, 1996). The determinants of gestational night blindness were identified through a hierarchical logistic regression model. SETTING: Public maternity hospital in Rio de Janeiro, RJ, Brazil. SUBJECTS: Adult pregnant and postpartum women (n 606), aged ≥20 years. RESULTS: The prevalence of gestational night blindness was 9·9 %. The final model revealed that not living in the South Zone of Rio de Janeiro (distal level: adjusted OR=1·846; 95 % CI 1·002, 3·401), belonging to group I (intermediate level: adjusted OR=2·183; 95 % CI 1·066, 4·471) and for the proximal level, having a history of abortion (adjusted OR=2·840; 95 % CI 1·134, 7·115) and having anaemia during the first and second trimesters of pregnancy (adjusted OR=3·776; 95 % CI 1·579, 9·029) were determinants of gestational night blindness. CONCLUSION: Gestational night blindness should be assessed for during the prenatal care of all pregnant women, especially those living in deprived areas of the city and/or who have a history of abortion or anaemia. Nutritional monitoring is recommended during pregnancy to control gestational night blindness.

Impact of different protocols of nutritional supplements on the status of vitamin A in class III obese patients after Roux-en-Y gastric bypass.

BACKGROUND: This study aims to investigate the nutritional status of vitamin A (VA) using biochemical and functional indicators in subjects with class III obesity, before and after RYGB, supplemented with three protocols. METHODS: The sample comprised 90 patients, with BMI ≥40 kg/m(2), divided into three groups: G1 that received routine supplementation containing 5,000 IU of retinol daily; G2 that received 10,000 IU of retinol daily; and G3 that received routine supplementation plus complementary of 50,000 IU of retinol intramuscularly every month. The status of VA was evaluated before (T0), 30 days (T1), and 180 days (T2) after surgery. RESULTS: The vitamin A deficiency (VAD) in G1, G2, and G3 was respectively 20.7, 21.2, and 20.2 % as regards retinol and 37.8, 63.3, and 40 % as regards ß-carotene in T0; 26.7, 10, and 23.4 % as regards retinol and 68, 37, and 32 % as regards ß-carotene in T1; and 21, 8.7, and 20.2 % as regards retinol and 63.3, 20, and 32 % as regards ß-carotene in T2. A reduction of retinol and ß-carotene with increasing BMI and waist circumference was observed in T0. The prevalence of night blindness (XN) in groups 1, 2, and 3 was respectively 23.3, 26.7, and 16.7 % in T0; 56.7, 40, and 60 % in T1; and 70, 43, and 63.3 % in T2. CONCLUSION: The study showed high prevalence of VAD. Among the supplementation protocols used, the one containing 10,000 IU of retinol showed the best impact. However, in cases of more severe VAD, intramuscular supplementation should be considered. The prevalence of XN, justifies attention to this segment of population.

Serum levels and liver store of retinol and their association with night blindness in individuals with class III obesity.

BACKGROUND: Studies showed a rise in obesity prevalence in world population and evidences point to a possible association with vitamin A deficiency (VAD). The objective of this study is to assess vitamin A nutritional status through functional [night blindness diagnosis-xerophthalmia (XN)] and biochemical (serum levels and retinol liver store) indicators of class III obesity individuals and its association. METHODS: We studied 114 patients of both genders with BMI ≥40 kg/m2, candidates to bariatric surgery at Clínica Cirúrgica Carlos Saboya in Rio de Janeiro, Brazil. XN was diagnosed through a standardized interview (WHO and MacLaren and Frigg), and serum levels and retinol liver store were quantified by HPLC-UV with <1.05 µmol/L and < 20 mg/g cutoffs for VAD, respectively. RESULTS: XN prevalence was 23.8%, and serum levels and retinol liver store inadequacy were 14.0% and 80%, respectively. The association between VAD and XN presence (p = 0.003) was observed with the biochemical indicator and the gold standard, retinol liver store (p = 0.003 and p = 0.018, respectively). Means were 59.3% (sensitivity), 87.4% (specificity), and 80.8% (accuracy) as regards to the XN role in predicting VAD according to the biochemical indicator. As regards to retinol liver store, XN diagnosis presented 48% of sensitivity and 75% of specificity. VAD highest indexes occurred in patients with highest BMI (rs-0.21, p = 0.02). Distribution of XN prevalence was 59.2% according to serum retinol. CONCLUSIONS: VAD and XN prevalence was high in class III obesity individuals, and the functional indicator for XN diagnosis may be a promising method for diagnosis in this group.

Reduction of vitamin A deficiency and anemia in pregnancy after implementing proposed prenatal nutritional assistance.

INTRODUCTION: Micronutrient deficiency is an unquestionable public health problem, specially anemia and vitamin A deficiency (VAD). This is due to the collective dimension of these carencies, which reflects on morbimortality rates in the maternal and infant group. OBJECTIVE: to evaluate the impact of a proposal for prenatal nutritional assistance, comparing the prevalence of anemia and VAD, in pre-intervention (GI) and intervention (GII) groups. METHODS: this is a prospective intervention study in a cohort of pregnant women. The GI group was made up of 225 the GII group of 208 pregnant adults and their respective newborns, attended a Public Maternity Ward in Rio de Janeiro, Brazil. Concentration of hemoglobin was used to diagnose anemia and a standardized interview to diagnose night blindness (XN). RESULTS AND CONCLUSION: after adjusting for confounding variables, through logistic regression, the protective effect of intervention at the onset of anemia (OR = 0.420; IC 95% = 0.251-0.702), with a significant reduction in prevalence, of 28.4% in the GI to 16.8% in the GII, also observed at the onset of XN (OR = 0.377; IC95% = 0.187- 0.759), with a reduction in prevalence of 18.7 % in the GI to 6.2% in the GII. Nutritional intervention has a beneficial effect on maternal health, reducing nutritional deficiencies most prevalent during pregnancy and the impact of these on the obstetric ailment.

[Association between Vitamin A deficiency and socioeconomic, nutritional and obstetric variables]. / Associação entre deficiência de vitamina A e variáveis socioeconômicas, nutricionais e obstétricas de gestantes.

This study verified the night blindness prevalence, the first manifestation of this deficiency, and its association with socioeconomic, nutritionals and obstetric variables of 92 pregnant who were assisted on a health municipal center in Diamantina, Vale do Jequitinhonha. Data was collected through a model interview recommended by WHO (1996) to diagnose night blindness. The statistic analysis used Fisher exact test and Wilcoxon test. The results showed a higher prevalence of night blindness at Diamantina districts and neighbor cities (13.04%). No significant association was found between night blindness and socioeconomic and obstetric variables (p>0.05). It was observed a low vitamin A levels by pregnant with night blindness (4.4). This found shows the necessity of more investigations on vitamin A deficiency in order to help prevent, diagnose and combat this issue.

Associação entre deficiência de vitamina A e variáveis socioeconômicas, nutricionais e obstétricas de gestantes / Association between Vitamin A deficiency and socioeconomic, nutritional and obstetric variables

Este estudo investigou a prevalência de cegueira noturna e sua associação com as variáveis socioeconômicas, nutricionais e obstétricas de 92 gestantes atendidas em um posto municipal de saúde da cidade de Diamantina, Alto Vale do Jequitinhonha (MG). Para a coleta de dados, utilizou-se a entrevista preconizada pela OMS (1996) para o diagnóstico da cegueira noturna. Na análise estatística, utilizou-se o teste exato de Fisher e o de teste de Wilcoxon. Os resultados demonstraram uma prevalência maior de cegueira noturna nos distritos de Diamantina (15,38 por cento) e cidades vizinhas (13,04 por cento). Não foi encontrada associação significativa entre cegueira noturna e as variáveis socioeconômicas e obstétricas (p>0,05). No entanto, observou-se um menor consumo de vitamina A pelas gestantes com cegueira noturna (4,4 por cento). Tais achados apontam a necessidade de realizar novas investigações acerca da deficiência de vitamina A, a fim de subsidiar ações de prevenção e combate a esse agravo neste grupo em particular.

This study verified the night blindness prevalence, the first manifestation of this deficiency, and its association with socioeconomic, nutritionals and obstetric variables of 92 pregnant who were assisted on a health municipal center in Diamantina, Vale do Jequitinhonha. Data was collected through a model interview recommended by WHO (1996) to diagnose night blindness. The statistic analysis used Fisher exact test and Wilcoxon test. The results showed a higher prevalence of night blindness at Diamantina districts and neighbor cities (13.04 percent). No significant association was found between night blindness and socioeconomic and obstetric variables (p>0.05). It was observed a low vitamin A levels by pregnant with night blindness (4.4). This found shows the necessity of more investigations on vitamin A deficiency in order to help prevent, diagnose and combat this issue.

Gestational nightblindness among women attending a public maternity hospital in Rio de Janeiro, Brazil.

This study evaluated the prevalence of gestational nightblindness among postpartum women seen at the University Maternal Hospital of the Federal University in Rio de Janeiro, Brazil and the association of this symptom with a biochemical indicator (serum retinol levels) and sociodemographic, anthropometric and antenatal care variables. In total, 262 postpartum women, who did not receive vitamin A supplementation during pregnancy, were interviewed. Gestational nightblindness was diagnosed through the standardized interview as proposed by WHO. Serum retinol levels were evaluated by spectrophotometry. Gestational nightblindness relating to low levels of serum retinol (<1.05 micromol/L, p = 0.000) was diagnosed in 17.9% of subjects interviewed. Less than five antenatal care appointments (odds ratio [OR] = 2.179; confidence interval [CI] 95% = 1.078 - 4.402) and a history of one or more miscarriage(s) (OR = 2.306; CI 95% = 1.185 - 4.491) were predictors for gestational nightblindness. These findings justify the need for nutritional counselling, aimed at improving the vitamin A nutritional status, especially among pregnant women with a history of previous miscarriages and poor antenatal care.

Xerophthalmia, protein-calorie malnutrition, and infections in children.

All children with evidence of xerophthalmia who were admitted to an inpatient facility for treatment of severe protein-calorie malnutrition and its complications were compared to other inpatients with severe PCM but free from signs or symptoms of vitamin A deficiency. Xerophthalmic inpatients were older and had more severe hypoproteinemia than inpatients without eye signs, and were more undernourished by anthropometric criteria than a comparison group matched for age, sex, and type of PCM. Children with more severe eye lesions were more retarded in growth than those with minimal ocular signs. All inpatients had high rates of bacterial infections, regardless of their vitamin status. However, xerophthalmic children had a highly significant increase in the rate of positive urine cultures. Mortality rates were similar in all study groups.