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1.
Medicine (Baltimore) ; 99(18): e19764, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358349

RESUMO

INTRODUCTION: Acne vulgaris is a chronic inflammatory disease of the sebaceous glands that occurs in adolescent men and women. In recent years, the incidence of acne has increased year by year, so it is of great significance to find a precise and effective treatment and further explore its possible mechanism of action. The purpose of this study will be to explore a treatment method that has both traditional Chinese medicine characteristics and significant effects, and provides a higher level of evidence for acupuncture for acne vulgaris. It also provides patients with more treatment options. METHODS/DESIGN: The study will be a randomized controlled trial divided into 2 parallel groups. This pragmatic randomized controlled trial will recruit 66 patients who are diagnosed with acne vulgaris. 30-minutes acupuncture sessions will be provided to patients assigned to the intervention group. All participants will continue to receive conventional treatment. The selection of outcomes will be evaluated by the skin lesions score scale. DISCUSSION: This trial may provide evidence regarding the clinical effectiveness, safety, and cost-effectiveness of acupuncture for patients with acne vulgaris. TRIAL REGISTRATION NUMBER: CTR2000030427.


Assuntos
Acne Vulgar/terapia , Terapia por Acupuntura/métodos , Medicina Tradicional Chinesa/métodos , Creme para a Pele/administração & dosagem , Vitamina A/administração & dosagem , Administração Tópica , Adolescente , Adulto , Terapia Combinada , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Adulto Jovem
2.
S Afr Med J ; 109(12): 907-910, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31865950

RESUMO

In accordance with World Health Organization guidelines, South Africa (SA) introduced routine periodic high-dose vitamin A supplementation (VAS) in 2002. These guidelines were developed after research in the 1980s and 1990s showed the efficacy of VAS in reducing childhood mortality. However, two recent studies in low- to middle-income countries (2013 and 2014) have shown no effect of high-dose VAS on mortality. Additionally, there is no clear research evidence that 6-monthly doses of vitamin A result in a sustained shift in serum retinol levels or reduce subclinical vitamin A deficiency. These two points should encourage SA to re-examine the validity of these guidelines. A long-term view of what is in the best interests of the majority of the people is needed. The short-term intervention of administering vitamin A capsules not only fails to improve serum retinol levels but may create dependence on a 'technical fix' to address the fundamental problem of poor nutrition, which is ultimately underpinned by poverty. It may also cause harm. Although there are those, some with vested interests, who will argue for continuation of the routine high-dose VAS programmes, SA policymakers and scientists need to evaluate the facts and be prepared to rethink this policy. There is cause for optimism: SA's health policymakers have previously taken bold stands on the basis of evidence. The examples of regulation of tobacco products and taxation of sugar-sweetened beverages, ending the free distribution of formula milk for HIV-positive mothers and legislating against the marketing of breastmilk substitutes provide precedents. Here is a time yet again for decision-makers to make bold choices in the interests of the people of SA. While the cleanest choice would be national discontinuation of the routine VAS programme, there may be other possibilities, such as first stopping the programme in Northern Cape Province (where there is clear evidence of hypervitaminosis A), followed by the other provinces in time.


Assuntos
Mortalidade da Criança , Suplementos Nutricionais , Política de Saúde , Vitamina A/administração & dosagem , Pré-Escolar , Humanos , Lactente , Guias de Prática Clínica como Assunto , África do Sul , Vitamina A/efeitos adversos , Vitamina A/sangue , Deficiência de Vitamina A/tratamento farmacológico
3.
J Drugs Dermatol ; 18(11): 174-1176, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31741362

RESUMO

Porokeratosis is a rare disorder of epidermal keratinization that encompasses several clinical forms, characterized by erythematous, annular plaques with an atrophic center and hyperkeratotic ridge-like border. The histopathological hallmark of porokeratosis is the cornoid lamella, a thin column of parakeratotic corneocytes embedded within the stratum corneum. There is no standard treatment regimen for porokeratosis. Current therapeutic modalities include topical agents, systemic medications, and surgical interventions that have variable efficacy. Here, we report a case of a patient with localized porokeratosis lesions on the face and extremities that resolved after one treatment session with carbon dioxide laser resurfacing combined with topical antioxidant serum containing L-ascorbic acid, alpha tocopherol, and ferulic acid. The diagnosis of porokeratosis was supported by the clinical presentation, dermoscopy, and in vivo skin imaging with optical coherence tomography and reflectance confocal microscopy. This case highlights the utility of using carbon dioxide laser to ablate porokeratosis lesions, as well as the clinical advantages offered by new noninvasive skin imaging modalities to examine, diagnose, and follow up skin pathologies. J Drugs Dermatol. 2019;18(11):1174-1176.


Assuntos
Lasers de Gás/uso terapêutico , Poroceratose/cirurgia , Administração Cutânea , Ácido Ascórbico/administração & dosagem , Terapia Combinada , Ácidos Cumáricos/administração & dosagem , Extremidades , Face , Humanos , Terapia a Laser , Masculino , Pessoa de Meia-Idade , Vitamina A/administração & dosagem
4.
Nutrients ; 11(9)2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31470574

RESUMO

Our aims were to investigate vitamin A and E status during lactation and the determinants of breast milk content for the appropriate nutrition of the infant in a study with nursing Brazilian women. We hypothesized that both inadequate intake and the lipoprotein distribution of vitamin A and E during lactation could have an impact on their breast milk levels from early- to mid-lactation. Nineteen adult lactating women participated in this longitudinal observational study, in which dietary records, blood and mature breast milk samples were collected for the analysis of vitamin A and E, and carotenoids in early- (2nd to 4th week) and mid-lactation (12th to 14th week). Nutrient intake was balanced by the Multiple Source Method (MSM), and the intake of vitamin A and E was inadequate in 74 and 100% of the women, respectively. However, these results were not reflected in low serum concentrations of retinol and only 37% of the volunteers were vitamin E deficient according to the blood biomarker. As lactation progressed, vitamin A and E status worsened, and this was clearly observed by the decrease in their content in breast milk. The reduced content of vitamin A and E in the breast milk was not related to their distribution in lipoproteins. Taken together, the contents of vitamin A and E in breast milk seemed to be more sensitive markers of maternal nutrition status than respective blood concentrations, and dietary assessment by the MSM in early lactation was sensitive to indicate later risks of deficiency and should support maternal dietary guidance to improve the infant's nutrition.


Assuntos
Dieta , Lactação , Fenômenos Fisiológicos da Nutrição Materna , Leite Humano/metabolismo , Estado Nutricional , Valor Nutritivo , Vitamina A/metabolismo , Vitamina E/metabolismo , Adulto , Brasil , Feminino , Humanos , Estudos Longitudinais , Gravidez , Fatores de Tempo , Vitamina A/administração & dosagem , Vitamina E/administração & dosagem , Adulto Jovem
5.
Cell Biochem Funct ; 37(8): 578-590, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31495961

RESUMO

Here, we tested a hypothesis that vitamin A and/or its metabolic pathways are involved in the high-fructose-mediated alteration in adipose tissue biology. For this purpose, weanling male Wistar rats were provided with one of the following diets: control (C), control with vitamin A deficiency (C-VAD), high fructose (HFr), and HFr with VAD (HFr-VAD) for 16 weeks, except that half of the C-VAD diet-fed rats were shifted to HFr diet (C-VAD(s)HFr), after 8-week period. Compared with control, feeding of HFr diet significantly increased the triglyceride content (P ≤ .01) and thus adipocyte size (hypertrophy) (P ≤ .001) in visceral adipose depot; retroperitoneal white adipose tissue (RPWAT) and these changes were corroborated with de novo lipogenesis, as evidenced by the increased glycerol-3-phosphate dehydrogenase activity (P ≤ .01) and up-regulation of lipogenic pathway transcripts, fructose transporter, and aldehyde dehydrogenase 1 A1. On the contrary, the absence of vitamin A in the HFr diet (HFr-VAD) failed to exert these changes; however, it induced adipocyte hyperplasia. Further, vitamin A deficiency-mediated changes were reversed by replenishment, as evident from the group that was shifted from C-VAD to HFr diet. In conclusion, vitamin A and its metabolic pathway play a key determinant role in the high-fructose-induced triglyceride accumulation and adipocyte hypertrophy of visceral white adipose depot. SIGNIFICANCE OF THE STUDY: Here, we report the metabolic impact of high-fructose feeding under vitamin A-sufficient and vitamin A-deficient conditions. Feeding of high-fructose diet induced triglyceride accumulation and adipocyte hypertrophy of the visceral white adipose depots. These changes corroborated with augmented expression of vitamin A and lipid metabolic pathway genes. Contrarily, absence of vitamin A in the high-fructose diet did not elicit such responses, while vitamin A replenishment reversed the changes exerted by vitamin A deficiency. To our knowledge, this is the first study to report the role of vitamin A and its metabolic pathway in the high-fructose-induced triglyceride synthesis and its accumulation in visceral adipose depot and thus provide a new insight and scope to understand these nutrients interaction in clinical conditions.


Assuntos
Frutose/farmacologia , Gordura Intra-Abdominal/efeitos dos fármacos , Triglicerídeos/metabolismo , Vitamina A/administração & dosagem , Adiponectina/análise , Adiponectina/sangue , Animais , Diferenciação Celular/efeitos dos fármacos , Dieta , Ácidos Graxos/análise , Ácidos Graxos/química , Gordura Intra-Abdominal/citologia , Gordura Intra-Abdominal/metabolismo , Leptina/análise , Leptina/sangue , Lipogênese/efeitos dos fármacos , Masculino , Ratos , Ratos Wistar , Vitamina A/metabolismo , Deficiência de Vitamina A/metabolismo , Deficiência de Vitamina A/patologia , Deficiência de Vitamina A/veterinária
6.
J Drugs Dermatol ; 18(9): 918-923, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31524348

RESUMO

Background: Facial chemical peels are highly sought after by patients with photodamage, acne, and melasma. An advanced, physician-strength superficial peel, containing 3% retinol with other firming and volumizing ingredients was developed to exfoliate, improve the appearance of fine lines and wrinkles, and plump and firm skin, while promoting a bright, even complexion. Objective: A clinical study was conducted to evaluate the tolerability, safety, and efficacy of the 3% retinol peel with a supportive homecare regimen across a range of peel candidates, females aged 18-65 years, with photodamage, acne, hyperpigmentation or melasma, and skin of color, over a series of 2-4 peels. Method: The 3% retinol peel formulation was administered under physician direction in 6-week intervals. Subjects with photodamaged skin, acne, hyperpigmentation/melasma, or skin of color (Fitzpatrick skin types IV-VI) received 2-4 peels along with a supportive homecare regimen. Dermatologist grading, self-assessment, and digital photography documented tolerability and efficacy parameters. Results: 24 subjects participated in the study with a total of 78 peels administered (Photodamage group, n=14 [with an Acne subgroup, n=5]; Melasma group, n=5; Skin of Color, n=5). The 3% retinol peel along with the homecare regimen was well tolerated under physician direction in all skin types and conditions assessed. Obvious peeling was noticeable in many subjects 3 days post-peel and resolved by day 7. In the photodamaged group, dermatologist clinical grading of fine lines, wrinkles, pore size, laxity, mottled pigmentation, lack of clarity/radiance, and overall photodamage was significantly improved (P<0.05). Benefits were observed in all groups and supported by self-assessment. Digital photography demonstrated tolerability in the days immediately post-peel, along with benefits to photodamage. Conclusion: The 3% retinol superficial peel was well tolerated and an efficacious cosmetic treatment under physician supervision in subjects of all skin types to firm skin, improve fine lines and wrinkles, and promote a bright, even complexion. J Drugs Dermatol. 2019;18(9):918-923.


Assuntos
Acne Vulgar/tratamento farmacológico , Abrasão Química/métodos , Melanose/tratamento farmacológico , Envelhecimento da Pele/efeitos dos fármacos , Vitamina A/administração & dosagem , Administração Cutânea , Adolescente , Adulto , Idoso , Abrasão Química/efeitos adversos , Relação Dose-Resposta a Droga , Feminino , Humanos , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Autoadministração , Pele/efeitos dos fármacos , Pigmentação da Pele/efeitos dos fármacos , Resultado do Tratamento , Vitamina A/efeitos adversos , Adulto Jovem
7.
Cien Saude Colet ; 24(8): 3037-3046, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31389550

RESUMO

200 million pre-school age children are not developing properly. Delays in child development are associated with multiple factors. This study aims to analyze if vitamin A supplementation is associated with improved development and how this effect could be mediated by nutritional status. Population-based study surveyed a representative sample of 8000 households, 1232 children 0-35 months, in the state of Ceará, Brazil. The variables analysed included child developmental status, nutritional determinants and confounding factors. The main effects and interactions were evaluated using Cox regressive models. Vitamin A supplementation showed protective effect to delay in cognitive and motor development modified by interaction with nutritional status. While well-nourished supplemented children presented a 67% lower risk of cognitive delay (adjusted PRR = 0·33 [0·21-0·53]), stunted children had no benefit from supplementation (adjusted PRR = 0·97 [0·39-2·40]). Vitamin A supplementation has a protective effect on child development, but not in stunted children. This suggests that supplementation is effective in promoting child development, especially if associated to a joint effort to improve the nutritional status of children, given the importance of this mediator.


Assuntos
Transtornos da Nutrição Infantil/prevenção & controle , Suplementos Nutricionais , Transtornos do Crescimento/prevenção & controle , Vitamina A/administração & dosagem , Brasil , Desenvolvimento Infantil/fisiologia , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estado Nutricional
8.
Nutrients ; 11(8)2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31412557

RESUMO

Vitamin A is a fundamental micronutrient that regulates various cellular patterns. Vitamin A deficiency (VAT) is a worldwide problem and the primary cause of nocturnal blindness especially in low income countries. Cystic fibrosis (CF) is a known risk factor of VAD because of liposoluble vitamin malabsorption due to pancreatic insufficiency. We describe a case of a 9-year-old girl who experienced recurrent episodes of nocturnal blindness due to profound VAD. This little girl is paradigmatic for the explanation of the key role of the gut-liver axis in vitamin A metabolism. She presents with meconium ileus at birth, requiring intestinal resection that led to a transient intestinal failure with parenteral nutrition need. In addition, she suffered from cholestatic liver disease due to CF and intestinal failure-associated liver disease. The interaction of pancreatic function, intestinal absorption and liver storage is fundamental for the correct metabolism of vitamin A.


Assuntos
Fibrose Cística/complicações , Absorção Intestinal , Cegueira Noturna/etiologia , Visão Noturna , Síndrome do Intestino Curto/complicações , Deficiência de Vitamina A/etiologia , Criança , Fibrose Cística/diagnóstico , Suplementos Nutricionais , Feminino , Humanos , Cegueira Noturna/diagnóstico , Cegueira Noturna/fisiopatologia , Cegueira Noturna/terapia , Estado Nutricional , Nutrição Parenteral no Domicílio , Recidiva , Síndrome do Intestino Curto/diagnóstico , Síndrome do Intestino Curto/fisiopatologia , Síndrome do Intestino Curto/terapia , Resultado do Tratamento , Vitamina A/administração & dosagem , Vitamina A/metabolismo , Deficiência de Vitamina A/diagnóstico , Deficiência de Vitamina A/fisiopatologia , Deficiência de Vitamina A/terapia
9.
Asia Pac J Clin Nutr ; 28(3): 607-613, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31464408

RESUMO

BACKGROUND AND OBJECTIVES: The aim of the present study was to evaluate the relationship between retinol and risk of diabetic retinopathy in Chinese adults. METHODS AND STUDY DESIGN: Eighty-six subjects with type 2 diabetes mellitus (T2DM) and 40 healthy subjects (healthy comparison group, HCG) were recruited in Beijing Luhe Hospital. Of the 86 T2DM subjects, 43 subjects were diagnosed with diabetic retinopathy (DRG), and 43 subjects had no retinopathy (DNRG). RESULTS: Dietary intake of retinol (p<0.001) and retinol equivalent (p<0.05) was significantly higher but serum retinol and (p<0.001) retinol binding protein 4 (RBP4) (p<0.05) were significantly lower in DNRG compared with HCG. Dietary intake of retinol (p<0.05) and retinol equivalent (p<0.05) was significantly lower, and serum retinol and (p<0.01) retinol binding protein 4 (RBP4) (p<0.01) were significantly higher in DRG compared with DNRG. In T2DM subjects, per 100 µg/day higher dietary retinol intake was associated with 17% lower risk of diabetic retinopathy (odds ratio (OR), 0.83; 95% CI, 0.70 to 0.98; p=0.032), and after adjusting for potential confounding factors, the OR was 0.82 (95% CI, 0.69 to 0.99; p=0.036); per 100 µg/day higher in dietary retinol equivalent intake was associated with 12% lower risk of diabetic retinopathy (OR, 0.88; 95% CI, 0.79 to 0.97; p=0.010), and after adjusting for potential confounding factors, the OR was 0.88 (95% CI, 0.79 to 0.98; p=0.025). CONCLUSIONS: Higher dietary intake of retinol or retinol equivalent is associated with lower risk of diabetic retinopathy.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/prevenção & controle , Vitamina A/administração & dosagem , Vitamina A/farmacologia , Idoso , Glicemia , Carotenoides , Estudos de Casos e Controles , Dieta/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Razão de Chances , Fatores de Risco
10.
Arq. bras. med. vet. zootec. (Online) ; 71(4): 1227-1235, jul.-ago. 2019. tab, graf
Artigo em Português | LILACS, VETINDEX | ID: biblio-1038598

RESUMO

O objetivo deste estudo foi avaliar o efeito metafilático de minerais traços e vitaminas A e E injetáveis, em parâmetros do estresse oxidativo e na função de neutrófilos em fêmeas da raça Holandesa no período de transição. Sessenta animais foram divididos em dois grupos: animais que receberam minerais traços e vitaminas A e E injetáveis (GMTV) (n= 30) e grupo controle (GC) (n= 30). Não houve diferença significativa entre os grupos nos parâmetros avaliados, porém observou-se diferença significativa entre tratamento e dia para os valores da SOD, com maior atividade dessa enzima em fêmeas GMTV, nas semanas próximas ao parto. Observou-se diferença de dia e para interação tratamento e dia para o TBARS, em que fêmeas GMTV mostraram menores valores de TBARS em todos os momentos, exceto sete dias após o parto. Houve efeito significativo de dia para leucócitos, interação tratamento e dia para neutrófilos e interação tratamento e dia para fagocitose de neutrófilos, em que as fêmeas GMTV apresentaram valores menores de leucócitos e neutrófilos próximo ao parto, além de maior fagocitose de neutrófilos. Pode-se observar que houve melhora no sistema oxidativo e imune de fêmeas GMTV, resposta que provavelmente está relacionada com a administração dos minerais traços e vitaminas A e E.(AU)


This study evaluates the metaphylactic of the subcutaneous administration of a trace minerals and vitamins A and E, on the oxidative stress and neutrophil function in Holsteins cows under the transition period. Sixty females were divided in two groups: group with trace minerals and vitamins (GMTV) (n= 30) and group control (GC) (n= 30). There was no significant difference between those groups; however, we find significant difference between treatment and day for Superoxide dismutase (SOD) values with higher activity of this enzyme in females GMTV on the weeks next to the parturition. Still, there was difference on day and, for interactions between treatment and day for TBARS, were females GMTV showed lower values of TBARS in all moments, except on day seven after the parturition. For leucocytes, there is a significant effect by day, interaction on treatment and day on neutrophils, and interaction treatment and day for neutrophil phagocytosis, were females GMTV showed lower values of leucocytes and neutrophils next to the parturition, and an increase of neutrophils phagocytosis. In summary, cows from the GMTV group had an improvement on the immune and oxidative systems, probably correlated with the administration of this supplement.(AU)


Assuntos
Animais , Feminino , Bovinos , Oligoelementos/análise , Vitamina A/administração & dosagem , Vitamina E/administração & dosagem , Estresse Oxidativo , Neutrófilos , Injeções Subcutâneas/veterinária
11.
PLoS One ; 14(7): e0218163, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31260473

RESUMO

BACKGROUND: Over the past 15 years, scaling up of cost effective interventions resulted in a remarkable decline of under-five mortality rates (U5MR) in sub-Saharan Africa. However, the reduction shows considerable heterogeneity. We estimated the association of child, maternal, and household interventions with U5MR in Burkina Faso at national and subnational levels and identified the regions with least effective interventions. METHODS: Data on health-related interventions and U5MR were extracted from the Burkina Faso Demographic and Health Survey (DHS) 2010. Bayesian geostatistical proportional hazards models with a Weibull baseline hazard were fitted on the mortality outcome. Spatially varying coefficients were considered to assess the geographical variation in the association of the health interventions with U5MR. The analyses were adjusted for child, maternal, and household characteristics, as well as climatic and environmental factors. FINDINGS: The average U5MR was as high as 128 per 1000 ranging from 81 (region of Centre-Est) to 223 (region of Sahel). At national level, DPT3 immunization and baby post-natal check within 24 hours after birth had the most important association with U5MR (hazard rates ratio (HRR) = 0.89, 95% Bayesian credible interval (BCI): 0.86-0.98 and HRR = 0.89, 95% BCI: 0.86-0.92, respectively). At sub-national level, the most effective interventions are the skilled birth attendance, and improved drinking water, followed by baby post-natal check within 24 hours after birth, vitamin A supplementation, antenatal care visit and all-antigens immunization (including BCG, Polio3, DPT3, and measles immunization). Centre-Est, Sahel, and Sud-Ouest were the regions with the highest number of effective interventions. There was no intervention that had a statistically important association with child survival in the region of Hauts Bassins. INTERPRETATION: The geographical variation in the magnitude and statistical importance of the association between health interventions and U5MR raises the need to deliver and reinforce health interventions at a more granular level. Priority interventions are DPT3 immunization, skilled birth attendance, baby post-natal visits in the regions of Sud-Ouest, Sahel, and Hauts Bassins, respectively. Our methodology could be applied to other national surveys, as it allows an incisive, data-driven and specific decision-making approach to optimize the allocation of health interventions at subnational level.


Assuntos
Mortalidade da Criança/tendências , Controle de Doenças Transmissíveis/estatística & dados numéricos , Doenças Transmissíveis/mortalidade , Assistência à Saúde/organização & administração , Mortalidade Infantil/tendências , Cuidado Pré-Natal/organização & administração , Adolescente , Adulto , Teorema de Bayes , Burkina Faso/epidemiologia , Criança , Pré-Escolar , Controle de Doenças Transmissíveis/métodos , Doenças Transmissíveis/epidemiologia , Assistência à Saúde/economia , Parto Obstétrico/estatística & dados numéricos , Água Potável/análise , Características da Família , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Masculino , Vacinação em Massa/estatística & dados numéricos , Pessoa de Meia-Idade , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Modelos de Riscos Proporcionais , Saneamento/métodos , Saneamento/estatística & dados numéricos , Fatores Socioeconômicos , Vitamina A/administração & dosagem
12.
Matern Child Nutr ; 15 Suppl 3: e12720, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31148403

RESUMO

In 2011, Tanzania mandated the fortification of edible oil with vitamin A to help address its vitamin A deficiency (VAD) public health problem. By 2015, only 16% of edible oil met the standards for adequate fortification. There is no evidence on the cost-effectiveness of the fortification of edible oil by small- and medium-scale (SMS) producers in preventing VAD. The MASAVA project initiated the production of sunflower oil fortified with vitamin A by SMS producers in the Manyara and Shinyanga regions of Tanzania. A quasi-experimental nonequivalent control-group research trial and an economic evaluation were conducted. The household survey included mother and child pairs from a sample of 568 households before the intervention and 18 months later. From the social perspective, the incremental cost of fortification of sunflower oil could be as low as $0.13, $0.06, and $0.02 per litre for small-, medium-, and large-scale producers, respectively, compared with unfortified sunflower oil. The SMS intervention increased access to fortified oil for some vulnerable groups but did not have a significant effect on the prevention of VAD due to insufficient coverage. Fortification of vegetable oil by large-scale producers was associated with a significant reduction of VAD in children from Shinyanga. The estimated cost per disability-adjusted life year averted for fortified sunflower oil was $281 for large-scale and could be as low as $626 for medium-scale and $1,507 for small-scale producers under ideal conditions. According to the World Health Organization thresholds, this intervention is very cost-effective for large- and medium-scale producers and cost-effective for small-scale producers.


Assuntos
Análise Custo-Benefício , Alimentos Fortificados/economia , Óleo de Girassol/economia , Deficiência de Vitamina A/prevenção & controle , Vitamina A/economia , Pré-Escolar , Comércio , Estudos Controlados Antes e Depois , Feminino , Política de Saúde/economia , Política de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde , Humanos , Lactente , Política Nutricional/economia , Política Nutricional/legislação & jurisprudência , Prevalência , Empresa de Pequeno Porte/economia , Óleo de Girassol/administração & dosagem , Tanzânia/epidemiologia , Vitamina A/administração & dosagem , Deficiência de Vitamina A/epidemiologia
13.
Pan Afr Med J ; 32: 96, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31231453

RESUMO

Introduction: Controlling vitamin A deficiency and soil-transmitted helminth infections are public health imperatives. We aimed at revealing some caregiver and child-related determinants of uptake of vitamin A supplementation and deworming, and examine their programmatic implications in Kenyan context. Methods: A cross-sectional study of randomly selected 1,177 households with infants and young children aged 6-59 months in three of the 47 counties of Kenya. The number of times a child was given vitamin A supplements and dewormed 6 months and one year preceding the study was extracted from mother-child health books. Results: Coverage for age-specific deworming was considerably depressed compared to corresponding vitamin A supplementation and for both services, twice-yearly provisions were disproportionately lower than half-yearly. Univariate and multivariate analyses showed relatively younger children, of Islam-affiliated caregivers (vis a vis Christians) and those who took less time to nearest health facilities as more likely to be supplemented with vitamin A. Similar observations were made for deworming where additionally, maternal and child ages were also determinants in favour of older groups. Other studied factors were not significant determinants. Programmatic allusions of the determining factors were discussed. Conclusion: Key to improving uptake of vitamin A supplementation and deworming among Kenyan 6-59 months olds are: increasing access to functional health facilities, expanding outreaches and campaigns, dispelling faith-related misconceptions and probably modulating caregiver and child age effects by complementing nutrition literacy with robust and innovative caregiver reminders. Given analogous service points and scheduling, relative lower uptake of deworming warrants further investigations.


Assuntos
Anti-Helmínticos/administração & dosagem , Helmintíase/tratamento farmacológico , Deficiência de Vitamina A/tratamento farmacológico , Vitamina A/administração & dosagem , Cuidadores , Pré-Escolar , Estudos Transversais , Suplementos Nutricionais , Feminino , Acesso aos Serviços de Saúde , Helmintíase/transmissão , Humanos , Lactente , Quênia , Masculino , Estado Nutricional , Religião , População Rural , Solo/parasitologia
14.
Nutrients ; 11(6)2019 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-31242605

RESUMO

Although vitamin A is essential for gut immune cell trafficking (paramount for the intestinal immune system), epidemiological studies on the role of vitamin A in colorectal cancer (CRC) aetiology are conflicting. By using functional polymorphisms, gene-environment (GxE) interaction analyses may identify the biological effects (or "mechanism of action") of environmental factors on CRC aetiology. Potential interactions between dietary or supplemental vitamin A intake and genetic variation in the vitamin A metabolic pathway genes related to risk of CRC were studied. We used a nested case-cohort design within the Danish "Diet, Cancer and Health" cohort, with prospectively collected lifestyle information from 57,053 participants, and the Cox proportional hazard models and likelihood ratio test. No statistically significant associations between the selected polymorphisms and CRC, and no statistically significant interactions between vitamin A intake and the polymorphisms were found. In conclusion, no support of an involvement of vitamin A in CRC aetiology was found.


Assuntos
Biomarcadores Tumorais/genética , Neoplasias Colorretais/genética , Polimorfismo Genético , Vitamina A/metabolismo , Idoso , Biomarcadores Tumorais/metabolismo , Biotransformação , Estudos de Casos e Controles , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/metabolismo , Dinamarca/epidemiologia , Feminino , Interação Gene-Ambiente , Predisposição Genética para Doença , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Estudos Prospectivos , Fatores de Risco , Vitamina A/administração & dosagem
15.
Optom Vis Sci ; 96(6): 453-458, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31107845

RESUMO

SIGNIFICANCE: Vitamin A deficiency is a known concern in developing countries, but it is often overlooked in developed regions. A history of conditions causing alimentary malabsorption should be considered when patients present with complaints of nyctalopia. PURPOSE: A case of vitamin A deficiency with nyctalopia in a patient with chronic pancreatitis including pertinent diagnostic testing, treatment, and management is presented. The intent is to draw attention to the condition as a differential diagnosis for nyctalopia due to increased prevalence of conditions causing malabsorption. CASE REPORT: A patient with a history of chronic pancreatitis and pancreatic tumor presented with symptoms of nyctalopia and xerophthalmia. Given his systemic history, testing was ordered to determine serum vitamin A levels and retinal function. After results had confirmed depleted vitamin A levels and diminished retinal function, treatment with both oral and intramuscular vitamin A supplementation was initiated to normalize vitamin A levels and improve retinal photoreceptor function. Subjective improvement in symptoms was reported shortly after beginning supplementation, and ultimately, vitamin A levels and retinal function showed improvement after intramuscular treatment. CONCLUSIONS: Detailed case history and a careful review of systems along with serum vitamin A testing and, if available, electroretinography to assess retinal function can help to make a definitive diagnosis. With appropriate comanagement with the patient's primary care physician, it is possible for those with nyctalopia to begin vitamin A supplementation and regain retinal function.


Assuntos
Cegueira Noturna/diagnóstico , Pancreatite Crônica/diagnóstico , Deficiência de Vitamina A/diagnóstico , Vitamina A/administração & dosagem , Administração Oral , Diagnóstico Diferencial , Suplementos Nutricionais , Eletrorretinografia , Humanos , Masculino , Pessoa de Meia-Idade , Cegueira Noturna/tratamento farmacológico , Cegueira Noturna/fisiopatologia , Pancreatite Crônica/fisiopatologia , Células Fotorreceptoras de Vertebrados , Retina/fisiopatologia , Vitamina A/sangue , Deficiência de Vitamina A/tratamento farmacológico , Deficiência de Vitamina A/fisiopatologia , Xeroftalmia/diagnóstico
16.
Nutrients ; 11(5)2019 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-31067775

RESUMO

Inadequate consumption of micronutrient-dense foods such as vegetables and meat are an important contributing cause for anemia and deficiencies of iron and vitamin A in rural communities of Tanzania. A cross-sectional study was conducted in 2016 to examine nutritional and micronutrient status and their associations to the diet of female small-scale farmers in the sub-humid Kilosa (n = 333) and the semi-arid Chamwino (n = 333) districts, in the Morogoro and Dodoma region. An overall higher prevalence of overweight (19.7%) and obesity (7.1%) than of underweight (5.9%) was detected. Significantly more women in the two villages of Kilosa (27-40%) than in the two villages of Chamwino district (19-21%) were overweight/obese, but also more frequently had anemia (34-41% vs. 11-17%), iron deficiency (24-32% vs. 15-17%), and low serum retinol (21-24% vs. 8-9%). Overall, only a small proportion of women reached recommended daily micronutrient intakes: 27% for vitamin A, 17% for iron, 7% for zinc, and 12-38% for B-vitamins. The amount of dark green leafy vegetables (DGLV) consumed was the main determinant of vitamin A and iron intake by women in Chamwino and corresponded to higher hemoglobin, serum retinol and iron status than in the villages of the Kilosa district; in agreement, DGLV consumption also predicted iron and vitamin A intake in Kilosa district. DGLV consumed with wholemeal millet was advantageous in terms of women's vitamin A and iron intake and status over the predominantly maize-rice-based diet lacking vegetables.


Assuntos
Dieta , Fazendeiros , Ferro/administração & dosagem , Estado Nutricional , Verduras , Vitamina A/administração & dosagem , Adulto , Peso Corporal , Criança , Estudos Transversais , Demografia , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Tanzânia
17.
Cochrane Database Syst Rev ; 5: CD010068, 2019 05 10.
Artigo em Inglês | MEDLINE | ID: mdl-31074495

RESUMO

BACKGROUND: Vitamin A deficiency is a significant public health problem in many low- and middle-income countries, especially affecting young children, women of reproductive age, and pregnant women. Fortification of staple foods with vitamin A has been used to increase vitamin A consumption among these groups. OBJECTIVES: To assess the effects of fortifying staple foods with vitamin A for reducing vitamin A deficiency and improving health-related outcomes in the general population older than two years of age. SEARCH METHODS: We searched the following international databases with no language or date restrictions: Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 6) in the Cochrane Library; MEDLINE and MEDLINE In Process OVID; Embase OVID; CINAHL Ebsco; Web of Science (ISI) SCI, SSCI, CPCI-exp and CPCI-SSH; BIOSIS (ISI); POPLINE; Bibliomap; TRoPHI; ASSIA (Proquest); IBECS; SCIELO; Global Index Medicus - AFRO and EMRO; LILACS; PAHO; WHOLIS; WPRO; IMSEAR; IndMED; and Native Health Research Database. We also searched clinicaltrials.gov and the International Clinical Trials Registry Platform to identify ongoing and unpublished studies. The date of the last search was 19 July 2018. SELECTION CRITERIA: We included individually or cluster-randomised controlled trials (RCTs) in this review. The intervention included fortification of staple foods (sugar, edible oils, edible fats, maize flour or corn meal, wheat flour, milk and dairy products, and condiments and seasonings) with vitamin A alone or in combination with other vitamins and minerals. We included the general population older than two years of age (including pregnant and lactating women) from any country. DATA COLLECTION AND ANALYSIS: Two authors independently screened and assessed eligibility of studies for inclusion, extracted data from included studies and assessed their risk of bias. We used standard Cochrane methodology to carry out the review. MAIN RESULTS: We included 10 randomised controlled trials involving 4455 participants. All the studies were conducted in low- and upper-middle income countries where vitamin A deficiency was a public health issue. One of the included trials did not contribute data to the outcomes of interest.Three trials compared provision of staple foods fortified with vitamin A versus unfortified staple food, five trials compared provision of staple foods fortified with vitamin A plus other micronutrients versus unfortified staple foods, and two trials compared provision of staple foods fortified with vitamin A plus other micronutrients versus no intervention. No studies compared staple foods fortified with vitamin A alone versus no intervention.The duration of interventions ranged from three to nine months. We assessed six studies at high risk of bias overall. Government organisations, non-governmental organisations, the private sector, and academic institutions funded the included studies; funding source does not appear to have distorted the results.Staple food fortified with vitamin A versus unfortified staple food We are uncertain whether fortifying staple foods with vitamin A alone makes little or no difference for serum retinol concentration (mean difference (MD) 0.03 µmol/L, 95% CI -0.06 to 0.12; 3 studies, 1829 participants; I² = 90%, very low-certainty evidence). It is uncertain whether vitamin A alone reduces the risk of subclinical vitamin A deficiency (risk ratio (RR) 0.45, 95% CI 0.19 to 1.05; 2 studies; 993 participants; I² = 33%, very low-certainty evidence). The certainty of the evidence was mainly affected by risk of bias, imprecision and inconsistency.It is uncertain whether vitamin A fortification reduces clinical vitamin A deficiency, defined as night blindness (RR 0.11, 95% CI 0.01 to 1.98; 1 study, 581 participants, very low-certainty evidence). The certainty of the evidence was mainly affected by imprecision, inconsistency, and risk of bias.Staple foods fortified with vitamin A versus no intervention No studies provided data for this comparison.Staple foods fortified with vitamin A plus other micronutrients versus same unfortified staple foods Fortifying staple foods with vitamin A plus other micronutrients may not increase the serum retinol concentration (MD 0.08 µmol/L, 95% CI -0.06 to 0.22; 4 studies; 1009 participants; I² = 95%, low-certainty evidence). The certainty of the evidence was mainly affected by serious inconsistency and risk of bias.In comparison to unfortified staple foods, fortification with vitamin A plus other micronutrients probably reduces the risk of subclinical vitamin A deficiency (RR 0.27, 95% CI 0.16 to 0.49; 3 studies; 923 participants; I² = 0%; moderate-certainty evidence). The certainty of the evidence was mainly affected by serious risk of bias.Staple foods fortified with vitamin A plus other micronutrients versus no interventionFortification of staple foods with vitamin A plus other micronutrients may increase serum retinol concentration (MD 0.22 µmol/L, 95% CI 0.15 to 0.30; 2 studies; 318 participants; I² = 0%; low-certainty evidence). When compared to no intervention, it is uncertain whether the intervention reduces the risk of subclinical vitamin A deficiency (RR 0.71, 95% CI 0.52 to 0.98; 2 studies; 318 participants; I² = 0%; very low-certainty evidence) . The certainty of the evidence was affected mainly by serious imprecision and risk of bias.No trials reported on the outcomes of all-cause morbidity, all-cause mortality, adverse effects, food intake, congenital anomalies (for pregnant women), or breast milk concentration (for lactating women). AUTHORS' CONCLUSIONS: Fortifying staple foods with vitamin A alone may make little or no difference to serum retinol concentrations or the risk of subclinical vitamin A deficiency. In comparison with provision of unfortified foods, provision of staple foods fortified with vitamin A plus other micronutrients may not increase serum retinol concentration but probably reduces the risk of subclinical vitamin A deficiency.Compared to no intervention, staple foods fortified with vitamin A plus other micronutrients may increase serum retinol concentration, although it is uncertain whether the intervention reduces the risk of subclinical vitamin A deficiency as the certainty of the evidence has been assessed as very low.It was not possible to estimate the effect of staple food fortification on outcomes such as mortality, morbidity, adverse effects, congenital anomalies, or breast milk vitamin A, as no trials included these outcomes.The type of funding source for the studies did not appear to distort the results from the analysis.


Assuntos
Alimentos Fortificados , Necessidades Nutricionais , Deficiência de Vitamina A/terapia , Vitamina A/administração & dosagem , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Deficiência de Vitamina A/prevenção & controle , Adulto Jovem
18.
Am J Clin Nutr ; 110(1): 91-101, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31089689

RESUMO

BACKGROUND: In some regions, multiple vitamin A (VA) interventions occur in the same target groups, which may lead to excessive stores. Retinol isotope dilution (RID) is a more sensitive technique than serum retinol to measure VA status. OBJECTIVE: We evaluated VA status before and after a high-dose supplement in preschool children living in a region in South Africa with habitual liver consumption and exposed to VA supplementation and fortification. METHODS: After baseline blood samples, subjects (46.7 ± 8.4 mo; n = 94) were administered 1.0 µmol [14,15]-13C2-retinyl acetate to estimate total liver retinol reserves by RID with a follow-up 14-d blood sample. Liver intake was assessed with a frequency questionnaire. In line with current practice, a routine 200,000 IU VA capsule was administered after the RID test. RID was repeated 1 mo later. Serum retinyl esters were evaluated using ultra-performance liquid chromatography. RESULTS: At baseline, 63.6% of these children had hypervitaminosis A defined as total liver retinol reserves ≥1.0 µmol/g liver, which increased to 71.6% after supplementation (1.13 ± 0.43 to 1.29 ± 0.46 µmol/g; P < 0.001). Total serum VA as retinyl esters was elevated in 4.8% and 6.1% of children before and after supplementation. The odds of having hypervitaminosis A at baseline were higher in children consuming liver ≥1/mo (ratio 3.70 [95% CI: 1.08, 12.6]) and in children receiving 2 (4.28 [1.03, 17.9]) or 3 (6.45 [0.64, 65.41]) supplements in the past 12 mo. Total body stores decreased after the supplement in children in the highest quartile at baseline compared with children with lower stores, who showed an increase (P = 0.007). CONCLUSIONS: In children, such as this cohort in South Africa, with adequate VA intake through diet, and overlapping VA fortification and supplementation, preschool VA capsule distribution should be re-evaluated. This trial was registered at https://clinicaltrials.gov/ct2/show/NCT02915731 as NCT02915731.


Assuntos
Dieta , Alimentos Fortificados , Hipervitaminose A/sangue , Fígado , Ovinos , Vitamina A/administração & dosagem , Animais , Pré-Escolar , Suplementos Nutricionais , Alimentos Fortificados/análise , Humanos , Fígado/química , África do Sul , Vitamina A/análise , Vitamina A/sangue
19.
Glob Health Action ; 12(1): 1588513, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31062664

RESUMO

BACKGROUND: Vitamin A deficiency (VAD) is one of the most prevalent micronutrient deficiencies in the world. About 2% of all deaths among children under five years of age (U-5) are attributable to VAD. Currently evidence-based knowledge is grossly lacking about the factors associated with low coverage of VAS. OBJECTIVE: This study aims to determine the factors affecting low coverage of the vitamin A supplementation program among the young children admitted to a diarrheal hospital. METHODS: We extracted data from the Diarrhoeal Diseases Surveillance System (DDSS) on children aged 12-59 months admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh, from 1996 to 2014. A logistic regression model was constructed to identify the factors that were significantly associated with non-compliance to vitamin A supplementation (VAS). Strength of association was determined by calculating adjusted odds ratios (aORs) and their 95% confidence intervals. RESULTS: A total of 8649 children were enrolled and comprised the analyzable sample. Their mean ± SD age was 25.2 ± 12.8 months and 40% were female. Around 68% of them had received VAS in the previous 6 months. In the logistic regression analysis, older (>24 months) children (aOR: 1.38; 95% CI: 1.24-1.53), having an illiterate mother (aOR: 1.43; 95% CI: 1.27-1.64), having an illiterate father (aOR: 1.3; 95% CI: 1.16-1.50), coming from the two lowest wealth quintiles (aOR:1.13; 95% CI: 1.02-1.27), with an average monthly household income <10,000 BDT, (1 USD = 60 BDT) and children who had not received the measles vaccine (aOR: 1.87; 95% CI: 1.63-2.19) were more likely not to have received VAS in the preceding six months. We also observed an increase in coverage of VAS from 61% to 76% over the last 18 years (p < 0.001). CONCLUSIONS: Non-compliance to VAS was found to be associated with older children, parents without formal schooling, family with greater poverty, low family income, and lack of measles vaccination. Specific programmatic approaches including prioritizing vulnerable children may enhance vitamin A coverage.


Assuntos
Diarreia/epidemiologia , Suplementos Nutricionais , Deficiência de Vitamina A/tratamento farmacológico , Deficiência de Vitamina A/epidemiologia , Vitamina A/administração & dosagem , Bangladesh/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Modelos Logísticos , Masculino , Adesão à Medicação , Razão de Chances , Prevalência , Fatores Socioeconômicos , Vitamina A/provisão & distribução
20.
Food Nutr Bull ; 40(2): 241-253, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31064219

RESUMO

BACKGROUND: Undernutrition among schoolchildren is a prevalent public health problem which may be due to inadequate energy and nutrient intakes associated with low dietary diversity. OBJECTIVE: This study assessed dietary diversity scores (DDS), energy and nutrient intakes of schoolchildren (6-15 years), and risks factors of DDS and determined if energy and nutrient intakes were dependent on dietary diversity. METHODS: The study involved a 2-stage random sampling of 90 schoolchildren. Dietary diversity and nutrient intake data were obtained through a 3-day weighed food intake. Analysis of variance, t test, and χ2 with Cochran-Mantel-Haenszel test were used to determine relationships among and between variables; P < .05 was reported as significant. RESULTS: Few (22.2%) had high DDS with no significant difference (P > .05) between age groups and sex. Children from male headed households were more likely to have medium DDS (odds ratio [OR] = 3.231; 95% confidence interval [CI] = 1.037-10.070) than those from female headed households (P < .05). Low nutrient intakes were observed among 85.6% for niacin, 76.7% for calcium, 72.2% for riboflavin, 54.4% for protein, 32.2% for thiamine, and 15.6% for vitamin C. Among boys, prevalence of inadequate riboflavin intake was significantly (P < .05) higher among 6- to 9-year-olds. Among girls, prevalence of inadequate vitamin A intake was significantly (P < .01) higher among 10 to 15-year-olds. Children with adequate intakes of iron (OR = 0.744, 95% CI = 0.653-0.847) and thiamine (OR = 5.651, 95% CI = 1.214-26.310) were more likely to have high DDS. CONCLUSION: The schoolchildren had low energy and nutrient intakes. Iron and thiamine, intakes were dependent on DDS.


Assuntos
Dieta , Ingestão de Energia , Nutrientes/administração & dosagem , Adolescente , Ácido Ascórbico/administração & dosagem , Cálcio na Dieta/administração & dosagem , Criança , Estudos Transversais , Feminino , Humanos , Ferro na Dieta/administração & dosagem , Masculino , Nigéria , Riboflavina/administração & dosagem , População Rural , Tiamina/administração & dosagem , Vitamina A/administração & dosagem
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