Comparison of administrative and survey data for estimating vitamin A supplementation and deworming coverage of children under five years of age in Sub-Saharan Africa.

OBJECTIVE: To compare administrative coverage data with results from household coverage surveys for vitamin A supplementation (VAS) and deworming campaigns conducted during 2010-2015 in 12 African countries. METHODS: Paired t-tests examined differences between administrative and survey coverage for 52 VAS and 34 deworming dyads. Independent t-tests measured VAS and deworming coverage differences between data sources for door-to-door and fixed-site delivery strategies and VAS coverage differences between 6- to 11-month and 12- to 59-month age group. RESULTS: For VAS, administrative coverage was higher than survey estimates in 47 of 52 (90%) campaign rounds, with a mean difference of 16.1% (95% CI: 9.5-22.7; P < 0.001). For deworming, administrative coverage exceeded survey estimates in 31 of 34 (91%) comparisons, with a mean difference of 29.8% (95% CI: 16.9-42.6; P < 0.001). Mean ± SD differences in coverage between administrative and survey data were 12.2% ± 22.5% for the door-to-door delivery strategy and 25.9% ± 24.7% for the fixed-site model (P = 0.06). For deworming, mean ± SD differences in coverage between data sources were 28.1% ± 43.5% and 33.1% ± 17.9% for door-to-door and fixed-site distribution, respectively (P = 0.64). VAS administrative coverage was higher than survey estimates in 37 of 49 (76%) comparisons for the 6- to 11-month age group and 45 of 48 (94%) comparisons for the 12- to 59-month age group. CONCLUSION: Reliance on health facility data alone for calculating VAS and deworming coverage may mask low coverage and prevent measures to improve programmes. Countries should periodically validate administrative coverage estimates with population-based methods.

Up-date on the NeoVitaA Trial: Obstacles, challenges, perspectives, and local experiences.

The aim of the NeoVitaA Trial is to assess the role of postnatal additional high-dose oral vitamin A supplementation for 28 days in reducing Bronchopulmonary dysplasia (BPD) or death in extremely low birth weight (ELBW) infants at 36 weeks postmenstrual age (PMA). All infants (both intervention and control group) will be provided with basic vitamin A (1000 IU/kg/day) in addition to trial intervention.In this short communication, we will give an up-date on obstacles, challenges as well as perspectives and potential solutions when putting into place a multicenter, double-blind, randomized trial in this cohort of extremely susceptible infants.

Enhancement of nutritional quality in maize kernel through marker-assisted breeding for vte4, crtRB1, and opaque2 genes.

Traditional maize is poor in vitamin-E [α-tocopherol (α-T): 6-8 ppm], vitamin-A [provitamin-A (proA): 1-2ppm], lysine (0.150-0.2-50%), and tryptophan (0.030-0.040%). Here, we combined favourable alleles of vte4, crtRB1, and opaque2 (o2) genes in the parents of maize hybrids, viz., APQH-10 (PMI-PV-9 × PMI-PV-14) and APQH-11 (PMI-PV-9 × PMI-PV-15) using molecular breeding. Gene-specific markers were successfully used to select vte4, crtRB1, and o2 in BC1F1, BC2F1, and BC2F2 generations. Simple sequence repeats (104-109) were used for background selection, leading to an average recovery of 94% recurrent parent genome. The introgressed inbreds possessed significantly higher α-T: 18.38 ppm, α-/γ-tocopherol (α-/γ-T: 52%), and α-/total tocopherol (α-/TT: 32%) compared to original inbreds (α-T: 8.17 ppm, α-/γ-T: 25%, α-/TT: 18%). These newly derived inbreds also possessed higher ß-carotene (BC: 8.91 ppm), ß-cryptoxanthin (BCX: 1.27 ppm), proA (9.54 ppm), lysine (0.348%), and tryptophan (0.082%) compared to traditional maize inbreds. The reconstituted hybrids recorded higher α-T (2.1-fold), α-/γ-T (1.9-fold), and α-/TT (1.6-fold) over the original hybrids. These reconstituted hybrids were also rich in BC (5.7-fold), BCX (3.3-fold), proA (5.3-fold), lysine (1.9-fold), and tryptophan (2.0-fold) over the traditional hybrids. The reconstituted hybrids had similar grain yield and phenotypic characteristics to original versions. These multinutrient-rich maize hybrids hold great potential to alleviate malnutrition in sustainable and cost-effective manner.

Vitamin-A enriched yogurt through fortification of pumpkin (Cucurbita maxima): A potential alternative for preventing blindness in children.

Vitamin-A deficiency associated with night blindness in children is a global health problem that could be prevented or reduced by promoting the intake of ß-carotene in food. The fortification of ß-carotene in yogurt using pumpkin flesh (PF) could be a very cost-effective public health intervention. The current study aimed to analyze the proximate, functional, microbial, textural, and sensory properties of yogurt fortified with PF to evaluate its suitability as a ß-carotene enriched food. The research was conducted with three treatments, control set-type yogurt (CSY) with no PF, 15% PF-fortified set-type yogurt (15PFSY), and 20% PF-fortified set-type yogurts (20PFSY) followed by pumpkin pie spice and ground pumpkin seed to improve consumer acceptability. The fortified yogurt with 20PFSY and 15PFSY contained a higher amount of ß-carotene, protein, fiber, and ash, and lower carbohydrate, fat, and energy in compression with CSY, which might attract health-conscious people. In addition, viable bacterial count, firmness, consistency, cohesiveness, and viscosity index were found better in fortified yogurt. Based on reports of sensory panellists, 15PFSY achieved a significantly (p < 0.01) highest overall acceptability than 20PFSY and CSY. These findings suggest that pumpkin-fortified yogurt could be used widely as a nutrient-enriched fermented food. In addition, as a ß-carotene (vitamin-A) fortified yogurt, it could be a potential alternative to prevent or reduce blindness in children with minimal cost.

Impact of Pregnancy and Vitamin A Supplementation on CYP2D6 Activity.

The mechanism of cytochrome P450 2D6 (CYP2D6) induction during pregnancy has not been evaluated in humans. This study assessed the changes in CYP2D6 and CYP3A activities during pregnancy and postpartum, and the effect of vitamin A administration on CYP2D6 activity. Forty-seven pregnant CYP2D6 extensive metabolizers (with CYP2D6 activity scores of 1 to 2) received dextromethorphan (DM) 30 mg orally as a single dose during 3 study windows (at 25 to 28 weeks of gestation, study day 1; at 28 to 32 weeks of gestation, study day 2; and at ≥3 months postpartum, study day 3). Participants were randomly assigned to groups with no supplemental vitamin A (control) or with supplemental vitamin A (10 000 IU/day orally for 3 to 4 weeks) after study day 1. Concentrations of DM and its metabolites, dextrorphan (DX) and 3-hydroxymorphinan (3HM), were determined from a 2-hour post-dose plasma sample and cumulative 4-hour urine sample using liquid chromatography-mass spectrometry. Change in CYP2D6 activity was assessed using DX/DM plasma and urine metabolic ratios. The activity change in CYP3A was also assessed using the 3HM/DM urine metabolic ratio. The DX/DM urine ratio was significantly higher (43%) in pregnancy compared with postpartum (P = .03), indicating increased CYP2D6 activity. The DX/DM plasma ratio was substantially higher in the participants, with an activity score of 1.0 during pregnancy (P = .04) compared with postpartum. The 3HM/DM urinary ratio was significantly higher (92%) during pregnancy, reflecting increased CYP3A activity (P = .02). Vitamin A supplementation did not change CYP2D6 activity during pregnancy; however, plasma all-trans retinoic acid (atRA) concentrations were positively correlated with increased CYP2D6 activity during pregnancy and postpartum. Further research is needed to elucidate the mechanisms of increased CYP2D6 activity during pregnancy.

Wilson's Disease in a 17-Year-Old Male With Sickle Cell Trait: A Report of a Rare Case.

This case report describes the atypical presentation of Wilson's disease in a 17-year-old male with sickle cell trait AS pattern. The patient initially presented with fever, generalized weakness, and joint pain, leading to an inconclusive diagnosis and unsuccessful initial treatment. A comprehensive re-evaluation revealed vitamin-A deficiency, adenoid hypertrophy, splenomegaly, and acalculous cholecystitis. Elevated copper levels in the 24-hour urine test confirmed the diagnosis of Wilson's disease. Treatment was modified to include amikacin, prednisolone, and Zinconia®, with analgesics for joint pain management. This case emphasizes the need for a thorough diagnostic approach and consideration of overlapping conditions in complex presentations, contributing to improved patient outcomes.

[Neurological pathology by liposoluble vitamin-related disorders]. / Patología neurológica por desequilibrio de vitaminas liposolubles.

INTRODUCTION: Background: the clinicians rarely have to cope with diseases of nutritional origin and scarcely, although possible, vitamins alterations produce neurological symptoms. Objectives: to show, based on two clinical cases, the neurological symptoms due to liposoluble vitamins alterations, focusing on vitamins E and A. Conclusions: it is important to consider liposoluble vitamin alterations as a cause of neurological symptoms, despite their rarity, after rolling out the most probable entities.

INTRODUCCIÓN: Introducción: en la práctica clínica hospitalaria nos enfrentamos a algunas patologías que tienen origen nutricional. Aunque rara vez, las alteraciones vitamínicas pueden desencadenar trastornos neurológicos graves. Objetivos: mostrar los síntomas neurológicos que pueden darse por alteraciones en los niveles de las vitaminas liposolubles, centrándonos en las vitaminas E y A, mediante la exposición de dos casos clínicos. Conclusiones: es importante tener en mente las alteraciones de vitaminas liposolubles como origen de un trastorno neurológico, a pesar de su escasa frecuencia, habiendo descartado primero las causas más probables.

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.

Coverage and educational actions related to the national vitamin A supplementation program: a study in children from the state of Alagoas.

OBJECTIVES: To estimate the coverage of the National Vitamin A Supplementation Program (Programa Nacional de Suplementação de Vitamina A) in children from Alagoas, to identify factors associated with this coverage, and to analyze the adequacy of nutrition education actions. METHODS: Household survey involving a representative probabilistic sample of children aged 6 to 59 months from Alagoas and their mothers (n=509). Coverage was defined by the percentage of children with supplementation records in the last semester. The association between the independent variables (socioeconomic, demographic, and health) and the National Vitamin A Supplementation Program coverage was analyzed based on the prevalence ratio and its 95% CI. The mothers' knowledge of questions related to vitamin A was considered as an indicator of the adequacy of nutrition education actions. RESULTS: Program coverage was 91.9% in children aged 6-11.9 months and 38.6% in children aged 12-59 months. In the adjusted analysis, the factors that were associated with greater coverage were: age between 6-11.9 months (PR=2.50, 95% CI: 2.10-2.96), living in rural areas (PR=1.45, 95% CI: 1.20-1.76) and living in a house with ≤ 4 rooms (PR=1.33, 95% CI: 1.09-1.63). Only 26.1% of the mothers were able to mention some food source of vitamin A and only 19.2% were aware of the consequences of vitamin deficiency for health. CONCLUSIONS: The National Vitamin A Supplementation Program coverage is below the targets set by the Ministry of Health (except for children <12 months). The factors associated with greater coverage indicate an adequate focus of the program. The nutrition education activities have not demonstrated satisfactory results. This information should guide actions to improve the program.

Effect of green leafy vegetables powder on anaemia and vitamin-A status of Ghanaian school children.

BACKGROUND: Nutritional anaemia and vitamin-A deficiency are public health issues confronting Ghanaian children. Their adverse effects are likely pronounced during the dry season when green leafy vegetables, rich-sources of iron and provitamin-A are scarce. This study assessed the effect of dried green leafy vegetables on anaemia and vitamin-A status of Ghanaian school children. METHOD: This was 3 months pretest, posttest nutrition intervention study. Children 4-9 years were randomized to receive or not receive supplement. High Performance Liquid Chromatography and Haemocue hemoglobinometer were used to determine vitamin-A and haemoglobin concentrations respectively. Malaria-parasitaemia and helminthes were examined by Giemsa-staining and Kato-Katz respectively. Nutritional status was assessed by anthropometry. Student's t-test was used to establish significant differences between groups. RESULTS: At baseline, the mean haemoglobin concentrations of control and supplemental were 116.9 ± 9.9 g/l and 117.6 ± 12.7 g/l respectively. At end-line, it was 121.9 ± 13.5 g/l for supplemental and 113.4 ± 8.5 g/l for control, significant at p = 0.001. At baseline prevalence of anaemia was 37.3 and 41.5% in control and supplemental respectively. At end-line it was 33.3% in supplemental against 57.5% in control, significant at p = 0.024. At baseline mean retinol concentrations were 16.79 ± 8.74 µg/dl and 16.97 ± 7.74 µg/dl for control and supplemental respectively. Mean retinol concentrations for control and supplemental were 24.35 ± 5.50 µg/dl and 26.96 ± 6.86 µg/dl respectively at end-line. At end-line 60% of control against 64.0% of supplemental had low vitamin-A status. At end-line, anaemic-control had mean retinol concentration of 23.78 ± 5.23 µg/dl and anaemic-supplemental had 27.46 ± 7.28 µg/dl. Prevalence of low vitamin-A status was 64.3 and 84.2% in anaemic-control and anaemic-supplemental respectively at baseline but it became 23.1 and 21.1% respectively, at end-line. The mean haemoglobin concentrations of anaemic-control and supplemental were 105.7 ± 7.5 g/l and 113.6 ± 13.6 g/l respectively at end-line. The change in prevalence of anaemia between the anaemic groups was 12.2%, significant at p = 0.042. CONCLUSION: Consumption of green leafy vegetables powder increased mean haemoglobin and retinol concentrations of the study participants. It had the potential to minimize prevalence of anaemia and low vitamin-A status of study participants.

Correcta nutrición y cuidado primario en salud visual / Correct nutrition and primary care in visual health / Nutrição correta e cuidados primários em saúde visual

El creciente aumento de daños visuales como, ha llevado a científicos y especialistas a realizar ensayos clínicos con pacientes vulnerables, usando alimentos con nutrientes específicos que aportan al cuidado de las estructuras del globo ocular, pues la nutrición de este órgano se obtiene directamente de la sangre. Objetivo. Analizar los ensayos clínicos con vigencia de 9 años sobre antioxidantes, betacarotenos y otras vitaminas para la prevención de enfermedades oculares. Metodología. Se realizó una revisión bibliográfica bajo con un análisis de 40 artículos, tesis y libros sobres la relación entre la nutrición y el cuidado primario de las estructuras oculares, esto se realizó en tres momentos, búsqueda, clasificación y sistematización de las fuentes. Conclusión. Se confirmó que del 50% de los pacientes que ingirieron placebo no mejoraban su condición anatomo fisiológica en relación aquellos pacientes que sí ingirieron nutrientes y vitaminas específicas, los mismos, mejoraron en un 30% el nivel de agudeza visual. La promoción y prevención como cuidado primario en salud visual es importante y se demuestran los altos porcentajes de buena salud visual en aquellos pacientes que durante su vida tuvieron hábitos alimenticios correctos y nutrición equilibrada, además de ser menormente propensos a adquirir problemas degenerativos visuales, aun teniendo antecedentes hereditarios.

The increasing increase in visual damage has led scientists and specialists to conduct clinical trials with vulnerable patients, using foods with specific nutrients that contribute to the care of the structures of the eyeball, since the nutrition of this organ is obtained directly from the blood. Objective. To analyze 9 years of clinical trials on antioxidants, beta-carotene and other vitamins for the prevention of ocular diseases. Methodology. A bibliographic review was carried out with an analysis of 40 articles, theses and books on the relationship between nutrition and primary care of the ocular structures, this was done in three moments, search, classification and systematization of the sources. Conclusion. It was confirmed that 50% of the patients who ingested placebo did not improve their anatomo-physiological condition in relation to those patients who ingested specific nutrients and vitamins, they improved their visual acuity level by 30%. The promotion and prevention as primary care in visual health is important and the high percentages of good visual health are demonstrated in those patients who during their life had correct eating habits and balanced nutrition, besides being less prone to acquire visual degenerative problems, even if they have hereditary antecedents.

O crescente aumento dos danos visuais tem levado cientistas e especialistas a realizarem ensaios clínicos com pacientes vulneráveis, utilizando alimentos com nutrientes específicos que contribuem para o cuidado das estruturas do globo ocular, uma vez que a nutrição desse órgão é obtida diretamente do sangue. Objetivo. Analisar 9 anos de ensaios clínicos sobre antioxidantes, betacaroteno e outras vitaminas para a prevenção de doenças oculares. Metodologia. Foi realizada uma revisão bibliográfica com análise de 40 artigos, teses e livros sobre a relação entre nutrição e cuidados primários das estruturas oculares, em três etapas: busca, classificação e sistematização das fontes. Conclusões. Confirmou-se que 50% dos pacientes que ingeriram placebo não melhoraram sua condição anátomo-fisiológica em relação aos pacientes que ingeriram nutrientes e vitaminas específicas, os mesmos pacientes melhoraram seu nível de acuidade visual em 30%. A promoção e a prevenção como cuidados primários na saúde visual são importantes e as altas porcentagens de boa saúde visual são demonstradas naqueles pacientes que, durante sua vida, tiveram hábitos alimentares corretos e nutrição balanceada, além de serem menos propensos a adquirir problemas degenerativos visuais, mesmo que tenham antecedentes hereditários.

Nutrition transition in Brazilian children under 5 years old from 2006 to 2019 / Transição nutricional em crianças brasileiras menores de 5 anos de idade entre 2006 e 2019 / Transición nutricional en niños brasileños menores de 5 años de edad entre 2006 y 2019

Abstract: This manuscript aims to report the nutrition transition in Brazilian children under 5 years old from 2006 to 2019. Microdata from the Brazilian National Survey on Demography and Health of Women and Children (PNDS 2006) and the Brazilian National Survey on Child Nutrition (ENANI-2019) were analyzed. The indicators considered were: micronutrient status (anemia and vitamin A deficiency), anthropometric status (stunting and excessive weight), and breastfeeding practice (exclusive breastfeeding among children < 6 months and continued breastfeeding among children 12-23 months). We also analyzed minimum dietary diversity (MDD), consumption of ultra-processed foods, consumption of meat or eggs, and not consuming fruits or vegetables in children 6-59 months of age only for ENANI-2019. Equiplot charts were generated according to geographic region, maternal schooling level, and maternal race/skin color. From 2006 to 2019, the prevalence rates of anemia and vitamin A deficiency decreased from 20.5% to 10.1% and 17.2% to 6%, respectively. The prevalence of stunting remained at 7%, and excessive weight rates increased from 6% to 10.1%. The prevalence of exclusive breastfeeding among children < 6 months increased from 38.6% to 45.8%, and of continued breastfeeding among children 12-23 months from 34.6% to 43.6%. In 2019, 61.5% of children achieved the MDD, 88.8% consumed ultra-processed foods, 83.1% consumed meat or egg, and 25.7% did not consume fruits or vegetables the day before the survey. Trends of decreased micronutrient deficiencies, increased breastfeeding, and excessive weight rates, as well as reductions in disparities related to geographic region, maternal schooling level, and maternal race/skin color, were observed for most of the indicators.

Resumo: Buscamos reportar a transição nutricional em crianças brasileiras menores de 5 anos de idade entre 2006 e 2019. Foram analisados microdados da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS 2006) e do Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019). Foram considerados os seguintes indicadores: status de micronutrientes (anemia e deficiência de vitamina A), estado nutricional antropométrico (excesso de peso e baixa estatura) e a prática de aleitamento materno (aleitamento materno exclusivo entre crianças < 6 meses e aleitamento materno continuado entre crianças de 12-23 meses). Analisamos a diversidade alimentar mínima (DAM), o consumo de alimentos ultraprocessados, de carne ou ovos e o não consumo de frutas ou hortaliças apenas para o ENANI-2019 em crianças de 6-59 meses de idade. Equiplots foram gerados de acordo com a região geográfica, escolaridade e raça/cor da pele maternas. Entre 2006 e 2019, as prevalências de anemia e deficiência de vitamina A diminuíram de 20,5% para 10,1% e de 17,2% para 6%, respectivamente. A prevalência de déficit de estatura manteve-se em 7% e a de excesso de peso aumentou de 6% para 10,1%. A prevalência de aleitamento materno exclusivo entre crianças < 6 meses aumentou de 38,6% para 45,8% e a de aleitamento materno continuado entre crianças de 12-23 meses aumentou de 34,6% para 43,6%. Em 2019, 61,5% das crianças atingiram a DAM, 88,8% consumiram alimentos ultraprocessados, 83,1% consumiram carne ou ovos e 25,7% não consumiram frutas ou hortaliças no dia anterior à pesquisa. Observamos tendências de diminuição das deficiências de micronutrientes, aumento do aleitamento materno e excesso de peso e reduções em disparidades regional, de escolaridade e de raça/cor da pele maternas para a maioria dos indicadores.

Resumen: Buscamos informar sobre la transición nutricional en niños brasileños menores de 5 años entre 2006 y 2019. Se analizaron microdatos de la Encuesta Nacional de Demografía y Salud del Niño y de la Mujer (PNDS 2006) y del Encuesta Nacional de Alimentación Nutrición Infantil (ENANI-2019). Se consideraron los siguientes indicadores: estado de micronutrientes (anemia y deficiencia de vitamina A), estado nuricional antropométrico (sobrepeso y baja estatura) y la práctica de la lactancia materna (lactancia materna exclusiva en niños < 6 meses y lactancia materna continua entre niños de 12-23 meses) como indicadores. Analizamos la diversidad dietética mínima (DDM), el consumo de alimentos ultraprocesados, carne o huevos, y el no consumo de frutas o verduras solo para ENANI-2019 en niños de 6-59 meses de edad. Se generaron equiplots en función de la región geográfica, la educación y raza/color de la piel de la madre. Entre 2006 y 2019, las prevalencias de anemia y deficiencia de vitamina A disminuyeron del 20,5% al 10,1% y del 17,2% al 6%, respectivamente. La prevalencia del déficit de estatura se mantuvo en el 7 % y la de sobrepeso aumentó del 6% al 10,1%. La prevalencia de lactancia materna exclusiva en niños < 6 aumentó del 38,6% al 45,8% y la de lactancia materna continua entre niños de 12-23 meses aumentó del 34,6% al 43,6%. En 2019, el 61,5% de los niños alcanzaron DDM, el 88,8% consumieron alimentos utraprocesados, el 83,1% consumieron carne o huevos y el 25,7% no consumieron frutas o verduras el día anterior a la encuesta. Observamos tendencias de disminución de las deficiencias de micronutrientes, un aumento de la lactancia materna y sobrepeso y reducciones en las disparidades regionales, de escolaridad y de raza/color de la piel de la madre para la mayoría de los indicadores.

Vitamin A nutritional status in high- and low-income postpartum women and its effect on colostrum and the requirements of the term newborn.

OBJECTIVE: To evaluate the vitamin A status in serum and colostrum of postpartum women with different socioeconomic status, comparing the colostrum retinol supply with the vitamin A requirement of the newborn. METHODS: Cross-sectional study conducted with 424 postpartum women. Vitamin A maternal dietary intake was estimated using a food frequency questionnaire. Colostrum and serum retinol levels were measured by high performance liquid chromatography (HPLC). Serum retinol concentrations <20µg/dL were indicative of vitamin A deficiency (VAD). Vitamin A levels provided by colostrum <400µgRAE/day were considered as insufficient for term newborns. RESULTS: The mean maternal vitamin A intake during pregnancy was 872.2±639.2µgRAE/day in low-income women and 1169.2±695.2µgRAE/day for high-income women (p<0.005). The prevalence of vitamin A deficiency was 6.9% (n=18) in the low-income group and 3.7% (n=6) in the high-income group. The estimated mean retinol intake by infants of the high- and low-income mothers were 343.3µgRAE/day (85.8% AI) and 427.2µgRAE/day (106.8% AI), respectively. CONCLUSIONS: Serum vitamin A deficiency was considered a mild public health problem in both populations; however, newborns of low-income women were more likely to receive lower retinol levels through colostrum when compared with newborns of high-income mothers.

Programa Nacional de Suplementação de Vitamina A na atenção primária: qual a realidade em Minas Gerais, Brasil? / National Vitamin A Supplementation Program in primary care: what is the reality in Minas Gerais, Brazil?

Resumo Objetivou-se avaliar o Programa Nacional de Suplementação de Vitamina A em Minas Gerais. Utilizou-se método misto sequencial explanatório. Na abordagem quantitativa, utilizou-se instrumento multidimensional segundo componentes de suplementação da vitamina A e educação alimentar e nutricional. Usou-se uma matriz de análise com parâmetros para definir a implantação como adequada, parcialmente adequada, não adequada e crítica. Na abordagem qualitativa, foram utilizadas entrevistas semiestruturadas. A dimensão processo foi melhor avaliada que a estrutura, apresentando grau de implantação de 84,6% e 78,5%, respectivamente. As fortalezas do programa incluem: planejamento da suplementação, alcance de metas, registro de informações, apoio ao aleitamento materno e atuação dos agentes comunitários de saúde. Entre as fragilidades estão: fragmentação do trabalho, limites na análise das informações, acesso às ações do programa, implantação de ações educativas, ausência ou insuficiência de nutricionistas e capacitações. A realidade do programa não contemplou, em sua totalidade, ações de promoção da saúde, sendo o foco a suplementação da vitamina A. É imperativo implementar ações de educação alimentar e nutricional para o enfrentamento da deficiência de vitamina A.

Abstract The present study aimed to evaluate the National Vitamin A Supplementation Program in Minas Gerais, adopting the mixed sequential explanatory method. The quantitative approach adopted the multidimensional instrument per the components of vitamin A supplementation and food and nutrition education. We employed an analysis matrix with parameters to define the implementation as adequate, partially adequate, inadequate, and critical. We used semi-structured interviews in the qualitative approach. The "process" dimension was better evaluated than the "structure", with an implementation level (IL) of 84.6% and 78.5%, respectively. The Program's strengths include supplementation planning, achieving goals, recording information, supporting breastfeeding, and the performance of Community Health Workers. Weaknesses are fragmented work, analysis of information limits, access to the Program's actions, implementation of educational actions, and lack of or insufficient availability of nutritionists and training. The Program's reality only partially considered health promotion actions and focused on vitamin A supplementation. Implementing food and nutritional education actions is imperative to face vitamin A deficiency.

Vitamin A could be a Therapeutic Agent in Ischemia/Reperfusion Induced Kidney Injury / La vitamina A podría ser un agente terapéutico en la lesión renal inducida por isquemia/reperfusión

ABSTRACT Introduction: Renal ischemia (I) could develop due to decreased or ceased blood flow to the kidney in some clinical conditions such as shock, sepsis, and kidney transplantation. The re-supply of blood to the kidney is called reperfusion (R). Ischemia and reperfusion periods can cause severe kidney damage. Objectives: When we examined the I/R molecular progression, antioxidant molecules such as vitamin A seem promising treatment agents. This study aimed to investigate the effects of vitamin A on renal I/R injury. Material and Methods: In the study, 40 Sprague-Dawley male rats were divided into five groups (n=8): the control group, only I/R, I/R+1000, I/R+3000, and I/R+9000 IU/kg of Vitamin A groups. Vitamin A was administrated to each group for seven days via oral gavage. Blood and kidney tissue samples were collected at the end of the experiment. We took blood samples for Superoxide dismutase (SOD), malondialdehyde (MDA), catalase (CAT), blood urea nitrogen (BUN), and creatinine (Cr) levels, and determined their values. The tissue samples were stained with hematoxylin/eosin to examine the renal changes histopathologically and stereologically under a light microscope. Results: Histopathological changes caused by I/R were decreased with vitamin A administration in a dose-dependent manner (p<0.05). Vitamin A administration decreased MDA levels and increased SOD and CAT activities (p<0.05). The most effective dose among treatment groups was 9000 IU/kg. There was no significant difference between the controls and all other groups regarding BUN and Cr concentrations. Conclusions: Consequently, administration of vitamin A after renal I/R reduced the histological damage and ameliorated the antioxidant state. These results showed that vitamin A could be a promising agent in treating I/R-induced acute kidney injury.

RESUMEN Introducción: La isquemia renal (I) puede desarrollarse debido a la disminución o interrupción del flujo sanguíneo al riñón en algunas condiciones clínicas como shock, sepsis y trasplante renal. El reabastecimiento de sangre al riñón se denomina reperfusión (R). Tanto la isquemia como los períodos de reperfusión pueden causar graves daños renales. Objetivos: Cuando examinamos la progresión molecular I/R, las moléculas antioxidantes como la vitamina A parecen agentes de tratamiento prometedores. El objetivo de este estudio fue investigar los efectos de la vitamina A sobre la lesión renal I/R. Material y Métodos: En el estudio, 40 ratas macho Sprague-Dawley se dividieron en 5 grupos (n=8) como: control, solo I/R, I/R+1000, I/R+3000 e I/R+9000 UI/kg de la Vitamina A. La vitamina A se administró a cada grupo durante 7 días por vía oral forzada. Al final del experimento se recolectaron muestras de sangre y tejido del riñón. A partir de muestras de sangre se determinaron los niveles de superóxido dismutasa (SOD), malondialdehído (MDA), catalasa (CAT), nitrógeno ureico en sangre (BUN) y creatinina (Cr). Las muestras de tejido se tiñeron con hematoxilina/eosina y los cambios en la histología renal se examinaron histopatológicamente y estereológicamente al microscopio de luz. Resultados: Los cambios histopatológicos causados por I/R disminuyeron con la administración de la vitamina A de manera dependiente de la dosis (p<0,05). La administración de la vitamina A disminuyó los niveles de MDA, aumentó las actividades de SOD y CAT (p<0,05). La dosis más eficaz entre los grupos del tratamiento fue de 9000 UI/kg. No hubo una diferencia significativa entre el grupo control y todos los demás grupos con respecto a las concentraciones de BUN y Cr. Conclusiones: Consiguientemente, la administración de la vitamina A, después de I/R renal, redujo el daño histológico y mejoró el estado antioxidante. Estos resultados mostraron que la vitamina A puede ser un agente promisorio en el tratamiento de la lesión renal aguda (LRA) inducida por I/R.

Avaliação do Programa Nacional de Suplementação de Vitamina A: o olhar dos profissionais da Atenção Primária à Saúde / Evaluation of the National Vitamin A Supplementation Program: the perspective of professionals from Primary Health Care

A carência de vitamina A é considerada um problema de saúde pública em vários países de baixa e média renda, inclusive no Brasil. Nesse contexto, foi instituído o Programa Nacional de Suplementação de Vitamina A (PNSVA), com o intuito de suplementar as crianças de 6 a 59 meses com megadoses dessa vitamina. O objetivo deste estudo foi avaliar o conhecimento dos profissionais a respeito desse programa, além da operacionalização, do funcionamento e da cobertura do PNSVA. Trata-se de um estudo transversal, realizado em Uberlândia, Minas Gerais, para o qual foram realizadas entrevistas com os profissionais de 58 Unidades Básicas de Saúde (UBS). Os dados da cobertura do PNSVA (2012 a 2020) foram coletados através do Sistema de Informação de Micronutrientes. Dos entrevistados, 39,6% citaram a distribuição de cápsulas de vitamina A como forma de atingir os objetivos do PNSVA, e apenas 36,2% receberam capacitação sobre o programa. Em relação à sua operacionalização, 56,9% relataram nunca terem faltado cápsulas de vitamina A na UBS, e 41,3% realizavam o registro das doses administradas no Mapa Diário de Administração de Vitamina A. Já sobre o funcionamento do programa, 61,1% o avaliaram como bom. A cobertura do PNSVA foi inferior à meta pactuada, tendo sido observadas lacunas no conhecimento, na operacionalização e no funcionamento do programa.

Vitamin A deficiency is considered a public health problem in several low-and middle-income countries, including Brazil. In this context, the National Vitamin A Supplementation Program (PNSVA) was instituted with the aim of supplementing children aged 6 to 59 months with megadoses of vitamin A. This cross-sectional study carried out in Uberlândia, Minas Gerais, aimed to evaluate professionals' knowledge, operationalization, functioning, and coverage of the PNSVA. We interviewed professionals from 58 Basic Health Units and collected PNSVA coverage data (2012-2020) from the Micronutrient Information System. Of those interviewed, 39.6% cited the distribution of vitamin A capsules to achieve the PNSVA objectives, and only 36.2% received training on the program. Operationalization-wise, 56.9% reported never running out of vitamin A capsules at the Unit, and 41.3% recorded the doses administered on the Daily Map. About the operation, 61.1% rated the PNSVA as good. PNSVA coverage was below the recommended target. PNSVA functioning, operationalization, and coverage did not reach the agreed goals, highlighting the current knowledge gaps in the program.

[Unusual case of struvite urolithiasis in a dog. A case report]. / Ungewöhnlicher Fall von Struvit-Urolithiasis bei einem Hund. Ein Fallbericht.

A dog was referred for nutrition consultation after surgical removal of struvite uroliths from the bladder. Inspection of the dog's current ration revealed a pronounced vitamin-A deficiency together with a marked deficiency of protein, phosphorus and magnesium. Therefore, a supersaturation of the urine with ammonium, magnesium and phosphate, the three constituents of struvite, as a cause of struvite calculi formation appears rather unlikely. Vitamin-A deficiency can promote urinary infections and consequently struvite stone formation because of the lack of the protective effect of vitamin A on the epithelia of the urinary tract. Not only common causes for struvite urolith formation, including urinary supersaturation with stone-forming constituents and urinary tract infection, but also less common causes, including vitamin-A deficiency, which was the presumed trigger in the present case study, have to be taken into consideration. Dietetic measures appear to be a useful tool in such cases to prevent uroliths from reoccurring.

Phasing out of the Universal Mega Dose of Vitamin-A Prophylaxis to Avoid Toxicity.

Childhood blindness due to corneal ulceration was prevalent among poor Indian children. To tackle this situation, the National Institute of Nutrition (NIN), Hyderabad, India, Vitamin-A (Vit-A) prophylaxis programme was launched nationally in 1970 after field testing. Research of Indian Council for Medical Research (ICMR) documented that prevalence of Vit-A deficiency signs such as Bitot's spot decreased among children, over a period of time. However, this decrease cannot be ascertained is due to mass Vit-A prophylaxis programme. This is because coverage was low and patchy. Improved nutrition status, wider vaccination coverage, increased rate in breast feeding and improvement of healthcare services played a crucial role. Rather many studies revealed that (mass prophylaxis to the child who is having adequate Vit-A level) it may be harmful to certain group of children as a result of acute toxic symptoms. High dose of Vit-A is capable of loss of bone density-hence retarded growth may be observed in susceptible individuals. To tackle this issue food based approach should be promoted (which includes breast feeding) along with timely measles vaccination. The children who have signs of Vit-A deficiency (e.g. night blindness, xeropthalmia, Bitot's spot) or post measles children should receive Vit-A in age specific daily doses for two weeks along with Vit-A rich food, like green leafy vegetables, red palm oil, liver etc. Public spirited citizens, together with scientific community in India, should discourage this "one size fit to all" approach. It will not only avoid the ill effects of high dose of Vit-A but also it will help us optimal utilization of health resources in a resource poor country like India.

Prevalência de anemia e deficiência de vitamina A e consumo de ferro e de vitamina A entre crianças usuárias do Sistema Único de Saúde na cidade do Rio de Janeiro, Brasil / Prevalence of anemia and vitamin A deficiency and iron and vitamin A intake in children that use the Brazilian Unified National Health System in Rio de Janeiro, Brazil / Prevalencia de anemia, deficiencia de vitamina A, y consumo de hierro y de vitamina A entre niños pacientes del Sistema Único de Salud en la ciudad de Río de Janeiro, Brasil

Estratégias nacionais para o controle de anemia e deficiência de vitamina A em crianças estão baseadas em estimativas de suas prevalências produzidas em âmbito nacional em 2006 com métodos não validados para este grupo etário e com nível de desagregação para macrorregiões. Com o intuito de subsidiar a gestão local para o (re)direcionamento de medidas de controle desses agravos, o presente trabalho apresenta estimativas de sua prevalência e, também, de marcadores de consumo alimentar de fontes de micronutrientes e do uso de suplementos de vitaminas e minerais em amostra probabilística de crianças de 6 a 59 meses, usuárias da atenção básica de saúde do Município do Rio de Janeiro, Brasil (n = 536). Foram coletadas amostras de sangue venoso para análise de hemoglobina, ferritina e retinol sérico e dados sobre o consumo alimentar, o uso de suplementos de vitaminas e minerais e as características sociodemográficas. As prevalências de anemia, anemia ferropriva e deficiência de vitamina A foram de, respectivamente, 13,7%, 5,5% e 13%. Quase todas as crianças haviam consumido alimentos ricos em ferro no dia anterior à entrevista, sendo altas as prevalências de consumo de fontes de origem animal. Somente 49,4% haviam consumido alimentos ricos em vitamina A. As prevalências de uso de algum suplemento, de suplemento com ferro e com vitamina A foram de, respectivamente, 51%, 14,7% e 24,4%. Os resultados apontam a necessidade de redirecionamento das estratégias de prevenção e controle de anemia e deficiência de vitamina A. Estudos futuros são necessários para examinar a evolução desses indicadores, tendo em vista as políticas de austeridade que entraram em vigor nos últimos anos e a crise econômica decorrente da pandemia da COVID-19.

Brazilian national strategies for the control of anemia and vitamin A deficiency in children are based on estimates of their nationwide prevalence rates in 2006 with methods not validated for this age group and with disaggregation at the level of major geographic regions. To back local administrations in (re)directing control measures for these two disorders, the current study presents estimates of their prevalence and markers of dietary intake of sources of micronutrients and use of vitamin and mineral supplements in a probabilistic sample of children 6 to 59 months of age, users of primary healthcare in the city of Rio de Janeiro, Brazil (n = 536). Venous blood samples were drawn for analysis of hemoglobin, ferritin, and serum retinol, besides collection of data on food consumption, use of vitamin and mineral supplements, and sociodemographic characteristics. Prevalence rates for anemia, iron deficiency anemia, and vitamin A deficiency were 13.7%, 5.5%, and 13%, respectively. Nearly all the children had consumed iron-rich food the day before the interview, with high prevalence of animal sources. Only 49.4% had consumed foods high in vitamin A. The prevalence rates for use of any supplement, iron supplements, and vitamin A supplements were 51%, 14.7%, and 24.4%, respectively. The findings point to the need to redirect the strategies for prevention and control of anemia and vitamin A deficiency. Future studies are necessary to examine trends in these indicators, focusing on austerity policies implemented in recent years and the economic crisis resulting from the COVID-19 pandemic.

Las estrategias brasileñas para el control de anemia y deficiencia de vitamina A en niños están basadas en estimaciones de sus prevalencias, producidas en el ámbito nacional en 2006 con métodos no validados para este grupo etario, y con un nivel de desagregación en las macrorregiones. Con el fin de apoyar la gestión local para la (re)orientación de medidas de control de esos problemas de salud, este trabajo presenta estimaciones de su prevalencia y, también, de los marcadores de consumo alimentario de fuentes de micronutrientes y del uso de suplementos de vitaminas y minerales, en una muestra probabilística de niños de 6 a 59 meses, pacientes de atención básica de salud del Municipio de Río de Janeiro, Brasil (n = 536). Se recogieron muestras de sangre venosa para el análisis de hemoglobina, ferritina y retinol sérico, así como datos sobre el consumo alimentario, de suplementos de vitaminas y minerales, así como de características sociodemográficas. Las prevalencias de anemia, anemia ferropénica y deficiencia de vitamina A fueron de, respectivamente, 13,7%, 5,5% y 13%. Casi todos los niños habían consumido alimentos ricos en hierro el día anterior a la entrevista, siendo altas las prevalencias de consumo de fuentes de origen animal. Solamente un 49,4% habían consumido alimentos ricos en vitamina A. Las prevalencias de consumo de algún suplemento, de suplemento con hierro y de suplemento con vitamina A fueron de, respectivamente, 51%, 14,7% y 24,4%. Los resultados apuntan la necesidad de reorientar las estrategias de prevención y control de la anemia y deficiencia de vitamina A. Se necesitan estudios futuros para examinar la evolución de esos indicadores, teniendo en vista las políticas de austeridad que entraron en vigor en los últimos años y la crisis económica a consecuencia de la pandemia de COVID-19.

[Not Available]. / Deficiencia clínica de vitamina A tras bypass gástrico. Descripción de un caso clínico y revisión de la literatura.

La deficiencia de vitamina A es infrecuente en los países desarrollados. La cirugía bariátrica constituye un factor de riesgo de deficiencia de esta vitamina. Se han descrito varios casos en pacientes sometidos a técnicas con un importante componente malabsortivo, como la derivación biliopancreática. En este artículo se describe un caso de deficiencia clínica de vitamina A con manifestaciones oculares y cutáneas tras bypass gástrico y se revisan las publicaciones sobre este tema y las recomendaciones para la prevención de esta importante complicación.