A food-based approach introducing orange-fleshed sweet potatoes increased vitamin A intake and serum retinol concentrations in young children in rural Mozambique

Vitamin A deficiency is widespread and has severe consequences for young children in the developing world. Food-based approaches may be an appropriate and sustainable complement to supplementation programs. Orange-fleshed sweet potato (OFSP) is rich in beta-carotene and is well accepted by young children. In an extremely resource poor area in Mozambique, the effectiveness of introduction of OFSP was assessed in an integrated agriculture and nutrition intervention, which aimed to increase vitamin A intake and serum retinol concentrations in young children. The 2-y quasi-experimental intervention study followed households and children (n = 741; mean age 13 mo at baseline) through 2 agricultural cycles. In y 2, 90% of intervention households produced OFSP, and mean OFSP plot size in intervention areas increased from 33 to 359 m(2). Intervention children (n = 498) were more likely than control children (n = 243) to eat OFSP 3 or more d in the last wk (55% vs. 8%, P < 0.001) and their vitamin A intakes were much higher than those of control children (median 426 vs. 56 microg retinol activity equivalent, P < 0.001). Controlling for infection/inflammation and other confounders, mean serum retinol increased by 0.100 micromol/L (SEM 0.024; P < 0.001) in intervention children and did not increase significantly in control subjects. Integrated promotion of OFSP can complement other approaches and contribute to increases in vitamin A intake and serum retinol concentrations in young children in rural Mozambique and similar areas in Sub-Saharan Africa.     

生物强化高β-胡萝卜素甘薯对儿童维生素A营养干预研究

目的研究通过生物强化技术培育的高β-胡萝卜素甘薯对儿童维生素A营养的改善作用,探讨解决人群维生素A缺乏的新途径。方法抽取四川省某县2个乡111名3～10岁维生素A缺乏和边缘性缺乏的儿童作为研究对象,按年龄、性别、血清维生素A水平随机分为干预组(n=56)和对照组(n=55),干预组每人每日食用高β-胡萝卜素甘薯(110g,β-胡萝卜素含量为52.8μg/g),对照组食用等量当地普通甘薯(β-胡萝卜素含量为2.3μg/g),干预期56d;干预前后分别对受试者进行24h膳食调查、测量身高、体重、血清维生素A含量,干预期间记录儿童膳食和患病情况。结果最终样本量为98人(干预组49人,对照组49人);干预期间儿童膳食和疾病情况无明显差异;干预后,干预组儿童血清维生素A水平(117μg/L)增加量明显高于对照组(58μg/L)(P<0.01);维生素A缺乏改善率干预组(63.3%)明显高于对照组(42.9%),两组之间差异有统计学意义(P<0.05)。结论生物强化高β-胡萝卜素甘薯能明显改善维生素A缺乏儿童的营养状况,这可能成为解决儿童维生素A缺乏问题的有效途径。     

Beta-carotene-rich orange-fleshed sweet potato improves the vitamin A status of primary school children assessed with the modified-relative-dose-response test

BACKGROUND: Beta-carotene-rich orange-fleshed sweet potato (OFSP) is an excellent source of provitamin A. In many developing countries, sweet potato is a secondary staple food and may play a role in controlling vitamin A deficiency. OBJECTIVE: The objective was to determine the efficacy of daily consumption of boiled and mashed OFSP in improving the vitamin A status of primary school children. DESIGN: Children aged 5-10 y were randomly assigned to 2 groups. The treatment group (n = 90) consumed 125 g boiled and mashed OFSP (1031 retinol activity equivalents/d as beta-carotene), and the control group (n = 90) consumed an equal amount of white-fleshed sweet potato devoid of beta-carotene for 53 school days. All children were dewormed to exclude helminthic infection. The modified-relative-dose-response test for vitamin A status was conducted before and after intervention. RESULTS: The estimated intervention effect for the ratio of 3,4-didehydroretinol to retinol (DR:R) was -0.008 (95% CI: -0.015, -0.001; P = 0.0203), which indicated a greater improvement in vitamin A liver stores in the treatment group than in the control group. The proportions of children with normal vitamin A status (DR:R < 0.060) in the treatment group tended to increase from 78% to 87% (P = 0.096) and did not change significantly (from 86% to 82%) in the control group (P = 0.267). These proportions were not used to test the intervention effect or within-group changes because the study was powered to test the intervention effect on DR:R. CONCLUSIONS: Consumption of OFSP improves vitamin A status and can play a significant role in developing countries as a viable long-term food-based strategy for controlling vitamin A deficiency in children.     

Predicting dietary intakes with simple food recall information: a case study from rural Mozambique

OBJECTIVE: Improving dietary status is an important development objective, but monitoring of progress in this area can be too costly for many low-income countries. This paper demonstrates a simple, inexpensive technique for monitoring household diets in Mozambique. DESIGN: Secondary analysis of data from an intensive field survey on household food consumption and agricultural practices, known as the Nampula/Cabo Delgado Study (NCD). SUBJECTS: In total, 388 households in 16 villages from a stratified random sample of rural areas in Nampula and Cabo Delgado provinces in northern Mozambique. METHODS: The NCD employed a quantitative 24-h food recall on two nonconsecutive days in each of the three different seasons. A dietary intake prediction model was developed with linear regression techniques based on NCD nutrient intake data and easy-to-collect variables, such as food group consumption and household size The model was used to predict the prevalence of low intakes among subsamples from the field study using only easy-to-collect variables. RESULTS: Using empirical data for the harvest season from the original NCD study, 40% of the observations on households had low-energy intakes, whereas rates of low intake for protein, vitamin A, and iron, were 14, 94, and 39, respectively. The model developed here predicted that 42% would have low-energy intakes and that 12, 93, and 35% would have low-protein, vitamin A, and iron intakes, respectively. Similarly, close predictions were found using an aggregate index of overall diet quality. CONCLUSIONS: This work demonstrates the potential for using low-cost methods for monitoring dietary intake in Mozambique.     

Dietary intake of vitamin A in African pre-school children in Umlazi, South Africa.

Vitamin A deficiency has been shown to have an impact on morbidity and mortality and therefore prevalence rates are important for public health policy. We report the use of a 7-day recall, dietary questionnaire, which was validated and administered to 203 randomly selected urban African pre-school children in Umlazi, South Africa. Common vitamin A containing foods eaten were leafy green vegetables, pumpkin, sweet potato, mangoes and chicken liver. Although the mean daily intake of vitamin A was adequate, 19 children had intakes below the recommended dietary allowance (RDA). Thirteen of these children had eaten liver in the previous week, and as such were probably not at risk. It is therefore estimated that only 6 of the children (3%) were at risk for developing vitamin A deficiency.     

Risk of inadequate intakes of vitamins A, B1, B6, C, E, folate, iron and calcium in the Spanish population aged 4 to 18

A meta-analysis of the most representative Spanish nutrition studies was carried out to identify inadequate intakes of vitamins, A, B1, B6, C, E, folate, iron, and calcium in children aged 4 to 18. Information on vegetable, fruit and fruit juice/beverage intake was also solicited. Data drawn from the selected studies yielded a total of 6540 children and adolescents in eight geographical areas. The sample was stratified by age (children: 4 to 14 years old and adolescents: 13-18 years old) and sex. Inadequate intakes (below two-thirds of the recommended values) were notable in children for vitamin E, vitamin C, and vitamin A and in girls, iron. In adolescents, low intakes were especially marked for vitamin E and vitamin A, and in girls, calcium, folate, and iron. Adolescents consumed more vegetables, fruit juice, and fruit drinks whereas children had higher fruit intakes. Regional differences in consumption were also detected. Strategies for improving nutrient intake in these vulnerable populations are discussed.     

Vitamin A deficiency among preschool children in a rural area of Egypt: the results of dietary assessment and biochemical assay

Vitamin A status was evaluated among a cohort of preschool children (mean age 43 months) pertinent to a traditional society in rural Egypt. The Helen Keller International food frequency questionnaire, the 7-day 24-h dietary recall method and serum vitamin A concentrations were the criteria used for the evaluation. Mean values of 280 and 382 retinol equivalents (RE) were the daily estimates of vitamin A intakes among male and female children, respectively. Animal foods made up 39 and 54% of the total vitamin A intake among male and female children, respectively. The aforementioned estimates of total vitamin A intakes were 58 and 81%, respectively, of the FAO/WHO requirements (35 RE/kg). Children from high socio-economic class had significantly higher (P < 0.05) mean vitamin A intake compared with the respective mean intake obtained with poor children. Serum vitamin A concentrations correlated significantly with the respective vitamin A intakes. A 10-week vitamin A intervention trial using either pharmaceutical vitamin A preparations or a food-based strategy consisting of carrot jam led to significant improvement in the growth velocity of the beneficiaries compared with the control group.     

山东省部分农村地区学龄前儿童膳食营养现状研究

目的了解山东省农村地区学龄前2~7岁儿童膳食营养状况,为科学合理的饮食、有针对性地开展营养干预,促进儿童健康成长提供现实依据。方法采用24h膳食回顾法调查儿童3d饮食情况,计算主要能量、蛋白质等营养素摄入;测量身高、体重,采用Z评分法进行生长发育评价。结果调查儿童膳食结构不合理,食物消费率低且摄入量不足;分别有32.7%和35.9%的调查儿童能量和蛋白质的摄入量达不到RNIs的80%;微量元素的摄入量均达不到推荐摄入量的标准;儿童低体重率为4.1%,生长迟缓率为4.3%。结论膳食营养问题突出,应加强对山东农村地区儿童家长营养知识的宣传教育,开展营养干预,保障儿童健康成长。     

裕固族3～6岁儿童营养状况6年对比分析

目的:了解裕固族3～6岁儿童6年前后(2003年与2009年)营养状况的变化情况,探讨该人群当前可能存在的营养相关性疾病,为我国少数民族儿童营养干预提供依据。方法:采用随机整群抽样的方法,随机抽取甘肃省肃南县裕固族聚居区140例3～6岁裕固族儿童,进行24h回顾法结合记账法的膳食调查及体格检查,并与6年前的调查结果进行对比分析。结果:调查对象膳食构成仍以粮谷类为主,动物性食物及豆类的摄入量较6年前有明显的提高,蔬菜类摄入量下降;多种营养素的摄入量较6年前有较大幅度提高,但是维生素A、维生素C、钙、锌的摄入量仍未能达到推荐摄入量(RNI)的60%;体格发育状况较6年前得到一定的改善。结论:裕固族3～6岁儿童营养状况较6年前得到了改善,但是一些营养素摄入不足问题依然存在,提示有必要提高该群体新鲜蔬菜、水果、蛋类等食物的摄入量,进一步改善该人群营养状况。     

Vitamin A deficiency among preschool children in a rural area of Egypt: the results of dietary assessment and biochemical assay

Vitamin A status was evaluated among a cohort of preschool children (mean age 43 months) pertinent to a traditional society in rural Egypt. The Helen Keller International food frequency questionnaire, the 7-day 24-h dietary recall method and serum vitamin A concentrations were the criteria used for the evaluation. Mean values of 280 and 382 retinol equivalents (RE) were the daily estimates of vitamin A intakes among male and female children, respectively. Animal foods made up 39 and 54% of the total vitamin A intake among male and female children, respectively. The afore-mentioned estimates of total vitamin A intakes were 58 and 81%, respectively, of the FAO/WHO requirements (35 RE/kg). Children from high socio-economic class had significantly higher (P < 0.05) mean vitamin A intake compared with the respective mean intake obtained with poor children. Serum vitamin A concentrations correlated significantly with the respective vitamin A intakes. A 10-week vitamin A intervention trial using either pharmaceutical vitamin A preparations or a food-based strategy consisting of carrot jam led to significant improvement in the growth velocity of the beneficiaries compared with the control group.     

1982年与2012年中国6~17岁学龄儿童膳食维生素A的摄入比较

  目的  了解中国6~17岁学龄儿童(以下简称学龄儿童)膳食维生素A、视黄醇和胡萝卜素摄入水平,为促进儿童营养改善和健康成长提供基础数据。  方法  通过分析1982年全国营养调查和2012年中国居民营养与健康状况监测中的膳食调查数据,计算学龄儿童每人每天各种食物及调味品摄入量。根据1982年与2012年的食物成分表,分别计算动物性食物来源的视黄醇和植物性食物来源的胡萝卜素摄入量,并将二者折合计算维生素A总量,与维生素A的推荐摄入量(recommended nutrient intake, RNI)进行比较。  结果  中国学龄儿童膳食维生素A摄入总量(μg RAE)从1982年的(333.3±15.9)μg RAE下降到2012年的(215.3±9.5)μg RAE(F=61.95, P < 0.001);其中,视黄醇摄入量从(28.4 ±2.0)μg增加到(107.6±4.8) μg(F=225.36, P < 0.001),胡萝卜素摄入量从(3 673.9±217.3)μg下降到(1 297.4±82.0)μg(F=214.98, P < 0.001)。1982年儿童膳食维生素A摄入总量为农村高于城市(F=5.28, P=0.022),2012年则为城市高于农村(F=14.85, P < 0.001)。2012年仅有四分之一的儿童膳食维生素A摄入量达到80%RNI以上。  结论  1982—2012年中国学龄儿童膳食维生素A摄入水平整体有所下降,动物性食物贡献率有所增加,植物性食物贡献率大幅度降低。建议加强膳食指导,丰富农村儿童食物供应的种类,改善儿童的维生素A营养状况。     

Intake of vitamin A-rich foods and lung cancer risk in Taiwan: with special reference to garland chrysanthemum and sweet potato leaf consumption

A case-control study was conducted to investigate the association between the consumption of local common foods that are rich in vitamin A and the risk of lung cancer in Taiwan. A total of 301 incident lung cancer cases, 602 hospital controls, and 602 neighborhood controls were recruited. The consumption of 13 food items and vitamin supplements was estimated by use of a food frequency questionnaire. The conditional logistic regression models were used to estimate the adjusted odds ratios (AOR) and 95% confidence intervals (CI) for lung cancer risk with each control group as reference by adjustment of covariates. A reduced risk for lung cancer was found to be associated with increased intakes of vitamin A, alpha-carotene, and beta-carotene from 13 food items. More servings of vegetables (AOR for the highest versus the lowest quartile = 0.67-0.70, 95% CI = 0.42-1.08, (plinear trend )= 0.04), garland chrysanthemum (AOR for the highest versus the lowest tertile = 0.58-0.74, 95% CI = 0.37-1.14, (plinear trend )<= 0.04) and sweet potato leaves (AOR for the highest versus the lowest tertile = 0.43-0.65, 95% CI = 0.28-0.96, (plinear trend )<= 0.03) were associated with the reduced risk for lung cancer. In conclusion, higher consumption of vitamin A-rich vegetables, especially garland chrysanthemum and sweet potato leaves might provide potential protection from lung cancer.     

健康教育对临床护士营养现状和营养KAP影响的效果评价

目的了解基层临床护士营养知识、态度、行为(knowledge-attitude-practice,KAP)及营养现状,评价营养健康教育对临床护士的干预效果。方法将某基层医院360名护士随机分成干预组和对照组,每组180人,干预组进行为期12个月的营养健康干预后,再次进行问卷调查,将两组结果进行比较分析。结果干预组护士营养KAP调查评分明显较高,与对照组比较差异具有统计学意义(P<0.01);护士膳食能量、营养素日平均摄入量方面,将干预组和对照组与推荐摄入量(recommended nutrient intake,RNI)标准比较,干预组的能量、维生素A、维生素B、维生素D、钙、磷、钠、锌、硒、铜、碘、生物素等摄入量明显提高(P<0.01),更接近RNIs值。结论通过对临床护士进行营养健康教育,其营养摄入状况和营养KAP有很大提高。     

Schoolchildren's food consumption and dietary intake during the dry season in north-west Namibia

The diet of school-aged children in north-west Namibia was investigated. Data on food consumption were collected using the 24-h recall interview method. The field study was conducted during the dry season. The subjects were schoolchildren aged between 8 and 15 years living in either a small town (n=43) or a rural area (n=10). In town, the main sources of energy were maize porridge and wheat bread, and for the rural children, sour milk and maize. The consumption of vegetables, fruit and legumes was very low in both groups. The mean intakes of energy were 6.7 MJ/day for children living in town and 4.7 MJ/day for rural subjects. The intakes of vitamin A, vitamin C and folate were inadequate in both groups. Our findings show that during the dry season, the diets of Namibian school-aged children are monotonous.     

Dietary vitamin A intakes of preschool-age children in South India.

The vitamin A intake of children aged 1-3 y (n = 683) was assessed using a quantitative food-frequency questionnaire in a vitamin A intervention study in South India. Trained field workers interviewed mothers about their children's usual consumption of common sources of vitamin A and collected information on portion sizes using standard cups. Mothers were asked to state the number of months in a year during which specific seasonal foods were available. Information about current breast-feeding was also obtained. Vitamin A intakes from nonbreast milk sources were extremely low at all ages. The median intake of total vitamin A, beta-carotene and retinol was 121, 100 and 21 retinol equivalents (RE), respectively. Maternal education and socioeconomic status (SES) were positively associated with total vitamin A and retinol intakes. Girls had significantly lower intakes than boys even after adjusting for differences in age, maternal education, SES and breast-feeding status. Breast-feeding was common, but declined to 60% by 24 mo and to 15% by 36 mo. Vitamin A intakes from nonbreast milk sources increased with age only for currently breast-fed children, who tended to be of lower SES. After taking into account the potential contribution of breast milk by using published estimates, nonbreast-fed children met only 60% of the Indian recommended dietary allowance (RDA; 250 RE/d), whereas breast-fed children met approximately 90% of the RDA during y 2 of life.     

Fresh Kids: the efficacy of a Health Promoting Schools approach to increasing consumption of fruit and water in Australia

The Fresh Kids programme utilized the Health Promoting Schools (HPSs) framework to design a whole-of-school, multifaceted intervention targeting specific behaviours to promote healthy eating and reduce the risk factors associated with childhood obesity. The aim of the programme was to evaluate the effectiveness of the HPS framework to increase fruit and water consumption among primary school-aged children over a 2-year period. The study design was an interrupted time series. Four primary schools in the inner west of Melbourne, Australia, participated in the programme intervention. Baseline data were collected using a lunch box audit to assess the frequency of children with fresh fruit, water and sweet drinks, either brought from home or selected from canteen lunch orders. The lunch box audit was repeated periodically for up to 2 years following programme implementation to assess the sustainability of dietary changes. Across all participating schools, significant increases between 25 and 50% were observed in the proportion of children bringing fresh fruit. Similarly, all schools recorded increases between 15 and 60% in the proportion of students bringing filled water bottles to school and reductions between 8 and 38% in the proportion of children bringing sweet drinks. These significant changes in dietary patterns were sustained for up to 2 years following programme implementation. Targeting key nutrition behaviours and using the HPS framework is an effective and simple approach which could be readily implemented in similar childhood settings. Effective strategies include facilitating organizational change within the school; integrating curriculum activities; formalizing school policy and establishing project partnerships with local community nutrition and dietetic services.     

黄绿色蔬菜改善学龄前儿童Vit A营养的研究

目的:研究增加富含Vit A原的黄绿色蔬菜是否能改善儿童的Vit A营养状态。方法:2007年9~12月在鹤壁市某幼儿园使用富含类胡萝卜素的蔬菜进行干预试验。选择年龄为5.3~6.5岁的儿童41名,其中39.02%(16名)的儿童血清视黄醇低于0.30mg/L,处于边缘缺乏状态。试验分为两组:对照组,不改变日常膳食,平均每人每日摄入193g浅色蔬菜和56g黄绿色蔬菜;试验组,平均每人每日摄入238g黄绿色蔬菜和34g浅色蔬菜。结果:试验组儿童的平均血清视黄醇浓度比试验前有所升高,而对照组在试验后显著降低,并且显著低于试验组。结论:膳食黄绿色蔬菜对改善儿童的Vit A营养有重要影响。     

An analysis of potato consumption habits and diet quality among adults and children in the UK

Many people are confused about the nutritional role of potatoes in a healthy, balanced diet. Starchy foods are often under‐regarded by the public and maligned by proponents of low carbohydrate diets, yet carbohydrate should supply around 50% of dietary energy, preferably from sources such as potatoes, pulses and wholegrains. Potatoes provide significant quantities of shortfall micronutrients, yet they do not count as vegetables in 5 A DAY targets. To provide balanced advice, research is needed on potato consumption and its possible nutritional consequences. Therefore we analysed individual dietary records from the National Diet and Nutrition Survey 2008–2012 to investigate potato consumption patterns and associations with nutrient intakes. We hypothesised that high consumption of potatoes would be associated with higher total intakes of potassium, B vitamins and fibre. Across the whole population, potatoes provided 7% of energy, 15% of potassium, 13% of dietary fibre (non‐starch polysaccharide) and vitamin C, 14% of vitamin B₆, 10% of folate, 8% of magnesium and 6% of iron. Both very low and very high consumption of potatoes (Q1 and Q5) was associated with lower energy and nutrient intakes, compared with average consumers. Lower micronutrient intakes were most pronounced in Q5 (mean 14.8% energy from potatoes), although Q1 had lowest intakes of potassium, vitamin B₆ and thiamin. Food intakes suggest a less healthy, varied dietary pattern among high potato consumers. Conversely, low consumers of potatoes had lower intakes of potassium, thiamin and vitamin B₆ (all found in potatoes) despite an apparently health‐conscious dietary pattern that included higher consumption of fruit, vegetables and fish. Our study suggests that based on current habits, a broad range of potato consumption is compatible with good nutrition, while high reliance on potatoes may be associated with an unbalanced diet. To help raise intakes of shortfall nutrients such as potassium and fibre, consumption of potatoes could be encouraged alongside existing healthy eating messages relating to vegetables, fruit and wholegrain foods.     

Schoolchildren's food consumption and dietary intake during the dry season in north-west Namibia

The diet of school-aged children in north-west Namibia was investigated. Data on food consumption were collected using the 24-h recall interview method. The field study was conducted during the dry season. The subjects were schoolchildren aged between 8 and 15 years living in either a small town (n=43) or a rural area (n=10). In town, the main sources of energy were maize porridge and wheat bread, and for the rural children, sour milk and maize. The consumption of vegetables, fruit and legumes was very low in both groups. The mean intakes of energy were 6.7 MJ/day for children living in town and 4.7 MJ/day for rural subjects. The intakes of vitamin A, vitamin C and folate were inadequate in both groups. Our findings show that during the dry season, the diets of Namibian school-aged children are monotonous.     

Estimated nutrient intakes and adequacies in Bangladesh change when newer values for vitamin A,iron and calcium in commonly consumed foods are applied

A food consumption survey was conducted in rural Bangladesh in January–March 1996 using a 24-h food weighing method. Intakes and adequacies of energy, vitamin A, vitamin C, iron and calcium were estimated for 81 children (aged 24–71 months) and 182 women (aged 18–45 years) using three sets of food composition tables. The local food composition table was modified with newer values for nutrient contents of foods identified as important for the contribution of vitamin A and iron. Significant differences in estimated dietary intakes and adequacies were found for vitamin A and iron when different sets of food composition values were used. This study shows that up-to-date chemical analyses of foods selected on the basis of a high frequency of consumption and a large contribution of the nutrients in focus is a useful approach in improving the quality of food composition tables, resulting in greater accuracy of estimates of nutrient intakes and adequacies.