补充维生素A对集体学龄前儿童血红蛋白的影响

【目的】　为探讨血清维生素 (VA)浓度对儿童血红蛋白的影响。　【方法】　对集体学龄前贫血儿童投维生素A每日 2 0 0 0IU ,观察治疗前后血红蛋白、血清铁、血清VA浓度的变化。　【结果】　亚临床状态VA缺乏占 31.6 % ,可疑缺乏占 5 8% ,仅 10 .4 %的儿童血清VA浓度正常 ;贫血组儿童血清VA量明显低于非贫血组 (P <0 .0 1)。给贫血组儿童投VA 2 0 0 0U/d ,3个月后 ,血红蛋白、血清铁、血清VA浓度明显提高 (P <0 .0 1) ,对照组无明显改变。　【结论】　亚临床状态VA缺乏在儿童中已是很重要的营养问题 ,并与贫血有一定关系 ,补充维生素A对儿童血红蛋白、血清铁、血清VA浓度有一定的影响     

每周补充维生素A及每周补铁对学龄前儿童贫血的干预试验

【目的】　了解每周补充维生素A及每周补铁对改善学龄前儿童铁和维生素A营养状况的效果。　【方法】　将筛选出的铁和 /或维生素A缺乏儿童随机分成三组 ,每周分别给予 5万IU维生素A胶丸、60mg元素铁、10mg维生素B1,补充 4周后观察Hb、血清VA、铁蛋白、运铁蛋白受体的变化情况。　【结果】　干预前后 ,补铁组、补维生素A组以及补维生素B1组Hb值分别上升 8.8g/L ,10 .8g/L ,7.2 g/L(P <0 .0 0 1) ;补维生素A组和补维生素B1组血清VA分别上升 0 .13 7μmol/L ,0 .10 3 μmol/L(P <0 .0 0 1) ,而补铁组血清VA补充前后差异无显著性。各组铁蛋白在补充后显著性降低 ,而运铁蛋白受体显著升高。　【结论】　①由幼儿园教师监督实施每周补铁是行之有效的。②维生素A缺乏会影响铁向组织的转运和造血过程。③维生素A和铁缺乏同时存在地区 ,每周补维生素A与每周补铁在改善贫血上效果一致。     

维生素A干预对大鼠抗氧化能力及细胞膜流动性影响的研究

目的　通过对大鼠补充不同剂量维生素A(VA)观察机体抗氧化能力及对红细胞膜流动性的影响 ,了解抗氧化活性的最佳剂量。方法　将Wistar大鼠随机分为 4组 ,分别为维生素A缺乏组 (VA1组 )补充1 1 4 3(VA2组 )、4 2 86 (VA3组 )和 1 4 2 86 μgRE·kg- 1 ·d- 1 (VA4组 )维生素A三个剂量组。测定各组大鼠血浆VA含量、SOD、MDA和GSH Px的含量和活性 ,用荧光偏振度P值和微粘度 η值评价红细胞膜的流动性。 结果　各组血浆中VA水平随补充剂量的增加而增加。血浆中SOD、GSH -Px和MDA的结果显示 ,补充剂量为VA2、VA3组SOD的水平较VA缺乏组和VA4组明显偏低 (P <0 0 1 )。VA3组的MDA较其它 3个剂量组明显下降 (P <0 0 1 )。VA4组的SOD、MDA含量明显高于其它三个剂量组 (P <0 0 1 )。VA3组血浆中GSH -Px的活性明显升高 ,P <0 0 1。细胞膜流动性的结果显示 :VA3组P值最小 (P <0 0 1 ) ;VA4组P值明显增高 (P<0 0 1 )。微粘度 η在VA3组与VA缺乏组和VA2组之间未见明显差异 ,与VA4组相比明显下降 (P <0 0 1 )。结论　维生素A补充剂量为 4 2 86 μgRE·kg- 1 ·d- 1 时 ,能够发挥较好抗氧化作用 ,红细胞膜的流动性明显增加 ,过量摄入维生素A可造成机体的中毒反应 ,增加机体的氧化损伤     

补充维生素A与铁对改善学龄前儿童贫血和免疫功能的影响

目的为观察学龄前儿童亚临床维生素A(VA)缺乏状态缺铁时,机体免疫功能的变化以及VA与铁同时补充对改善儿童铁营养状况和免疫功能的影响.方法检测北京农村270名3～7岁儿童血清VA含量和血红蛋白(Hb)、血清铁(SI)、运铁蛋白饱和度(TS)及血清铁蛋白(SF)后,将其分为正常、低 VA、低铁和低VA低铁4组,每组选40人,检测血清免疫球蛋白IgA、IgG、IgM 与白细胞介素-2(IL-2).然后将低VA低铁组儿童随机分为补铁组 (每日口服相当于30 mg元素铁的硫酸亚铁,连续8周)和补VA+铁组(口服VA胶丸12 500 IU /次,2次/周,连续8周;口服铁量同补铁组,连续8周),分别进行干预.干预后重复检测血清VA、血液铁生化指标和以上免疫指标,进行两组间比较,并与干预前比较. 结果低VA低铁组儿童血清IgM为(1 260±310) mg/L显著高于正常组的(1 0 7 0±170) mg/L.对其实施VA+铁联合干预后,血清TS为(26.5±8.6)%,明显高于补铁前的(16.2±1.6)%和单纯补铁组的(22.3±3.8)%;IL-2在VA与铁同时补充后为(2 78.9±117.7) ng/L,显著高于补充前的(161.6±90.3) ng/L和单纯补铁组的(189 .5 ±89.3)ng/L的水平;其他铁生化指标和免疫指标无明显变化.结论对存在亚临床VA缺乏状态的缺铁儿童实施一定剂量的VA+铁联合干预,对改善机体铁营养状况和免疫功能有明显作用.     

肺炎和腹泻患儿维生素A状况的分析

【目的】　探讨肺炎、腹泻患儿的维生素A(VA)状况并对其进行分析。　【方法】　用血清VA值评价 60例肺炎、85例腹泻患儿和 10 0名健康儿童的血清VA状况。用相对剂量反应 (RDR)深入研究患儿体内VA状况并对其进行多元回归分析。以血清VA <0 .7μmol/L ,RDR≥ 2 0 %为亚临床VA缺乏 (SVAD)诊断标准。 　【结果】　肺炎、腹泻患儿的血清VA值分别为 (1.0± 0 .4) μmol/L、(0 .7± 0 .4) μmol/L ,明显低于健康儿童 (1.9± 0 .6) μmol/L(P <0 .0 1)。肺炎、腹泻患儿的RDR均值分别为 2 3 %± 2 0 % ,2 3 %± 13 % ,SVAD检出率分别为 43 .3 %和 61.2 % (P <0 .0 5 )。肺炎患儿的RDR值和SVAD检出率以小年龄农村、发热组为高 (P <0 .0 5 )。腹泻患儿的RDR值和SVAD检出率以小年龄、脱水组为高 (P <0 .0 1)。多元回归分析提示 :家居农村发热是肺炎患儿 ,小年龄、热度高、脱水是腹泻患儿SVAD的影响因素。　【结论】　肺炎、腹泻患儿的血清VA状况劣于健康儿童。年龄小、家居农村、发热和脱水与其体内VA状况关系较密切     

我国0～6岁儿童血清维生素A水平调查

【目的】　调查我国 0～ 6岁儿童的维生素A(VA)营养状况。　【方法】　以分层抽样法将全国划分为沿海、内地和边远三层 ,抽取 1 4个省、市、自治区的 8669名儿童进行问卷和血清VA含量测定。以FoxBase建立数据库 ,以Epinfo软件统计分析 ,计量资料用F、t检验和多元回归处理。　【结果】　儿童血清VA均值为(1 .0 6± 0 .33) μmol/L ,亚临床维生素A缺乏 (SVAD)患病率为 1 1 .7%。儿童血清VA水平随着年龄的增长 ,富含VA食物摄入频率的增加 ,所在地区呼吸道、发热、腹泻发病率的降低 ,家庭年人均收入和所在地区年人均国民生产总值 (GNP)的升高 ,母亲受教育程度的升高而逐渐升高(P均 <0 .0 0 0 )。儿童血清VA水平 ,取血前 2周内曾患呼吸道感染、发热、腹泻者明显低于未曾患病者。母亲是少数民族者明显低于母亲是汉族者 (P均 <0 .0 0 0 )。多元回归结果表明 :年龄小 ,未食用乳、蛋、鱼虾、肝炎、鱼肝油 ,曾患呼吸道感染、腹泻 ,所在地区及家庭经济状况差 ,母亲文化程度低 ,母亲为少数民族是其血清VA水平低下的危险因素。　【结论】　我国儿童血清VA含量尚处于较低水平     

浙江省0～4岁儿童血清维生素A水平抽样调查及影响因素分析

【目的】调查浙江省0~4岁儿童血清维生素A缺乏(vitamin A deficiency,VAD)的流行病学概况及危险因素,为防治VAD提供依据。【方法】采用分层抽样的方法抽取符合条件的儿童,抽取静脉血进行血清维生素A(vi-tamin A)水平的测定,并同时请家长填写喂养和家庭状况调查问卷。【结果】共抽取适龄儿童357名,平均血清VA水平为(1.653±0.47)μmol/L,亚临床VA缺乏的发生率为3.08%;1岁以内缺乏的发生率最高,随年龄增加,发生率逐渐下降;不同性别儿童的血清VA水平和VAD的发生率差异无显著性;回归分析发现居住农村、父母教育水平低、不规律口服VA胶丸和年龄小的儿童是VAD的高危人群。【结论】浙江省0~4岁儿童血清VAD的发生率较1998年明显下降,但仍属轻度缺乏的地区,高危因素是儿童年龄小、居住在农村、父母受教育程度低和未口服VA胶丸。     

VA对电离辐射损伤大鼠组织VE含量的影响

目的 :观察VA、VE联合应用对大鼠在电离辐射损伤中组织VE含量的变化 ,为治疗和预防自由基损伤相关疾病和抗氧化剂合理的应用提供理论依据。方法 :SD大鼠随机分成 8组 ,分别为阴性对照组、阳性对照组、VA(10mg·kg 1)组、VE(30mg·kg 1)组、和VA、VE联合用药 4组 (VE剂量固定在 30mg·kg 1,而VA剂量分别为 2 0、10、5、2 .5mg·kg 1) ,给药 6d后 ,除阴性对照组以外 ,其余各组均用 6 0　Co(6Gy)照射 ,3d后宰杀 ,并检测血清、脑及肝组织内的VA、VE含量。结果 :动物经辐照后 ,组织VA、VE含量均明显下降 (P <0 .0 5 )。单纯补充VA组的脑、肝组织中VA含量分别为 (14 .2 1± 1.6 8)、(86 .5 7± 3.97) μg·ml 1,较阳性对照组的 (8.31± 2 .0 6 )、(18.90±9.89) μg·ml 1明显升高 (P <0 .0 5 ) ;单纯补充VE组的血清、脑、肝VE含量分别为 (16 .5 7± 1.71)、(2 8.36± 3.98)、(41.6 3± 8.7) μg·ml 1,较阳性对照组的 (3.71± 1.12 )、(10 .96± 2 .74 )、(2 7.15±3.5 ) μg·ml 1明显升高 ;给予固定的VE剂量同时变动VA的干预剂量后 ,则血清、脑、肝组织VE含量随着VA剂量的增加呈现逐渐下降趋势 ,在VA为 10或 2 0mg时组织VE含量虽略回升 ,但仍低于初始剂量 (不含VA)组〔血清VE :(14 .0 4± 4 .6 9)vs(16 .5     

北京和贵州地区儿童维生素A缺乏的影响因素分析

【目的】　了解北京和贵州地区儿童维生素A缺乏 (vitaminAdeficiency ,VAD)的现状和影响因素。　【方法】　从两地区各选择一市二县共 12 3 6名儿童 ,其中北京随机选择城区儿童 2 0 2名、农村儿童 42 6名 ;贵州随机选择城区儿童 2 0 7名、农村儿童 40 1名。各地调查儿童年龄范围均为 0～ 71个月。采用自行设计的膳食频率问卷表对每位被调查儿童询问调查前 1周儿童的饮食摄入情况 ,并采集儿童指血 2 0 0 μl,用微量荧光法检测血清VA值。 　【结果】　城区儿童血清VA水平 (平均 1.2 7μmol/L)明显高于农村 (平均 1.0 2 μmol/L) ;北京地区儿童血清VA水平(平均 1.17μmol/L)明显高于贵州地区 (平均 1.0 3 μmol/L)。各地区被调查儿童家庭收入也呈现贵州低于北京、农村低于城区的状况 ,儿童血清VA水平和家庭收入呈正相关 (r =0 .2 3 9,P <0 .0 1)。在所有调查地区中 ,贵州农村地区儿童血清VA水平最低 (平均 0 .92 μmol/L) ,家庭收入也最低 (年收入平均 180 0元 )。在调查的所有年龄组儿童中 ,婴儿组血清VA水平最低 ( 2 8.8μmol/L) ,可疑亚临床VAD发生率最高 ( 5 0 .0 %) ,血清VA水平与年龄呈正相关 (r =0 .13 2 ,P <0 .0 1)。儿童饮食摄入呈现明显的地区差异 ,动物性食品高摄入频率的比例北京地区高于贵州     

补充维生素A和铁对孕妇铁营养状况的影响

目的　研究补充维生素 A、铁对孕妇铁营养状况的影响。方法　对 1 6 7名孕中期妇女进行铁和维生素 A营养状况的横断面调查并随机分成 4组 :对照组 (复合维生素 B片每日一片 ) ;补充维生素 A组 (1 1 0 0 μg/d) ;补充铁组 (6 0 mg/d元素铁 ) ;补充维生素 A和铁组 (VA1 1 0 0μg/d,Fe6 0 mg/d) ,共补充 1 0 w。结果　被调查孕妇孕中期维生素 A轻度缺乏率为 0 .6 % ,贫血患病率为 7.8% ,贮存铁缺乏率为 6 .2 %。血清 VA水平补充前各组正常 ,补充后对照组明显下降 ,但仍维持在正常范围。补 VA、补铁及补 VA+铁组血清 VA与补充前无明显差异 ,仍保持恒定。各组补充前后 Hb均在正常范围 ,差别不显著。血清铁蛋白、游离红细胞原卟啉及运铁蛋白饱和度补充后的改善效果均以补充 VA铁组优于单独补 VA或补铁组。结论　孕期同时补充 VA和铁对改善铁的营养状况优于单纯补铁。     

A multiple-micronutrient-fortified beverage affects hemoglobin, iron, and vitamin A status and growth in adolescent girls in rural Bangladesh

Adolescent girls have high nutrient needs and are susceptible to micronutrient deficiencies. The objective of this study was to test the effect of a multiple-micronutrient-fortified beverage on hemoglobin (Hb) concentrations, micronutrient status, and growth among adolescent girls in rural Bangladesh. A total of 1125 girls (Hb > or = 70 g/L) enrolled in a randomized, double-blind, placebo-controlled trial and were allocated to either a fortified or nonfortified beverage of similar taste and appearance. The beverage was provided at schools 6 d/wk for 12 mo. Concentrations of Hb and serum ferritin (sFt), retinol, zinc, and C-reactive protein were measured in venous blood samples at baseline, 6 mo, and 12 mo. In addition, weight, height, and mid-upper arm circumference (MUAC) measurements were taken. The fortified beverage increased the Hb and sFt and retinol concentrations at 6 mo (P < 0.01). Adolescent girls in the nonfortified beverage group were more likely to suffer from anemia (Hb <120 g/L), iron deficiency (sFt <12 microg/L), and low serum retinol concentrations (serum retinol <0.70 micromol/L) (OR = 2.04, 5.38, and 5.47, respectively; P < 0.01). The fortified beverage group had greater increases in weight, MUAC, and BMI over 6 mo (P < 0.01). Consuming the beverage for an additional 6 mo did not further improve the Hb concentration, but the sFt level continued to increase (P = 0.01). The use of multiple-micronutrient-fortified beverage can contribute to the reduction of anemia and improvement of micronutrient status and growth in adolescent girls in rural Bangladesh.     

Synergistic effect of zinc and vitamin A on the biochemical indexes of vitamin A nutrition in children.

BACKGROUND: Zinc deficiency limits the bioavailability of vitamin A. Because zinc and vitamin A deficiency often coexist in malnourished children, simultaneous zinc and vitamin A supplementation may improve the vitamin A deficiency in these children. OBJECTIVE: A randomized, double-blind, placebo-controlled intervention trial was conducted to evaluate whether combining zinc and vitamin A supplementation would improve the biochemical indexes of vitamin A nutriture. DESIGN: Children aged 12-35 mo were randomly assigned to 1 of 4 intervention groups: 20 mg Zn/d for 14 d (Z group), 60000 retinol equivalents (200000 IU) vitamin A on day 14 (A group), zinc plus vitamin A (ZA group), or placebo syrup and placebo capsule (placebo group). Venous blood was drawn at enrollment and on day 21. RESULTS: Mean serum retinol concentrations were not significantly different between the A and ZA groups. Among vitamin A-deficient children, the proportion of children who remained vitamin A deficient (serum retinol <0.7 micromol/L) after supplementation was 40.6% in the Z group, 37.5% in the A group, and 47.0% in the placebo group; only 13.3% in the ZA group remained vitamin A deficient (P < 0.05 compared with the placebo group). The proportion of children whose retinol binding protein concentrations remained low was significantly lower in the ZA group than in the other groups (P < 0.05). CONCLUSION: Combined zinc and vitamin A supplementation improves vitamin A nutriture in vitamin A-deficient children.     

Effect of vitamin A, vitamin A plus iron and multiple micronutrient-fortified seasoning powder on infectious morbidity of preschool children

Objective

Improvement of hemoglobin and serum retinol and facilitation of the mobilization of iron storage were achieved with a multiple-micronutrient-fortified diet in preschoolers for 6 mo in a suburb of Chongqing, China. We investigated whether fortification with multiple micronutrients in a diet for preschool children results in changes in children's infectious morbidity compared with diets fortified solely with vitamin A and with vitamin A plus iron.

Methods

From December 2005 to June 2006, 226 2- to 6-y-old preschool children were recruited from three nurseries randomly assigned to three different fortified-diet groups for 6 mo. Group I was fortified with vitamin A; groups II and III were fortified with vitamin A plus iron and vitamin A plus iron, thiamine, riboflavin, folic acid, niacinamide, zinc, and calcium, respectively. The secondary functional outcomes, morbidity of diarrhea and respiratory infection, were collected during supplementation.

Results

The groups were comparable concerning compliance and loss to follow-up. There was evidence of a lower incidence rate of respiratory-related illnesses, diarrhea-related illness, fewer symptoms of runny nose, cough, and fever, and shorter duration of respiratory-related illnesses and cough for children in group III compared with children in groups I and II. However, there was no significantly or clinically important difference between children in groups I and II.

Conclusion

The beneficial effects on infectious morbidity over 6 mo, in addition to some biochemical improvements, highlight the potential of this micronutrient-fortified seasoning powder supplied in a diet for preschool children.     

Community-level micronutrient fortification of a food supplement in India: a controlled trial in preschool children aged 36-66 mo

BACKGROUND: Children participating in the Integrated Child Development Service (ICDS) in India have high rates of iron and vitamin A deficiency. OBJECTIVE: The objective was to assess the efficacy of a premix fortified with iron and vitamin A and added at the community level to prepared khichdi, a rice and dal mixture, in increasing iron and vitamin A stores and decreasing the prevalence of iron deficiency, anemia, and vitamin A deficiency. DESIGN: This cluster, randomized, double-blind, controlled trial was initiated in 30 Anganwadi centers (daycare centers) in West Bengal state, India. Children aged 36-66 mo (n = 516) attending village-based ICDS centers were randomly assigned to receive either a fortified or a nonfortified premix for 24 wk. Blood was drawn at 0 and 24 wk by venipuncture for the measurement of hemoglobin, serum ferritin, and serum retinol. RESULTS: The change in the hemoglobin concentration of anemic children was significantly different between fortified and nonfortified khichdi groups (P < 0.001). Prevalence rates of anemia, iron deficiency, and iron deficiency anemia were significantly lower after 24 wk in the fortified-khichdi group than in the nonfortified-khichdi group (P < 0.001). There were no significant differences in serum retinol concentrations or in the prevalence of vitamin A deficiency between the fortified- and nonfortified-khichdi groups. CONCLUSION: A premix fortified with iron, vitamin A, and folic acid and added to supplementary food at the community level can be effective at increasing iron stores and reducing the prevalence of iron deficiency and anemia.     

Weekly vitamin A and iron supplementation during pregnancy increases vitamin A concentration of breast milk but not iron status in Indonesian lactating women

Studies on the effect of vitamin A and iron supplementation during pregnancy on maternal iron and vitamin A status postpartum are scarce. We investigated whether retinol and iron variables in breast milk and in serum postpartum were enhanced more with weekly vitamin A and iron supplementation during pregnancy than with weekly iron supplementation. During pregnancy, subjects were randomly allocated to two groups and received either (n = 88) a weekly supplement of iron (120 mg Fe as FeSO(4)) and folic acid (500 microg) or (n = 82) the same amount of iron and folic acid plus vitamin A [4800 retinol equivalents (RE)]. Transitional milk (4-7 d postpartum) had higher (P < 0.001) concentrations of retinol and iron than mature milk (3 mo postpartum). Compared with the weekly iron group, the weekly vitamin A and iron group had a greater (P < 0.05) concentration of retinol in transitional milk (as micromol/L) and in mature milk (as micromol/g fat). Although serum retinol concentrations approximately 4 mo postpartum did not differ significantly, the weekly vitamin A and iron group had significantly fewer (P < 0.01) subjects with serum retinol concentrations < or = 0.70 micromol/L than the weekly iron group. Iron status and concentrations of iron in transitional and mature milk did not differ between groups. We have shown that weekly vitamin A and iron supplementation during pregnancy enhanced concentrations of retinol in breast milk although not in serum by approximately 4 mo postpartum. However, no positive effects were observed on iron status and iron concentration in breast milk.     

The early changes in retinol-binding protein and prealbumin concentrations in plasma of protein-energy malnourished children after treatment with retinol and an improved diet

1. Changes in total retinol-binding protein (RBP), the holoprotein (holoRBP) and prealbumin (PA) concentrations have been monitored in plasma of thirty protein- and vitamin A-deficient preschool children from within a few hours up to 7 weeks after treatment with retinol and a good-quality protein diet. 2. The children were classified into groups according to nutritional status as having either kwashiorkor, marasmus-kwashiorkor or marasmus, and given formula diets whose protein and energy contents increased stepwise from 1 g and 105 kJ/kg body-weight respectively up to 4 g and 733 kJ/kg body-weight after 4 weeks. Retinol was administered in the forms of retinyl palmitate either orally or intramuscularly. 3. PA and total RBP were determined by electroimmunoassay procedures and the holoRBP by its fluorescence after separation from other plasma proteins. 4. RBP in plasma of the vitamin A-deficient child is largely denatured and incapable of binding administered retinol, which must first be taken up by the liver before native holoRBP is released. An increased pool of native apoprotein accumulates in the liver during vitamin A deficiency which is released into plasma quickly after retinol uptake to form peak concentrations of total and holoRBP approximately 3 h after dosing intramuscularly and 6 h orally. 5. The accumulated pool of RBP was highest in livers from the marasmus group and lowest in those from the kwashiorkor group, reflecting their relative capacities to synthesize plasma proteins. 6. The mean plasma concentrations of total and holoRBP for the various groups were minimal 24-48 h after dosing with retinol and then improved almost linearly over the following week. 7. Mean plasma PA concentrations of the various groups on admission were also in order of the severity of their malnutrition. There was little or no change in this protein concentration over the first 24 h after dosing with retinol, but thereafter the mean values rose almost linearly over 2 weeks. Albumin on the other hand changed little during the first week. The results show that PA is the more sensitive measurement of protein nutritional status.     

The Effects of an Oil and Wheat Flour Fortification Program on Pre-School Children and Women of Reproductive Age Living in C?te d’Ivoire,a Malaria-Endemic Area

Anemia and micronutrient deficiencies are widespread in sub-Saharan Africa, but the impact of food fortification is still debated. The objective of this study was to estimate the iron and vitamin A status of preschool children (PSC) and women of reproductive age (WRA) in households consuming fortified oil and wheat flour. The survey was cross-sectional in a rural and an urban area. Data on demographics, socioeconomic status, and fortified foods were collected at households. Hemoglobin (Hb), retinol binding protein (RBP), ferritin, soluble transferrin receptors (sTfR), subclinical inflammation, and Plasmodium spp. infection data were collected. In PSC, vitamin A deficiency (VAD) was prevalent, but for each 1 mg retinol equivalents (RE)/kg of oil consumed, RBP increased by 0.37 μmol/L (p = 0.03). In WRA, there was no significant VAD in the population (0.7%). Anemia was found in 92.2% of rural and 56.3% of urban PSC (p < 0.001). PSC with access to adequately fortified flour had Hb concentrations 15.7 g/L higher than those who did not (p < 0.001). Hb levels increased by +0.238 g/L per mg/kg increase in iron fortification levels (p < 0.001). The national program fortifying vegetable oil with vitamin A and wheat flour with iron and folic acid may have contributed to improved micronutrient status of PSC from two areas in Côte d’Ivoire.     

Randomized efficacy trial of a micronutrient-fortified beverage in primary school children in Tanzania

BACKGROUND: Dietary supplements providing physiologic amounts of several micronutrients simultaneously have not been thoroughly tested for combating micronutrient deficiencies. OBJECTIVE: We determined whether a beverage fortified with 10 micronutrients at physiologic doses influenced the iron and vitamin A status and growth of rural children (aged 6-11 y) attending primary schools. DESIGN: In this randomized, double-blind, placebo-controlled efficacy trial, children were assigned to receive the fortified beverage or an unfortified beverage at school for 6 mo. RESULTS: There were nonsignificant differences at baseline between children in the fortified and nonfortified groups in iron status, serum retinol, and anthropometry. At the 6-mo follow-up, among children with anemia (hemoglobin < 110 g/L), there was a significantly larger increase in hemoglobin concentration in the fortified group than in the nonfortified group (9.2 and 0.2 g/L, respectively). Of those who were anemic at baseline, 69.4% in the nonfortified group and 55.1% in the fortified group remained anemic at follow-up (RR: 0.79), a cure rate of 21%. The prevalence of children with low serum retinol concentrations (< 200 microg/L) dropped significantly from 21.4% to 11.3% in the fortified group compared with a nonsignificant change (20.6% to 19.7%) in the nonfortified group. At follow-up, mean incremental changes in weight (1.79 compared with 1.24 kg), height (3.2 compared with 2.6 cm), and BMI (0.88 compared with 0.53) were significantly higher in the fortified group than in the nonfortified group. CONCLUSION: The fortified beverage significantly improved hematologic and anthropometric measurements and significantly lowered the overall prevalence of anemia and vitamin A deficiency.     

Efficacy of a vitamin A-fortified wheat-flour bun on the vitamin A status of Filipino schoolchildren

BACKGROUND: Wheat flour is a possible food vehicle for vitamin A fortification. OBJECTIVE: This study assessed the efficacy of consumption of a vitamin A-fortified wheat-flour bun (pandesal) on the vitamin A status of school-age children. DESIGN: This was a double-masked clinical trial conducted in 396 and 439 children aged 6-13 y attending 4 rural schools in the Philippines. The children were randomly assigned to a vitamin A-fortified (experimental) or nonfortified (control) group. A 60-g vitamin A-fortified pandesal (containing approximately 133 microg retinol equivalents) or a nonfortified pandesal was consumed by the children 5 d/wk for 30 wk. Vitamin A status, hemoglobin concentration, anthropometric status, morbidity, and dietary intake were assessed at baseline and 30 wk later. A modified relative dose response (MRDR) was assessed in a subsample of 20% of the children ( approximately 75/group) with the lowest initial serum retinol concentration at the 30-wk follow-up. RESULTS: Baseline serum retinol significantly modified the effect of the intervention. The fortified group, whose initial serum retinol concentrations were below the median, had a 0.07 +/- 0.03-micromol/L greater improvement in serum retinol at the 30-wk follow-up than did the control group (P: = 0.02). Improved vitamin A status was also evident in the MRDR subsample. End-of-study differences in the MRDR showed that vitamin A- fortified pandesal intake decreased the percentage of children with inadequate liver vitamin A stores by 50% (15.3% compared with 28.6%; P: = 0.05). CONCLUSIONS: Daily consumption of vitamin A-fortified pandesal significantly improved the vitamin A status of Filipino school-age children with marginal-to-low initial serum retinol concentrations.     

Children's consumption of dark green, leafy vegetables with added fat enhances serum retinol.

A randomized, double-blind, controlled study was conducted to determine whether the consumption of leafy vegetables by preschool children would enhance their serum vitamin A concentration to acceptable levels. Preschool children (n = 519; 2.5-6 y) in Saboba, northern Ghana, were randomly assigned to five feeding groups, differing essentially in the amount of fat and beta-carotene, fed once per d, 7 d per wk, for 3 mo. Serum retinol levels, anthropometric measurements, hemoglobin, rapid turnover proteins (pre-albumin and retinol-binding protein), worm infestation (stool examinations) and level of acute and chronic infection (serum C-reactive protein and acid glycoprotein) were determined before and after study. Relative to the baseline serum retinol values, consumption of dark green, leafy vegetables (Manihot sp. and Ceiba sp.) with fat (10 g/100 g) significantly (P < 0.05) enhanced serum retinol; consequently, the percentage of children with adequate retinol status increased from 28.2-48.2% after feeding (P < 0.05). There were no significant differences among groups, ages or pre- versus post-anthropometric measurements, hemoglobin concentration, or levels of worm infestation. The importance of these findings in alleviating and/or controlling vitamin A deficiency in developing countries is discussed.