[Is the Finnish "healthy margarine" food or medicine? Addition of plant sterols can lower cholesterol levels]

Sine the autumn of 1995, Benecol, a proprietary brand of cholesterol-lowering margarine, has been available in ordinary grocery shops in Finland. The active ingredient is a sitostanol ester. Several studies in humans have shown use of the margarine to result in an approximately 10 per cent reduction in total serum cholesterol, and a 13-15 per cent reduction of LDL-cholesterol. However, further studies are required of its phyto-oestrogenic and endocrine effects, and its effects on growing children, particularly regarding subsequent fertility in boys. Although the margarine is classed as a 'functional food' in Finland, the question arises where the line is to be drawn between medicines and food-stuffs.

Effect on plasma lipids and lipoproteins of replacing partially hydrogenated fish oil with vegetable fat in margarine

We have compared the effects on lipoproteins and haemostatic variables of two hard margarines with similar functional properties, one traditional margarine containing partially hydrogenated fish oil (PHFO), and one experimental margarine based on vegetable oil (VO). Both were all-purpose cooking margarines with nearly identical functional properties. Trans fatty acids from PHFO in the traditional margarine were replaced mostly by saturated, monounsaturated and trans fatty acids of vegetable origin in the new formulation. Both test margarines contained approximately the same amount of cis polyunsaturated fatty acids. Sixteen female normolipidaemic students consumed each diet with the two test margarines for 14 d in random order (crossover design). The amount of fat was 31% energy in the PHFO diet and 32% energy in the VO diet. The test margarines provided approximately 26% energy in both diets. In the PHFO diet 7.8% of the energy was derived from trans fatty acids and 9.2% from saturated fatty acids (12:0, 14:0 and 16:0) while in the VO diet, 1.1% energy was derived from trans fatty acids and 13.3% from saturated fatty acids (12:0, 14:0 and 16:0). The natural content of cholesterol in PHFO was deliberately not balanced by addition of cholesterol to the VO diet, thus the PHFO diet contained 215 mg and the VO diet 86 mg cholesterol per 8.5 MJ. LDL-cholesterol concentration was 19% higher in subjects on the PHFO diet compared with the VO diet (P < 0.01). The ratio LDL-cholesterol:HDL-cholesterol was 12.6% higher in subjects on the PHFO diet compared with the VO diet (P < 0.01). The level of apolipoprotein (apo)A-I was 6% lower in subjects on the PHFO diet compared with the VO diet (P < 0.01). The ratio apoB:apoA-I was 10.4% higher in subjects on the PHFO diet than on the VO diet (P < 0.01). There were no significant differences in total cholesterol, HDL-cholesterol, triacylglycerols, apoB, lipoprotein(a) and haemostatic variables between the diets. Our results demonstrate that PHFO, with its unfavourable effects on plasma lipids, can be replaced by vegetable oils in margarine without appreciable loss of functional properties but with significant improvement in the effects on plasma lipoproteins.

Comparable efficacy of hydrogenated versus nonhydrogenated plant sterol esters on circulating cholesterol levels in humans

A recent study in The Netherlands compared the effects of margarine enriched with different vegetable oil sterols with margarine containing sitostanol-ester on plasma total, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol concentrations. Margarine with sterolesters from soybean oil (mainly esters from sitosterol, campesterol, and stigmasterol) was as effective as a margarine with sitostanol-ester in lowering blood total and LDL cholesterol levels without affecting HDL cholesterol levels.

Effect of fish-oil-enriched margarine on plasma lipids, low-density-lipoprotein particle composition, size, and susceptibility to oxidation

We investigated the effect of incorporating n-3 polyunsaturated fatty acids (PUFAs) into the diet on the lipid-class composition of LDLs, their size, and their susceptibility to oxidation. Forty-seven healthy volunteers incorporated 30 g sunflower-oil (SO) margarine/d into their habitual diet during a 3-wk run-in period and then used either SO or a fish-oil-enriched sunflower oil (FO) margarine for the following 4 wk. Plasma concentrations of total cholesterol, triacylglycerols, HDL cholesterol, LDL cholesterol, and apolipoproteins A-I and B did not differ significantly between the groups during intervention. The FO margarine increased the concentration of n-3 very-long-chain PUFAs in the LDL particles, showing 93% (P < or = 0.0001), 8% (P = 0.05), and 35% (P = < 0.0001) increases in eicosapentaenoic acid, docosapentaenoic acid, and docosahexaenoic acid, respectively, in the FO group compared with 3%, 7%, and 7%, respectively, in the SO group during the intervention. The cholesterol content of the LDL particles increased in the FO group [total cholesterol: 6% (P = 0.008); cholesterol ester: 12% (P = 0.014)], although it was not significantly different from that in the control group, whereas the other lipid classes and the size of the LDL particles remained unchanged in both groups. A reduction in the alpha-tocopherol content in LDL (6%, P = 0.005) was observed in the FO group. Ex vivo oxidation of LDL induced with Cu2+ showed a significantly reduced lag time (from 91 to 86 min, P = 0.003) and lower maximum rate of oxidation (from 10.5 to 10.2 nmol x mg(-1) x min(-1), P = 0.003) after intake of the FO margarine. The results indicate that consumption of the FO compared with the SO margarine had no effect on LDL size and lipid composition and led to minor changes in LDL a-tocopherol content and oxidation resistance.

Oil blends containing partially hydrogenated or interesterified fats: differential effects on plasma lipids

We compared the effects on plasma lipids of margarines containing either a trans fatty acid- (TFA)-free hard fraction achieved through interesterification (from primarily saturated fatty acids) or a partially hydrogenated hard fraction. Thirty-eight mildly hyperlipidemic subjects consumed a low-fat diet for 2 wk. They were then allocated to 2 groups and underwent 3 dietary interventions for 3 wk each in random order (diets contained 35% of energy as fat with 20% of energy as margarines or butter): group 1 (n = 18), butter, canola oil blend with TFAs, and TFA-free canola oil blend: group 2 (n = 19), butter, polyunsaturated oil blend with TFAs, and TFA-free polyunsaturated oil blend. Plasma LDL-cholesterol concentrations after consumption of all oil blends and after the low-fat diet were not significantly different, but were 11-15% lower than after butter (P < 0.001). Whereas the canola oil blends did not differ from each other in their effects on lipoprotein profiles, the TFA-free polyunsaturated oil blend resulted in a significant 6% reduction (-0.25 mmol/L; 95% CI: -0.08, -0.42) in total and LDL cholesterol compared with the blend containing TFAs (P = 0.006). In the canola oil blend, 10% TFAs and 6% oleic acid were replaced by approximately 14% saturated fatty acids plus a 2% increase in linoleic acid. In the polyunsaturated oil blend, 10% TFAs and 5% linoleic acid were replaced by a 10% increase in saturated fatty acids as well as 3% and 1% increases in oleic and linolenic acids, respectively. We conclude that, compared with butter, TFA-free margarines may be equal to or more effective than margarines containing TFAs in lowering LDL cholesterol.

Plant sterol-enriched margarines and reduction of plasma total- and LDL-cholesterol concentrations in normocholesterolaemic and mildly hypercholesterolaemic subjects

OBJECTIVES

To compare effects on plasma total-, LDL-, and HDL-cholesterol concentrations of margarines enriched with different vegetable oil sterols or sitostanol-ester.

DESIGN

A randomized double-blind placebo-controlled balanced incomplete Latin square design with five treatments and four periods of 3.5 weeks. Margarines enriched with sterols from soybean, sheanut or ricebran oil or with sitostanol-ester were compared to a non-enriched control margarine. Sterol intake was between 1.5-3.3 g/d. Two thirds of the soybean oil sterols were esterified to fatty acids.

SETTING

Unilever Research Laboratory, Vlaardingen, The Netherlands.

SUBJECTS

One hundred healthy non-obese normocholesterolaemic and mildly hypercholesterolaemic volunteers aged 45+/-12.8 y, with plasma total cholesterol levels below 8 mmol/L at entry.

MAIN OUTCOME MEASURES

Plasma lipid, carotenoid and sterol concentrations, blood clinical chemistry and haematology, fatty acid composition of plasma cholesterylesters and food intake.

RESULTS

Ninety-five volunteers completed the study. None of the margarines induced adverse changes in blood clinical chemistry, serum total bile acids or haematology. Plasma total- and LDL-cholesterol concentrations were significantly reduced by 8-13% (0.37-0.44 mmol/L) compared to control for margarines enriched in soybean oil sterol-esters or sitostanol-ester. No effect on HDL-cholesterol concentrations occurred. The LDL- to HDL-cholesterol ratio was reduced by 0.37 and 0.33 units for these margarines, respectively. Effects on blood lipids did not differ between normocholesterolaemic and mildly hypercholesterolaemic subjects. Plasma sitosterol and campesterol levels were significantly higher for the soybean oil sterol margarine and significantly lower for the sitostanol-ester margarine compared to control. Dietary intake was very similar across treatments. The fatty acid composition of plasma cholesterylesters confirmed the good compliance to the treatment. All sterol enriched margarines reduced lipid-standardized plasma alpha- plus beta-carotene levels. Plasma lycopene levels were also reduced but this effect was not significant for all products.

CONCLUSIONS

A margarine with sterol-esters from soybean oil, mainly esters from sitosterol, campesterol and stigmasterol, is as effective as a margarine with sitostanol-ester in lowering blood total- and LDL-cholesterol levels without affecting HDL-cholesterol concentrations. Incorporation in edible fat containing products of such substances may substantially reduce the risk of cardiovascular disease in the population.

Comparison of self-report of reduced fat and salt foods with sales and supply data

OBJECTIVE

Examine the validity of self-reported use of reduced fat and reduced salt foods.

DESIGN

Compare data collected in a food frequency questionnaire with supermarket sales data and food supply data.

SETTING

Rural Australia.

SUBJECTS

Four hundred and fifty-three respondents from an original sample of 1616 randomly-selected residents.

INTERVENTIONS

Community health campaign to reduce cardiovascular disease.

RESULTS

Reported use of reduced fat and reduced salt foods was greater than store sales and milk deliveries of these products.

CONCLUSIONS

External data did not support the validity of self-reported use of these products.

Subjective and clinical evaluation of oral lubricants in xerostomic patients

The purpose of this investigation was to evaluate and compare four oral lubricants in relation to oral mucosal status, perceived relief of dry mouth symptoms, and patient acceptance. Three commercial oral lubricants--two sprays and one gel--and a home remedy of margarine were evaluated. Twenty-five xerostomic/salivary gland dysfunctional patients demonstrating < 0.20 mL/min of unstimulated whole saliva participated in the randomized, four-phase, cross-over study. Each phase included a ten-day use of oral lubricants, followed by a four-day washout period. On the first and tenth days of use, lip and buccal mucosa dryness and perceived oral dryness were evaluated. Patient acceptance of the oral lubricant was evaluated at the end of each ten-day period. The Wilcoxon matched-pairs signed-rank test was used to analyze data over time and between-group differences. The gel group reported a statistically significant improvement in perceived oral dryness from Day 1 to Day 10. No other significant within-group differences were found. Subjects rated the gel significantly better than margarine for convenience, perceived value, minutes of relief, and in the "overall" rating. No other significant between-group differences were noted.

Antioxidant fortified margarine increases the antioxidant status

OBJECTIVE

To assess the effect of supplementation with an antioxidant fortified margarine on the body's antioxidant status and on parameters of oxidative damage to lipids.

DESIGN

Single blind, placebo controlled trial, two treatment groups balanced for sex, age and Quetelet Index.

SETTING

Unilever Research Laboratorium, The Netherlands.

SUBJECTS

Thirty-one healthy adult volunteers accomplished the study. Volunteers were recruited among inhabitants of the surrounding area of the research laboratory.

INTERVENTIONS

Volunteers consumed during the four weeks either 15 g/d of an antioxidant fortified margarine (providing 121 mg vitamin C, 31 mg vitamin E, 2.7 mg alpha-carotene and 5.3 mg beta-carotene) or an ordinary margarine. Fasting blood samples were taken before and at the end of the study.

RESULTS

Consumption of the antioxidant fortified margarine significantly increased the levels of the supplied antioxidants in plasma and LDL as compared to the changes found after consumption of the control margarine, with the largest increases found in LDL levels of alpha-carotene (15.5-fold increase, 95% CI: 8.4-27.8-fold) and beta-carotene (4.3-fold increase, 95% CI: 2.2-7.9-fold). This increased antioxidant status in the antioxidant fortified margarine group resulted in a significantly increased total antioxidant activity of LDL and resistance of LDL to oxidation (lag time and rate of oxidation) as compared to baseline but not in comparison to the changes found in the control group.

CONCLUSION

Consumption of moderate doses of vitamin E, vitamin C, alpha-carotene and beta-carotene, supplied in a full-fat margarine and consumed as part of a normal diet, effectively increases the blood levels of these antioxidants.

Chemical and epidemiological aspects of modified butter oil fractions

Butter lipids are an important traditional source of dietary energy intake in the form of fat. Butter lost a sizable portion of its market share due to controversies associated with its cholesterol content and high percentage of long-chain saturated fatty acids. Accordingly, the use of vegetable oils and their chemically manipulated counterparts such as those produced by partial hydrogenation or interestrification increased proportionally. However, beginning in 1940, researchers developed several procedures such as temperature-controlled crystallization, refractionation of crystallized butter oil solids, and supercritical carbon dioxide extraction to improve the acceptance of butter oil. Others proposed preparation of synthetic substitutes such as sucrose polyesters to reduce intestinal absorption of fatty acids, thus reducing caloric intake with concomitant reduction in serum cholesterol. The present review provides a summary of the efforts of several attempts to improve the acceptability of butter together with the anticipated epidemiological consequences of long-term consumption of altered butter oil to mammalian health.

[Poisoning by enterotoxin from Staphylococcus aureus associated with mocha pastry. Microbiology and epidemiology]

A brief description of a foodborne outbreak due to S. aureus enterotoxin associated with the consumption of mocha cake in the city of Guadalajara is presented. The cake was prepared in a bakery and affected nearly 100 persons. S. aureus was isolated from the nose and skin of one of the pastry cooks. A S. aureus strain isolated from the cake involved in the outbreak was not only unable to grow in the mocha cream, but it actually decreased in numbers by 2 log after 72 h of storage at 30 degrees C. The pH of mocha cream ranged from 6.2 to 6.6, and water activity from 0.833 to 0.859, with a media of 0.841. In preparing mocha cake at the shop, one half of the dough used to be sprayed with a sucrose solution in water (20% w/v); mocha cream was spread on the other half of the dough before overlapping the two halves. When mocha cake was prepared in this manner, and stored at 30 degrees C, S. aureus increased in number by more than 4 log after 48 h. S. aureus did not grow in the cake stored at 4-7 degrees C. Contributory factors in this outbreak were an increase of water activity in the interphase of the mocha and the cake dough, storage of the cake in an unrefrigerated area, and an unusually high ambient temperature (28-32 degrees C) at that time.

Reduction of serum cholesterol in postmenopausal women with previous myocardial infarction and cholesterol malabsorption induced by dietary sitostanol ester margarine: women and dietary sitostanol

BACKGROUND

Reduction of serum cholesterol decreases mortality in primary and especially in secondary prevention. We investigated how effectively postmenopausal women with a previous myocardial infarction reduced their serum cholesterol with dietary means by using sitostanol ester rapeseed oil margarine, alone and in combination with statins, and to what extent cholesterol metabolism was affected.

METHODS AND RESULTS

The first study group consisted of 22 randomly chosen women with angiographically documented coronary artery disease. Baseline studies on home diet were followed by double-blind, randomized, cross-over studies on margarine without and with sitostanol (3 g/d) ester for 7 weeks in random order. A second group of 10 women on simvastatin consumed sitostanol ester margarine for 12 weeks. Sitostanol ester margarine lowered serum total cholesterol by 13% (P<.05) and LDL cholesterol by 20% (P<.01). Sitostanol ester margarine reduced total cholesterol in all patients, LDL cholesterol <2.6 mmol/L (<100 mg/dL) in 32%, and <3.4 mmol/L (<133 mg/dL) in 73% versus none and 27% during the home diet (P<.01 for both). Combined with simvastatin, sitostanol still reduced total and LDL cholesterol by 11+/-3% and 16+/-5% (P<.01 for both). Sitostanol reduced absorption (-45%), increased fecal elimination (+45% as neutral sterols), and stimulated synthesis (+39%) of cholesterol. High cholestanol and plant sterol (high cholesterol absorption) and low baseline precursor sterol proportions (low cholesterol synthesis) predicted high decreases in serum cholesterol.

CONCLUSIONS

Dietary use of sitostanol ester margarine normalizes LDL cholesterol in about one third of women with previous myocardial infarction, especially in those with high baseline absorption and low synthesis of cholesterol, and in combination with statins reduces the needed drug dose.

[Biodegradation of a lipid-rich effluent by native bacteria]

From samples of effluent derived from a biological treatment plant of a mayonnaise and margarine producing factory, several bacteria strains presenting high lipolytic activities were isolated. The strain having the highest activity was used for treating a typical final effluent and the results obtained were compared with those achieved with Yarrowia lipolytica and Saccharomycopsis lipolytica strains. The isolated strain showed the highest specific capacity for reducing chemical oxygen demand (COD).

Risk factors for lung cancer among women in Poland

A total of 118 women with histologically confirmed lung cancer and 141 healthy controls, were involved in a case-control study conducted in Cracow between 1991 and 1994. The aim of this study was to examine the role of smoking, alcohol consumption, and diet in female lung cancer risk. Multivariate analysis has shown that cigarette smoking was the most strongly active risk factor in female lung cancer. Vodka drinkers showed significantly higher risk than non-drinking women. Frequent intakes of carrots (at least three times a week) significantly lowered the risk. The significant protective effect was also observed in women using margarine on bread. The analysis of dose-response relationship in reference to cigarette smoking, vodka drinking and consumption of carrots also confirmed significant influence of these factors on risk.

Comparison of three formulations of alpha-chloralose for immobilization of Canada geese

The effectiveness of an alpha-chloralose (AC)-corn oil suspension, an AC-margarine mixture, and AC tablets were compared for immobilizing Canada geese (Branta canadensis). Responses to AC immobilization also were compared in male and female Canada geese. There was no difference in mean time to first effects or mean time to capture between male and female geese dosed with 30 mg/kg AC in orally-administered bread baits. Recovery times (< or = 24 hr) also were similar between sexes. Mean (+/-SE) time to first effects for geese immobilized with AC tablets in bread baits (19 +/- 3 min) was significantly less than mean time to first effects for geese immobilized with AC in margarine (28 +/- 6 min) or AC in corn oil (32 +/- 7 min) applied to bread baits (n = 12 geese/treatment). Respective mean times to capture geese immobilized with AC tablets, AC-margarine, and AC-corn oil were not significantly different at 62 +/- 25, 89 +/- 48, and 88 +/- 30 min, respectively. Ten, 11 and, seven geese immobilized with AC tablets, AC-margarine, and AC-corn oil recovered within 24 hr, respectively; all geese recovered within 28 hr. Male and female Canada geese respond similarly to AC immobilization, at least during molt, and AC mixed with margarine or AC in tablet form is at least as effective as the presently used AC-corn oil suspension. AC tablets or AC-margarine also would be more practical for some field situations. Additional development of AC tablets will be required prior to field use for capturing nuisance waterfowl.

Butter, margarine and serum lipoproteins

Intake of trans fatty acids unfavorably affects blood lipoproteins. As margarines are a major source of trans, claims for the advantages of margarines over butter need to be scrutinized. Here we review dietary trials that directly compared the effects of butter and margarine on blood lipids. We identified 20 studies in which subjects had stable body weights, and margarine and butter were exchanged in the diet at constant energy and fat intake. We calculated the changes in average blood lipid levels between study diets (49 comparisons) as a function of the percentage of calories as margarine substituted for butter. Replacing 10% of calories from butter by hard high-trans stick margarines lowered total serum cholesterol by 0.19, LDL by 0.11, and HDL by 0.02 mmol/l, and did not affect the total/HDL cholesterol ratio. Soft low-trans tub margarines decreased total cholesterol by 0.25 and LDL by 0.20 mmol/l, did not affect HDL, and decreased the total/HDL cholesterol ratio by 0.20. Based on the total/HDL cholesterol ratio, replacement of 30 g of butter per day by soft tub margarines would theoretically predict a reduction in coronary heart disease risk of 10%, while replacement of butter by hard, high-trans margarines would have no effect. Replacing butter by low-trans soft margarines favorably affects the blood lipoprotein profile and may reduce the predicted risk of coronary heart disease, but high-trans hard margarines probably confer no benefit over butter.

Dietary fat and asthma: is there a connection?

The last two decades have seen an increase in the prevalence of asthma, eczema, and allergic rhinitis in developed countries. This increase has been paralleled by a fall in the consumption of saturated fat and an increase in the amount of polyunsaturated fat in the diet. This is due to a reduction in the consumption of animal fat and an increase in the use of margarine and vegetable oils containing omega-6 polyunsaturated fatty acids (PUFAs), such as linoleic acid. There is also evidence for a decrease in the consumption of oily fish which contain omega-3 PUFAs, such as eicosapentaenoic acid. In a number of countries, there are social class and regional differences in the prevalence of allergic disease, which are associated with differences in the consumption of PUFAs. Linoleic acid is a precursor of arachidonic acid, which can be converted to prostaglandin E2 (PGE2), whereas eicosapentaenoic acid inhibits the formation of PGE2. PGE2 acts on T-lymphocytes to reduce the formation of interferon-gamma (IFN-gamma) without affecting the formation of interleukin-4 (IL-4). This may lead to the development of allergic sensitization, since IL-4 promotes the synthesis of immunoglobulin E (IgE), whereas IFN-gamma has the opposite effect. Changes in the diet may explain the increase in the prevalence of asthma, eczema and allergic rhinitis. The effects of diet may be mediated through an increase in the synthesis of prostaglandin E2 which in turn can promote the formation of immunoglobulin E.

Elaidic and trans-vaccenic acids in plasma phospholipids as indicators of dietary intake of 18:1 trans-fatty acids

Octadecenoic (18:1) trans-fatty acid fractions from margarine, butter and plasma phospholipids (PL) were isolated by silver ion TLC, and nine positional isomers (n-11-n-3) were identified by GC-MS based on their ozonolysis products. The GC analysis of the isolated fractions gave similar peak profiles and separated seven trans-isomers (n-11-n-6 and n-3). Without a preceding isolation step, the reproducibility of the GC method for plasma PL elaidic (18:1 n 9 trans) and trans-vaccenic acids (n-7) was 3.4 and 2.7% (R.S.D.), respectively. These trans-isomers were rapidly incorporated and cleared in plasma PL and they closely reflected both increased and decreased intake of 18:1 trans-fatty acids during moderate fat substitutions. Significant associations between high-density lipoprotein cholesterol (HDL-C) and PL elaidic and trans-vaccenic acids appeared in habitual margarine users only.

Intake and sources of alpha-linolenic acid in Dutch elderly men

OBJECTIVE

Intake of alpha-linolenic acid may have a beneficial effect on coronary heart disease, but little information is available on the intake and sources of alpha-linolenic acid (C18:3 n-3) in populations. We therefore assessed intake and sources of alpha-linolenic acid in Dutch elderly men.

DESIGN AND SUBJECTS

Dietary histories were obtained from participants of the Zutphen Elderly Study, a Dutch cohort study. Food consumption data were available from 876 men in 1985 and from 541 of the same men in 1990. Daily intakes of alpha-linolenic acid were assessed using a food table developed for this purpose. Alpha-linolenic acid content of edible fats, seafood and some commonly eaten dishes were mainly derived from chemical analyses of Dutch foods, and other values were obtained from published food tables.

RESULTS

Alpha-linolenic acid provided 0.5 +/- 0.1% of energy intake (mean +/- s.d.) or 1.30 +/- 0.46 g/day in 1985, and 1.21 +/- 0.52 g/day in 1990. The Pearson correlation coefficient for intake of alpha-linolenic acid in 1985 and 1990 was 0.34. Margarines were the main source (25.4%), followed by meat and the fats used in cooking meat (10.8%), bread (9.8%) and vegetables (7.8%).

CONCLUSIONS

An increase in intake of alpha-linolenic acid, is most easily realized by the use of unhydrogenated oils rich in alpha-linolenic acid such as rapeseed and soybean oil, and of margarines and other fats containing such oils.

Evaluation of the effect of vitamin A-fortified margarine on the vitamin A status of preschool Filipino children

OBJECTIVES

This study assessed the effects of consuming a highly hydrogenated, vitamin A (VA)-fortified margarine not requiring refrigeration on VA status of preschool children.

DESIGN

A double-masked randomized community trial.

SETTING

Six rural villages in Cavite, Southern Luzon, the Philippines.

SUBJECTS

296 and 285 children 3-6 y of age in the VA-fortified (experimental) and non-fortified (control) margarine groups, respectively.

INTERVENTION

Each week for 6 months households were given 250 g of VA-fortified margarine [providing 28.8 micrograms retinol equivalents (RE) per g] or non-fortified (0 microgram RE) margarine of identical appearance for each enrolled child. Children's vitamin A status [serum retinol, xerophthalmia, and conjunctival impression cytology (CIC) status] and dietary intake were assessed at baseline and follow-up; margarine intake was monitored throughout the study.

RESULTS

Daily margarine intake per child averaged 27 g in the experimental group (providing 776 micrograms RE) and 24 g (0 microgram RE) in the control group. After 6 months, mean serum retinol increased from 26.4 to 28.8 micrograms/dl in the experimental group but decreased from 26.6 to 25.1 micrograms/dl in controls (P < 0.001 at 6 months); the multiple-adjusted increment over controls was 2.4 micrograms/dl (P < 0.01). More importantly, the prevalence of low serum retinol (< 20 micrograms/dl) decreased from 25.7 to 10.1% in the experimental group but remained unchanged in controls (26.7 to 27.7%) (P < 0.01 at 6 months). At follow-up no experimental children had developed xerophthalmia but 1.4 and 1.8% of controls developed nightblindness and Bitot's spots, respectively. There were no differences in CIC between groups.

CONCLUSION

Consumption of VA-fortified margarine significantly improved VA status of preschool Filipino children.