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Zhang H, Ren X, Yang Z, Lai J. Vitamin A Concentration in Human Milk: A Meta-Analysis. Nutrients 2022; 14:nu14224844. [PMID: 36432530 PMCID: PMC9699574 DOI: 10.3390/nu14224844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022] Open
Abstract
Humans require vitamin A (VA). However, pooled VA data in human milk is uncommon internationally and offers little support for dietary reference intake (DRIs) revision of infants under 6 months. As a result, we conducted a literature review and a meta-analysis to study VA concentration in breast milk throughout lactation across seven databases by August 2021. Observational or intervention studies involving nursing mothers between the ages of 18 and 45, with no recognized health concerns and who had full-term infants under 48 months were included. Studies in which retinol concentration was expressed as a mass concentration on a volume basis and determined using high-, ultra-, or ultra-fast performance liquid chromatography (HPLC, UPLC, or UFLC) were chosen. Finally, 76 papers involving 9171 samples published between 1985 and 2021 qualified for quantitative synthesis. Results from the random-effects model showed that the VA concentration of healthy term human milk decreased significantly as lactation progressed. VA (µg/L) with 95% CI at the colostrum, transitional, early mature and late mature stages being 920.7 (744.5, 1095.8), 523.7 (313.7, 733.6), 402.4 (342.5, 462.3) and 254.7 (223.7, 285.7), respectively (X2 = 71.36, p < 0.01). Subgroup analysis revealed no significant differences identified in VA concentration (µg/L) between Chinese and non-Chinese samples at each stage, being 1039.1 vs. 895.8 (p = 0.64), 505.7 vs. 542.2(p = 0.88), 408.4 vs. 401.2 (p = 0.92), 240.0 vs. 259.3 (p = 0.41). The findings have significant implications for the revision of DRIs for infants under six months.
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Affiliation(s)
- Huanmei Zhang
- Department of Maternal and Child Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- China-DRIs Expert Committee on Human Milk Composition, Chinese Nutrition Society, Beijing 100050, China
| | - Xiangnan Ren
- Department of Maternal and Child Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- China-DRIs Expert Committee on Human Milk Composition, Chinese Nutrition Society, Beijing 100050, China
| | - Zhenyu Yang
- Department of Maternal and Child Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- China-DRIs Expert Committee on Human Milk Composition, Chinese Nutrition Society, Beijing 100050, China
| | - Jianqiang Lai
- China-DRIs Expert Committee on Human Milk Composition, Chinese Nutrition Society, Beijing 100050, China
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- Correspondence:
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OUP accepted manuscript. Nutr Rev 2022; 80:2029-2050. [DOI: 10.1093/nutrit/nuac018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Maternal age has more pronounced effect on breast milk retinol and β-carotene content than maternal dietary pattern. Nutrition 2019; 65:120-125. [PMID: 31082789 DOI: 10.1016/j.nut.2019.02.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 01/29/2019] [Accepted: 02/23/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The effects on breast milk composition of advanced maternal age and maternal dietary habits during pregnancy and lactation have not, to our knowledge, been investigated in southeastern Europe and the Balkans. The aim of this study was to compare the content of retinol and β-carotene in colostrum and mature milk samples obtained from different maternal age (MA) groups and to assess the potential relationship with maternal and demographic characteristics, dietary patterns, and lifestyle habits during pregnancy and lactation. METHODS Forty-three nursing mothers were divided in two groups according to MA: ≥35 y of age (n = 22) and <35 y of age (n = 21). Total lipid concentrations were determined by gravimetric method, whereas retinol and β-carotene contents were assessed by high-performance liquid chromatography method. Dietary patterns during pregnancy and lactation were assessed using food frequency questionnaires, and principal component analysis (PCA) statistical analysis was performed. RESULTS Except for retinol levels in mature milk, significantly higher levels of total fats, retinol, and β-carotene were found in the older group. Results of PCA analysis showed that MA was strongly correlated with fat content, retinol, and β-carotene levels in colostrum samples, whereas in mature milk samples MA was highly correlated with fat content and moderately with β-carotene. In terms of dietary patterns, retinol contents in milk samples from both groups were weakly to moderately correlated with consumption frequency of eggs, meat, milk and dairy products, whereas β-carotene contents were weakly to strongly associated with consumption frequency of fruits and vegetables. CONCLUSIONS PCA analysis used in the study clearly confirmed that MA, total lipids, retinol, and β-carotene levels might serve as a good criterion for delimitation of breast milk samples collected in different stages of lactation from mothers of various ages. The present findings could represent key basis for further investigations.
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Biesalski Hans K, Jana T. Micronutrients in the life cycle: Requirements and sufficient supply. NFS JOURNAL 2018. [DOI: 10.1016/j.nfs.2018.03.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Deminice TMM, Ferraz IS, Monteiro JP, Jordão AA, Ambrósio LMCS, Nogueira-de-Almeida CA. Vitamin A intake of Brazilian mothers and retinol concentrations in maternal blood, human milk, and the umbilical cord. J Int Med Res 2018; 46:1555-1569. [PMID: 29436245 PMCID: PMC6091812 DOI: 10.1177/0300060518757155] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objectives To analyse intake of vitamin A (VA) and retinol concentrations in maternal blood, breast milk (BM), and the umbilical cord (UC) of newborns, and to determine the associations among these variables. Methods We performed a cross-sectional, epidemiological study of 180 mother-newborn dyads. Maternal and UC blood samples and BM were collected. VA intake by the mother over 30 days was assessed using a questionnaire. Results Mean retinol concentrations in maternal serum, the UC, and BM were 0.65 ± 0.27, 0.36 ± 0.18, and 2.95 ± 2.70 µmol/L, respectively. Retinol concentrations <0.70 µmol/L were found in 57.2% of maternal blood samples and in 94.9% of UC samples. A total of 27.9% of BM samples showed retinol concentrations <1.05 µmol/L. Mean VA intake by the mothers was 1041.33 ± 1187.86 µg retinol activity equivalents/day and was inadequate (<550 µg retinol activity equivalents/day) in 44.7%. Conclusions High proportions of insufficient retinol concentrations were observed in the UC, maternal blood, and BM. A high percentage of pregnant women had inadequate VA intake. Mothers with insufficient serum retinol concentrations had newborns with lower retinol concentrations in the UC. Higher retinol concentrations were observed in maternal blood and the UC with a higher VA intake.
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Affiliation(s)
- Thalia Manfrin Martins Deminice
- 1 Department of Puericulture and Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, Monte Alegre, Ribeirão Preto/SP, Brazil
| | - Ivan Savioli Ferraz
- 1 Department of Puericulture and Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, Monte Alegre, Ribeirão Preto/SP, Brazil
| | - Jacqueline Pontes Monteiro
- 1 Department of Puericulture and Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, Monte Alegre, Ribeirão Preto/SP, Brazil
| | - Alceu Afonso Jordão
- 2 Nutrition and Metabolism Division of the Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, Monte Alegre, Ribeirão Preto/SP, Brazil
| | - Lívia Maria Cordeiro Simões Ambrósio
- 3 Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, Monte Alegre, Ribeirão Preto/SP, Brazil
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Lira L, de Souza A, Amâncio A, Bezerra C, Pimentel J, Moia M, Dimenstein R. Retinol and Betacarotene Status in Mother-Infant Dyads and Associations between Them. ANNALS OF NUTRITION AND METABOLISM 2017; 72:50-56. [DOI: 10.1159/000485042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 10/30/2017] [Indexed: 01/09/2023]
Abstract
Background/Aims: Assessing the diet and biochemical indicators of vitamin A deficiency (VAD) in high-risk populations is crucial in cases where this deficiency is mainly caused by chronically inadequate intake. This study aimed to determine the retinol and betacarotene status in mother-infant dyads, and to evaluate the associations between them. Methods: Umbilical cord serum, maternal serum, and colostrum were collected from 134 healthy mothers living in a risk region for VAD. Vitamin A and betacarotene were quantified by liquid chromatography, and dietary information was collected using a food frequency questionnaire. Results: Although the overall mean intakes of vitamin A and betacarotene were considered adequate, 16% of the women had insufficient intake. Mean retinol levels were also adequate, yet low levels were diagnosed in about 8% of the mothers, based on maternal serum and colostrum, and in 16% of the cord serum samples. Retinol and betacarotene were positively associated in cord serum (p = 0.004), maternal serum (p = 0.041), and colostrum (p < 0.001) but was not associated with dietary intake. Conclusions: A diagnosis of adequacy based on mean biochemical and dietary data of this population in fact masks the marginal vitamin A status presented by mothers and children.
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Health Effects of Carotenoids during Pregnancy and Lactation. Nutrients 2017; 9:nu9080838. [PMID: 28777356 PMCID: PMC5579631 DOI: 10.3390/nu9080838] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 02/07/2023] Open
Abstract
Adequate nutrition is particularly important during pregnancy since it is needed not only for maintaining the health of the mother, but also determines the course of pregnancy and its outcome, fetus development as well as the child’s health after birth and during the later period of life. Data coming from epidemiological and interventions studies support the observation that carotenoids intake provide positive health effects in adults and the elderly population. These health effects are the result of their antioxidant and anti-inflammatory properties. Recent studies have also demonstrated the significant role of carotenoids during pregnancy and infancy. Some studies indicate a correlation between carotenoid status and lower risk of pregnancy pathologies induced by intensified oxidative stress, but results of these investigations are equivocal. Carotenoids have been well studied in relation to their beneficial role in the prevention of preeclampsia. It is currently hypothesized that carotenoids can play an important role in the prevention of preterm birth and intrauterine growth restriction. Carotenoid status in the newborn depends on the nutritional status of the mother, but little is known about the transfer of carotenoids from the mother to the fetus. Carotenoids are among the few nutrients found in breast milk, in which the levels are determined by the mother’s diet. Nutritional status of the newborn directly depends on its diet. Both mix feeding and artificial feeding may cause depletion of carotenoids since infant formulas contain only trace amounts of these compounds. Carotenoids, particularly lutein and zeaxanthin play a significant role in the development of vision and nervous system (among others, they are important for the development of retina as well as energy metabolism and brain electrical activity). Furthermore, more scientific evidence is emerging on the role of carotenoids in the prevention of disorders affecting preterm infants, who are susceptible to oxidative stress, particularly retinopathy of prematurity.
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Grilo EC, Medeiros WF, Silva AGA, Gurgel CSS, Ramalho HMM, Dimenstein R. Maternal supplementation with a megadose of vitamin A reduces colostrum level of α-tocopherol: a randomised controlled trial. J Hum Nutr Diet 2016; 29:652-61. [PMID: 27231056 DOI: 10.1111/jhn.12381] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Maternal supplementation with vitamin A is one of the strategies for controlling its deficiency in the mother-child dyad, although studies with animals showed that supplementation with high doses of vitamin A reduces the levels of α-tocopherol (vitamin E) in the mother's serum and milk. The objective of the present study was to assess the influence of maternal supplementation with vitamin A on the concentration of retinol and α-tocopherol in human milk. METHODS Healthy puerperal women were randomly distributed into a control group (n = 44) and a supplemented group (n = 44). Blood and colostrum samples were collected after delivery, and mature milk samples were collected 30 days later. The supplemented group received 200 000 IU of retinyl palmitate after the first colostrum collection. The retinol and α-tocopherol levels in the samples were determined by high-performance liquid chromatography. RESULTS The mean (SD) retinol and α-tocopherol levels in the maternal serum were considered adequate at 46.4 (15.9) and 1023.6 (380.4) μg dL(-1) , respectively. The colostrum retinol levels of the supplemented group increased significantly 24 h after the intervention (P < 0.001). However, the retinol levels in the mature milk of both groups did not differ (P > 0.05). Moreover, after maternal supplementation with vitamin A, the colostrum α-tocopherol level decreased by 16.4%, which is a significant reduction (P < 0.05). However, vitamin A supplementation did not affect the α-tocopherol level of mature milk (P > 0.05). CONCLUSIONS Maternal supplementation with high doses of vitamin A increased the colostrum level of this nutrient but reduced the bioavailability of α-tocopherol, which may harm the newborn's health because newborns have limited vitamin E reserves.
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Affiliation(s)
- E C Grilo
- Department of Biochemistry, Biosciences Center, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil.
| | - W F Medeiros
- Department of Biochemistry, Biosciences Center, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - A G A Silva
- Department of Biochemistry, Biosciences Center, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - C S S Gurgel
- Department of Biochemistry, Biosciences Center, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - H M M Ramalho
- Department of Biotechnology, School of Health, Potiguar University (UnP), Laurate International Universities, Natal, Brazil
| | - R Dimenstein
- Department of Biochemistry, Biosciences Center, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
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Zhang Z, Ma H, Wang X, Zhao Z, Zhang Y, Zhao B, Guo Y, Xu L. A tetrapeptide from maize protects a transgenic Caenorhabditis elegans Aβ1-42model from Aβ-induced toxicity. RSC Adv 2016. [DOI: 10.1039/c6ra06130c] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A food-derived bioactive peptide that works as an important antioxidantin vivocould be used to remedy oxidative stress-related diseases.
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Affiliation(s)
- Zhixian Zhang
- Key Laboratory for Molecular Enzymology and Engineering
- The Ministry of Education
- National Engineering Laboratory for AIDS Vaccine
- School of Life Sciences
- Jilin University
| | - Heran Ma
- Key Laboratory for Molecular Enzymology and Engineering
- The Ministry of Education
- National Engineering Laboratory for AIDS Vaccine
- School of Life Sciences
- Jilin University
| | - Xiaoying Wang
- Jilin Province People's Hospital
- Changchun 130021
- China
| | - Ziyuan Zhao
- Key Laboratory for Molecular Enzymology and Engineering
- The Ministry of Education
- National Engineering Laboratory for AIDS Vaccine
- School of Life Sciences
- Jilin University
| | - Yue Zhang
- Key Laboratory for Molecular Enzymology and Engineering
- The Ministry of Education
- National Engineering Laboratory for AIDS Vaccine
- School of Life Sciences
- Jilin University
| | - Baolu Zhao
- State Key Laboratory of Brain and Cognitive Science
- Institute of Biophysics
- Chinese Academy of Sciences
- Beijing 100101
- China
| | - Yi Guo
- Key Laboratory for Molecular Enzymology and Engineering
- The Ministry of Education
- National Engineering Laboratory for AIDS Vaccine
- School of Life Sciences
- Jilin University
| | - Li Xu
- Key Laboratory for Molecular Enzymology and Engineering
- The Ministry of Education
- National Engineering Laboratory for AIDS Vaccine
- School of Life Sciences
- Jilin University
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Troesch B, Biesalski HK, Bos R, Buskens E, Calder PC, Saris WHM, Spieldenner J, Verkade HJ, Weber P, Eggersdorfer M. Increased Intake of Foods with High Nutrient Density Can Help to Break the Intergenerational Cycle of Malnutrition and Obesity. Nutrients 2015; 7:6016-37. [PMID: 26197337 PMCID: PMC4517043 DOI: 10.3390/nu7075266] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/13/2015] [Accepted: 07/14/2015] [Indexed: 12/15/2022] Open
Abstract
A workshop held at the University Medical Center in Groningen, The Netherlands, aimed at discussing the nutritional situation of the population in general and the role diet plays during critical windows in the life course, during which the body is programmed for the development of non-communicable diseases (NCDs). NCDs are increasingly prevalent as our society ages, and nutrition is well known to play an important role in determining the risk and the time of onset of many common NCDs. Even in affluent countries, people have difficulties to achieve adequate intakes for a range of nutrients: Economic constraints as well as modern lifestyles lead people to consume diets with a positive energy balance, but low in micronutrients, resulting in increasing prevalence of obesity and suboptimal nutritional status. Information about nutrient density, which refers to the content of micronutrients relative to energy in food or diets, can help identify foods that have a low calorie to nutrient ratio. It thus allows the consumption of diets that cover nutritional needs without increasing the risk of becoming obese. Given the impact a nutrient dense, low energy diet can have on health, researchers, food industry and governments jointly should develop options for affordable, appealing nutrient-rich food products, which, in combination with physical activity, allow for optimal health throughout the life-course.
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Affiliation(s)
- Barbara Troesch
- DSM Nutritional Products Ltd., Wurmisweg 576, Kaiseraugst 4303, Switzerland.
| | - Hans K Biesalski
- Institut für Biologische Chemie und Ernährungswissenschaft, Universität Hohenheim, Stuttgart 70599, Germany.
| | - Rolf Bos
- FrieslandCampina, Bronland 20, Wageningen 6708 WH, The Netherlands.
| | - Erik Buskens
- Department of Pediatrics, Beatrix Children's Hospital/University Medical Center Groningen, University of Groningen, P.O. Box 30001, Groningen 9700 RB, The Netherlands.
| | - Philip C Calder
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.
| | - Wim H M Saris
- Department of Human Biology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht 6200MD, The Netherlands.
| | - Jörg Spieldenner
- Nestlé Research Center, Vers-chez-les Blanc, Lausanne 26 1000, Switzerland.
| | - Henkjan J Verkade
- Department of Pediatrics, Beatrix Children's Hospital/University Medical Center Groningen, University of Groningen, P.O. Box 30001, Groningen 9700 RB, The Netherlands.
| | - Peter Weber
- DSM Nutritional Products Ltd., Wurmisweg 576, Kaiseraugst 4303, Switzerland.
| | - Manfred Eggersdorfer
- DSM Nutritional Products Ltd., Wurmisweg 576, Kaiseraugst 4303, Switzerland.
- Department of Pediatrics, Beatrix Children's Hospital/University Medical Center Groningen, University of Groningen, P.O. Box 30001, Groningen 9700 RB, The Netherlands.
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Grilo EC, Lima MS, Cunha LR, Gurgel CS, Clemente HA, Dimenstein R. Effect of maternal vitamin A supplementation on retinol concentration in colostrum. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2015. [DOI: 10.1016/j.jpedp.2014.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Grilo EC, Lima MSR, Cunha LRF, Gurgel CSS, Clemente HA, Dimenstein R. Effect of maternal vitamin A supplementation on retinol concentration in colostrum. J Pediatr (Rio J) 2015; 91:81-6. [PMID: 25193595 DOI: 10.1016/j.jped.2014.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 05/09/2014] [Accepted: 05/14/2014] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the effect of vitamin A supplementation on the retinol concentration in colostrum under fasting and postprandial conditions. METHODS This was a quasi-experimental study, with before and after assessments, conducted with 33 patients treated at a public maternity hospital. Blood and colostrum samples were collected under fasting conditions in the immediate postpartum period. A second colostrum collection occurred two hours after the first meal of the day, at which time a mega dose of 200,000 IU of retinyl palmitate was administered. On the following day, the colostrum was collected again under fasting and postprandial conditions. Serum and colostrum retinol concentrations were determined by high performance liquid chromatography. RESULTS The serum retinol concentration was 37.3 (16.8-62.2) μg/dL, indicating adequate nutritional status. The colostrum retinol concentration before supplementation was 46.8 (29.7-158.9) μg/dL in fasting and 67.3 (31.1-148.7) μg/dL in postprandial condition (p < 0.05), showing an increase of 43.8%. After supplementation, the values were 89.5 (32.9-264.2) μg/dL and 102.7 (37.3-378.3) μg/dL in fasting and postprandial conditions, respectively (p < 0.05), representing an increase of 14.7%. CONCLUSIONS This study demonstrated that maternal supplementation with high doses of vitamin A in postpartum resulted in a significant increase of the retinol concentration in colostrum under fasting conditions, with an even greater increase after a meal.
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Affiliation(s)
- Evellyn C Grilo
- Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil.
| | - Mayara S R Lima
- Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil.
| | - Lahyana R F Cunha
- Universidade Federal de Campina Grande (UFCG), Campina Grande, PB, Brazil
| | | | - Heleni A Clemente
- Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil
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Ulbricht C, Basch E, Chao W, Conquer J, Costa D, Culwell S, Flanagan K, Guilford J, Hammerness P, Hashmi S, Isaac R, Rusie E, Serrano JMG, Ulbricht C, Vora M, Windsor RC, Woloszyn M, Zhou S. An evidence-based systematic review of vitamin A by the natural standard research collaboration. J Diet Suppl 2013; 9:299-416. [PMID: 23157584 DOI: 10.3109/19390211.2012.736721] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
An evidence-based systematic review of vitamin A by the Natural Standard Research Collaboration consolidates the safety and efficacy data available in the scientific literature using a validated and reproducible grading rationale. This paper includes written and statistical analysis of clinical trials, plus a compilation of expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.
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Belderbos ME, Levy O, Meyaard L, Bont L. Plasma-mediated immune suppression: a neonatal perspective. Pediatr Allergy Immunol 2013; 24:102-13. [PMID: 23173652 DOI: 10.1111/pai.12023] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2012] [Indexed: 01/31/2023]
Abstract
Plasma is a rich mixture of immune regulatory factors that shape immune cell function. This immunomodulatory role of plasma is especially important in neonates. To maintain in utero feto-maternal tolerance and to allow for microbial colonization after birth, the neonatal immune system is biased against pro-inflammatory responses while favoring immune suppression. Therefore, the neonatal period provides a unique opportunity to study the physiologic mechanisms regulating the immune system. Several recent studies in neonates have identified plasma factors that play a key role in immune regulation. Insight into immune regulation by neonatal and adult plasma may have clinical implications, because plasma is easily accessible, affordable, and widely available. Herein, we review plasma-mediated immune regulation, with specific focus on neonatal plasma. We discuss how immune suppression is a key function of plasma and provide a systematic overview of the published literature regarding plasma-derived immune suppressive proteins, lipids, purines, and sugars. Finally, we outline how immune regulation by these factors, which are particularly abundant in neonatal plasma, may eventually be used to treat immune-mediated diseases, such as autoimmune, allergic, and inflammatory diseases.
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de Lira LQ, Lima MSR, de Medeiros JMS, da Silva IF, Dimenstein R. Correlation of vitamin A nutritional status on alpha-tocopherol in the colostrum of lactating women. MATERNAL & CHILD NUTRITION 2013; 9:31-40. [PMID: 22099335 PMCID: PMC6860850 DOI: 10.1111/j.1740-8709.2011.00376.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The adequate supply of vitamins A and E to newborns is essential. However, factors such as maternal nutritional status and nutrient interaction may limit its bioavailability. The aim of this study was to establish nutritional status for vitamins A and E and evaluate the correlation of retinol on colostrum alpha-tocopherol in lactating women. A total of 103 lactating women were recruited at a Brazilian public maternity hospital. Fasting serum and colostrum samples were collected in the immediate post-partum. Retinol and alpha-tocopherol levels were determined by high-performance liquid chromatography and nutritional status for these vitamins was defined from specific cut-off points for serum and colostrum. Mean serum and colostrum retinol (1.49 µmol L(-1) , 2.18 µmol L(-1) ) and alpha-tocopherol (26.4 µmol L(-1) , 26.1 µmol L(-1) ) indicated satisfactory biochemical status. However, we found a prevalence of subclinical deficiency of vitamin A and vitamin E in serum (15.5% and 16%) and colostrum (50% and 60%). Lactating women with serum retinol ≥ 1.05 µmol L(-1) showed an inverse correlation between serum retinol and alpha-tocopherol concentration in the colostrum (P = 0.008, r = -0.28). This association was not observed in serum level < 1.05 µmol L(-1) . The nutritional status of lactating women for vitamins A and E was adequate, although there is a risk of subclinical deficiency. The negative correlation of serum retinol on alpha-tocopherol concentration in the colostrum must be carefully evaluated in situations of vitamin A supplementation, because alpha-tocopherol bioavailability in maternal milk may be compromised.
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Affiliation(s)
- Larissa Queiroz de Lira
- Postgraduate Program in Biochemistry and Molecular Biology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Mayara Santa Rosa Lima
- Department of Nutrition, Health Science Center, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Isabelle Ferreira da Silva
- Postgraduate Program in Biochemistry and Molecular Biology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Roberto Dimenstein
- Department of Biochemistry at the Federal University of Rio Grande do Norte, Natal, Brazil
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Wendt A, Gibbs CM, Peters S, Hogue CJ. Impact of increasing inter-pregnancy interval on maternal and infant health. Paediatr Perinat Epidemiol 2012; 26 Suppl 1:239-58. [PMID: 22742614 PMCID: PMC4562277 DOI: 10.1111/j.1365-3016.2012.01285.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Short inter-pregnancy intervals (IPIs) have been associated with adverse maternal and infant health outcomes in the literature. However, many studies in this area have been lacking in quality and appropriate control for confounders known to be associated with both short IPIs and poor outcomes. The objective of this systematic review was to assess this relationship using more rigorous criteria, based on GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. We found too few higher-quality studies of the impact of IPIs (measured as the time between the birth of a previous child and conception of the next child) on maternal health to reach conclusions about maternal nutrition, morbidity or mortality. However, the evidence for infant effects justified meta-analyses. We found significant impacts of short IPIs for extreme preterm birth [<6 m adjusted odds ratio (aOR): 1.58 [95% confidence interval (CI) 1.40, 1.78], 6-11 m aOR: 1.23 [1.03, 1.46]], moderate preterm birth (<6 m aOR: 1.41 [1.20, 1.65], 6-11 m aOR: 1.09 [1.01, 1.18]), low birthweight (<6 m aOR: 1.44 [1.30, 1.61], 6-11 m aOR: 1.12 [1.08, 1.17]), stillbirth (aOR: 1.35 [1.07, 1.71] and early neonatal death (aOR: 1.29 [1.02, 1.64]) outcomes largely in high- and moderate-income countries. It is likely these effects would be greater in settings with poorer maternal health and nutrition. Future research in these settings is recommended. This is particularly important in developing countries, where often the pattern is to start childbearing at a young age, have all desired children quickly and then control fertility through permanent contraception, thereby contracting women's fertile years and potentially increasing their exposure to the ill effects of very short IPIs.
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Affiliation(s)
- Amanda Wendt
- Nutrition and Health Sciences Program, Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, MS #1599-001-1BX, 1599 Clifton Road, NE, Atlanta, GA 30322, USA.
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Abstract
We have determined and compared the concentration levels of retinol and β-carotene in the plasma of three Sudanese women groups (displaced southern Sudanese women (DSSW), non-displaced southern Sudanese (NDSSW) and northern Sudanese women (NSW)), who were either pregnant or non-pregnant; and in their neonates (cord plasma). Plasma samples were analysed by high-performance liquid chromatography using reversed-phase column and diode-array detectors. The results revealed that retinol and β-carotene in the plasma of non-pregnant and pregnant women in the three groups were very low compared with studies reported elsewhere. Over 50% of pregnant DSSW and NDSSW had a low concentration of retinol plasma (< 0.70 µmol/L), and about 15-20% were deficient (< 0.35 µmol/L) according to World Health Organization criteria. Although the average retinol concentration in the plasma of pregnant NSW was > 0.70 µmol/L, which suggests sufficiency status, 32% showed lower levels and 10% were deficient. Plasma retinol β-carotene levels in the neonates' cords were also lower than their mothers and in comparison with other studies. These findings are in agreement with previous survey data and clinical reports, which also suggest that vitamin A deficiency is of great concern in the country. We concluded that insufficient intake of food of animal origin and repeated malarial and other parasitic diseases are the most likely causes of vitamin A deficiency.
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Affiliation(s)
- Kot B Nyuar
- Institute of Brain Chemistry and Human Nutrition, London Metropolitan University, UK.
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Goldberg JS. Monitoring maternal Beta carotene and retinol consumption may decrease the incidence of neurodevelopmental disorders in offspring. CLINICAL MEDICINE INSIGHTS. REPRODUCTIVE HEALTH 2011; 6:1-8. [PMID: 24453512 PMCID: PMC3888066 DOI: 10.4137/cmrh.s8372] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Retinoic acids (13-cis and 13-trans) are known teratogens, and their precursor is retinol, a form of vitamin A. In 1995, Rothman et al demonstrated an association between excessive vitamin A, >10,000 IU/day, during the first trimester of pregnancy and teratogenic effects, particularly in the central nervous system. However, vitamin A deficiency has long been known to be deleterious to the mother and fetus. Therefore, there may be a narrow therapeutic ratio for vitamin A during pregnancy that has not previously been fully appreciated. Neurodevelopmental disorders may not be apparent by macroscopic brain examination or imaging, and proving the existence of a behavioral teratogen is not straightforward. However, an excess of retinoic acid and some neurodevelopmental disorders are both associated with abnormalities in cerebellar morphology. Physical and chemical evidence strongly supports the notion that beta carotene crosses the placenta and is metabolized to retinol. Only very limited amounts of beta carotene are stored in fetal fat cells as evidenced by the fact that maternal fat is yellow from beta carotene, whereas non-brown neonatal fat is white. Furthermore, newborns of carotenemic mothers do not share the yellow complexion of their mothers. The excess 13-trans retinoic acid derived from metabolized beta carotene in the fetus increases the concentration of the more teratogenic 13-cis retinoic acid since the isomerization equilibrium is shifted to the left. Therefore, this paper proposes that consideration be given to monitoring all potential sources of fetal 13-cis and 13-trans retinoic acid, including nutritional supplements, dietary retinol, and beta carotene, particularly in the first trimester of pregnancy.
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Affiliation(s)
- Joel S Goldberg
- Durham Veterans Affairs Medical Center and Duke University, 508 Fulton Street, Durham, NC, 27705
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Berti C, Biesalski HK, Gärtner R, Lapillonne A, Pietrzik K, Poston L, Redman C, Koletzko B, Cetin I. Micronutrients in pregnancy: current knowledge and unresolved questions. Clin Nutr 2011; 30:689-701. [PMID: 21872372 DOI: 10.1016/j.clnu.2011.08.004] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 07/30/2011] [Accepted: 08/04/2011] [Indexed: 01/11/2023]
Abstract
Micronutrient status is increasingly recognized to play an important role in the health and well-being of pregnant women and in the development and long-term health of the offspring. On 26th - 28th February 2009, The Child Health Foundation invited leading experts in this area to a scientific workshop at Obergurgl, Austria to review and critically discuss current knowledge, to identify issues that may need to be addressed in future recommendations, and to highlight priorities and opportunities for future research. This report summarizes updated key conclusions of the workshop with regards to micronutrients' intake and physiological role related to mother, placenta and fetus, as well as relevance for adverse pregnancy and long-term outcomes.
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Affiliation(s)
- C Berti
- Unit of Obstetrics and Gynecology and Center for Fetal Research Giorgio Pardi, University of Milan, Via G. B. Grassi, 74, 20157 Milano, Italy.
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21
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Vitamin A: a multifunctional tool for development. Semin Cell Dev Biol 2011; 22:603-10. [PMID: 21693195 DOI: 10.1016/j.semcdb.2011.06.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 06/06/2011] [Indexed: 11/24/2022]
Abstract
Extensive research carried out over the last 100 years has established that the fat-soluble organic compound vitamin A plays crucial roles in early development, organogenesis, cell proliferation, differentiation and apoptosis as well as in tissue homeostasis. Given its importance during development, the delivery of vitamin A to the embryo is very tightly regulated with perturbations leading to severe malformations. This review discusses the roles of vitamin A during human development and the molecular mechanisms controlling its biological effects, hence bridging the gap between human development and molecular genetic work carried out in animal models. Vitamin A delivery during pregnancy and its developmental teratology in humans are thus discussed alongside work on model organisms, such as chicken or mice, revealing the molecular layout and functions of vitamin A metabolism and signaling. We conclude that, during development, vitamin A-derived signals are very tightly controlled in time and space and that this complex regulation is achieved by elaborate autoregulatory loops and by sophisticated interactions with other signaling cascades.
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Garcia L, Ribeiro K, Araújo K, Pires J, Azevedo G, Dimenstein R. Alpha-tocopherol concentration in the colostrum of nursing women supplemented with retinyl palmitate and alpha-tocopherol. J Hum Nutr Diet 2011; 23:529-34. [PMID: 20831709 DOI: 10.1111/j.1365-277x.2010.01063.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vitamins A and E are recognisably important in the initial stages of life, and the newborn depends on nutritional adequacy of breast milk to meet their needs. These vitamins share routes of transport to the tissues and antagonistic effects have been observed in animals after supplementation with vitamin A. The present study aimed to determine the effect of maternal supplementation with a megadose of retinyl palmitate in the immediate post-partum on α-tocopherol concentration in the colostrum. METHODS Healthy parturient women at a Brazilian public maternity were recruited for the study and divided into two groups: control (n = 37) and supplemented (n = 36). Blood and colostrum samples were collected up to 16 h post-partum. The supplemented group was administered with a retinyl palmitate capsule and, 24 h after the first collection, the second colostrum sample was obtained in the two groups for analysis of α-tocopherol. The cut-off points for deficiency are <1.05 μmol L(-1) for retinol and <11.6 μmol L(-1) for α-tocopherol. RESULTS The mean (SD) serum concentration of 1.77 (0.50) μmol L(-1) for retinol and 30.81 (6.46) μmol L(-1) for α-tocopherol indicates an adequate biochemical status. The supplemented group showed an increase of α-tocopherol in the colostrum 24 h after supplementation (P = 0.04), and this finding was not observed in the control group. CONCLUSIONS Supplementation with a 200,000 IU megadose of vitamin A did not negatively affect α-tocopherol levels in colostrum.
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Affiliation(s)
- L Garcia
- Department of Biochemistry, Center for Biosciences, Universidade Federal do Rio Grande do Norte, Natal (RN), Brazil
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Biesalski HK. Vitamin D Recommendations – Beyond Deficiency. ANNALS OF NUTRITION AND METABOLISM 2011; 59:10-6. [DOI: 10.1159/000332066] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Grune T, Lietz G, Palou A, Ross AC, Stahl W, Tang G, Thurnham D, Yin SA, Biesalski HK. Beta-carotene is an important vitamin A source for humans. J Nutr 2010; 140:2268S-2285S. [PMID: 20980645 PMCID: PMC3139236 DOI: 10.3945/jn.109.119024] [Citation(s) in RCA: 282] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Experts in the field of carotenoids met at the Hohenheim consensus conference in July 2009 to elucidate the current status of β-carotene research and to summarize the current knowledge with respect to the chemical properties, physiological function, and intake of β-carotene. The experts discussed 17 questions and reached an agreement formulated in a consensus answer in each case. These consensus answers are based on published valid data, which were carefully reviewed by the individual experts and are justified here by background statements. Ascertaining the impact of β-carotene on the total dietary intake of vitamin A is complicated, because the efficiency of conversion of β-carotene to retinol is not a single ratio and different conversion factors have been used in various surveys and following governmental recommendations within different countries. However, a role of β-carotene in fulfilling the recommended intake for vitamin A is apparent from a variety of studies. Thus, besides elucidating the various functions, distribution, and uptake of β-carotene, the consensus conference placed special emphasis on the provitamin A function of β-carotene and the role of β-carotene in the realization of the required/recommended total vitamin A intake in both developed and developing countries. There was consensus that β-carotene is a safe source of vitamin A and that the provitamin A function of β-carotene contributes to vitamin A intake.
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Affiliation(s)
- Tilman Grune
- Institute of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart 70593, Germany
| | - Georg Lietz
- School of Agriculture, Food and Rural Development, University of Newcastle, Newcastle upon Tyne NE1 7RU, UK
| | - Andreu Palou
- Universidad de las Islas Baleares and CIBER de Fisiopatología de la Obesidad y Nutrición, Palma de Mallorca 07112, Spain
| | - A. Catharine Ross
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA 16802
| | - Wilhelm Stahl
- Institute of Biochemistry and Molecular Biology I, Heinrich Heine University, Düsseldorf 40001, Germany
| | - Guangweng Tang
- USDA Human Nutrition Research Center on Aging, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111
| | - David Thurnham
- Northern Ireland Centre for Food and Health, University of Ulster, Coleraine BT51 4LA, Co. Londonderry, UK
| | - Shi-an Yin
- National Institute for Nutrition and Food Safety, Chinese Centre for Disease Control and Prevention, Bejing, 100050 China
| | - Hans K. Biesalski
- Institute of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart 70593, Germany
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Bezerra DS, de Araújo KF, Azevêdo GMM, Dimenstein R. A randomized trial evaluating the effect of 2 regimens of maternal vitamin a supplementation on breast milk retinol levels. J Hum Lact 2010; 26:148-56. [PMID: 20110563 DOI: 10.1177/0890334409356445] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to assess the effect of 2 different megadoses of retinyl palmitate on the level of retinol in the breast milk of healthy women. In total, 199 women were randomly allocated to 3 groups and supplemented in the postpartum period with a single retinyl palmitate dose of 200 000 IU (S1), a double dose of 200 000 IU 24 hours apart (S2), or no supplementation (C). Retinol content of colostrum and mature milk at 4 weeks was determined by high-performance liquid chromatography (HPLC). For colostrum, no significant difference was found between the groups (P = .965). The retinol content in mature milk differed between group C and groups S1 and S2 (P < .05). The double dose of vitamin A did not significantly increase the retinol content of milk at 4 weeks postpartum in comparison to a single dose; however, future research is needed to determine the optimal timing of the second dose of vitamin A.
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da Silva Ribeiro KD, de Araújo KF, de Souza HHB, Soares FB, da Costa Pereira M, Dimenstein R. Nutritional vitamin A status in northeast Brazilian lactating mothers. J Hum Nutr Diet 2010; 23:154-61. [PMID: 20113385 DOI: 10.1111/j.1365-277x.2009.01026.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Vitamin A deficiency is the major cause of morbidity and mortality among children and in women of reproductive age in developing countries. The present study aimed to assess maternal nutritional vitamin A status, as well as analyse the association of preformed vitamin A and pro-vitamin A consumption on the nutritional status of nursing mothers, based on serum retinol and retinol colostrum concentrations coupled with dietary intake. METHODS Serum and colostrums were collected from 86 healthy parturients, recruited within 16 h postpartum. Blood samples were obtained, the morning after an overnight fast. Retinol was analysed by high-performance liquid chromatography. Dietary vitamin A was assessed using a food frequency questionnaire and the women were separated into two groups according to the predominant dietary source of vitamin A: group A, > 50% preformed vitamin A (n = 37); and group B > 50% pro-vitamin A carotenoids, (n = 49). RESULTS Serum retinol and total vitamin A ingestion (mean +/- SD) were higher in group A than in group B (1.4 +/- 0.4 micromol L(-1) and 2072.0 +/- 1465.9 microg retinol activity equivalent (RAE) day(-1) versus 1.2 +/- 0.6 micromol L(-1) and 1051.6 +/- 920.4 microg RAE day(-1), respectively (P < 0.05), but colostrum retinol (3.4 +/- 1.7 micromol L(-1) and 3.6 +/- 1.9 micromol L(-1)) was similar in both groups. In group B, 36.7% (n = 18) of the nursing mothers presented a risk of developing vitamin A deficiency, based on their dietary intake. CONCLUSIONS On the basis of the intake of the pro-vitamin A carotenoids, some women may be at risk of vitamin A deficiency. However, their status is currently normal, as indicated by serum and milk retinol concentrations.
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Affiliation(s)
- K D da Silva Ribeiro
- Department of Biochemistry, Center for Biosciences, Universidade Federal do Rio Grande do Norte, Natal (RN), Brazil
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Kraemer K, Waelti M, De Pee S, Moench-Pfanner R, Hathcock JN, Bloem MW, Semba RD. Are low tolerable upper intake levels for vitamin A undermining effective food fortification efforts? Nutr Rev 2008; 66:517-25. [DOI: 10.1111/j.1753-4887.2008.00084.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Strobel M, Tinz J, Biesalski HK. The importance of β-carotene as a source of vitamin A with special regard to pregnant and breastfeeding women. Eur J Nutr 2007; 46 Suppl 1:I1-20. [PMID: 17665093 DOI: 10.1007/s00394-007-1001-z] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Vitamin A is essential for growth and differentiation of a number of cells and tissues. Notably during pregnancy and throughout the breastfeeding period, vitamin A has an important role in the healthy development of the fetus and the newborn, with lung development and maturation being particularly important. The German Nutrition Society (DGE) recommends a 40% increase in vitamin A intake for pregnant women and a 90% increase for breastfeeding women. However, pregnant women or those considering becoming pregnant are generally advised to avoid the intake of vitamin A rich liver and liver foods, based upon unsupported scientific findings. As a result, the provitamin A carotenoid beta-carotene remains their essential source of vitamin A. Basic sources of provitamin A are orange and dark green vegetables, followed by fortified beverages which represent between 20% and 40% of the daily supply. The average intake of beta-carotene in Germany is about 1.5-2 mg a day. Assuming a vitamin A conversion rate for beta-carotene for juices of 4:1, and fruit and vegetables between 12:1 and 26:1; the total vitamin A contribution from beta-carotene intake represents 10-15% of the RDA. The American Pediatrics Association cites vitamin A as one of the most critical vitamins during pregnancy and the breastfeeding period, especially in terms of lung function and maturation. If the vitamin A supply of the mother is inadequate, her supply to the fetus will also be inadequate, as will later be her milk. These inadequacies cannot be compensated by postnatal supplementation. A clinical study in pregnant women with short birth intervals or multiple births showed that almost 1/3 of the women had plasma retinol levels below 1.4 micromol/l corresponding to a borderline deficiency. Despite the fact that vitamin A and beta-carotene rich food is generally available, risk groups for low vitamin A supply exist in the western world. It is therefore highly critical to restrict the beta-carotene supply from diet, particularly from sources of beta-carotene with high consumer acceptance such as fortified juices (e.g. "ACE juices") or dietary supplements (e.g. multivitamins for pregnant women). For the part of the population unable to meet vitamin A requirements according to the DACH recommendations, sufficient intake of beta-carotene may be crucial to help improve and maintain adequate vitamin A status and prevention of developmental disorders. At this time it has to be urgently advised against restricting the beta-carotene supply or putting warning labels on beta-carotene fortified products. It is, however, highly recommended to improve the available data on nutrient intakes in Germany, especially for pregnant and breastfeeding women. For them, recommendations to be aware of potential nutrient intake inadequacies might prove useful.
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