Vitamin A deficiency among Brazilian school-aged children in a healthy child service

High prevalence of malnutrition and vitamin A deficiency among schoolchildren of rural areas in Malaysia using a multi-school assessment approach

Childhood malnutrition is known as a public health concern globally. The present study aims to assess the anthropometry and blood biochemical status of rural primary schoolchildren in Malaysia. A total of 776 children (7-11 years old) from ten rural primary schools from five states were included in this study. Nutritional outcomes were assessed based on sex, age group and school categories among the children (median age: 9 years (P25:8, P75:10)). The overall prevalence of malnutrition was 53·4 %. Vitamin A deficiency (VAD) was recorded at 20·6 and 39·8 % based on retinol and retinol-binding protein (RBP) levels, respectively. Anaemia, iron deficiency (ID), iron-deficiency anaemia (IDA) and elevated inflammation were found at 14·9, 17·9, 9·1 and 11·5 %, respectively. Malnutrition, VAD, anaemia, ID, IDA and elevated inflammation were more prevalent among Orang Asli (OA) schoolchildren compared with Non-Orang Asli schoolchildren. Higher occurrences of VAD and anaemia were also found among children aged <10 years. Retinol, RBP, α-carotene, ferritin and haemoglobin levels were lower among undernourished children. Besides, overweight/obese children exhibited a higher level of high-sensitivity C-reactive protein. Multivariate analysis demonstrated that OA school children (adjusted OR (AOR): 6·1; 95 % CI 4·1, 9·0) and IDA (AOR: 3·6; 95 % CI 1·9, 6·6) were associated with stunting among this population. The present study revealed that malnutrition, micronutrient deficiencies and anaemia are prevalent among rural primary schoolchildren in Malaysia, especially those from OA schools and younger age children (<10 years). Hence, more appropriate and targeted measures are needed to improve the nutritional status of these children.

Vitamin A Deficiency, COVID-19, and Rhino-Orbital Mucormycosis (Black Fungus): An Analytical Perspective

Mucormycosis is a rare but serious opportunistic fungal disease characterized by rhino-orbito-cerebral and pulmonary involvement. It is mainly seen in people with secondary immunosuppression, isolated vitamin A deficiency, measles, and AIDS patients. It showed a rise during the second wave of the COVID-19 epidemic in the spring of 2021 in India, especially in diabetic COVID-19 patients. Vitamin A deficiency is known to cause nutritional immunodeficiency and hence leading the way to increased opportunistic fungal, bacterial, and viral infections. In the eye, it causes keratitis, night blindness, xerophthalmia, conjunctivitis, Bitot spots, keratomalacia, and retinopathy. It also causes decreased tear secretion and deterioration of the anatomical/physiological defense barrier of the eye. The negative impact of vitamin A deficiency has been previously demonstrated in measles, AIDS, and COVID-19. We think that mucormycosis in COVID-19 might be rendered by vitamin A deficiency and that vitamin A supplementation may have preventive and therapeutic values against mucormycosis and other ocular symptoms associated with COVID-19. However, any vitamin A treatment regimen needs to be based on laboratory and clinical data and supervised by medical professionals.

Secular Trends in the Prevalence of and Disability-Adjusted Life Years Due to Common Micronutrient Deficiencies in China From 1990 to 2019: An Age-Period-Cohort Study and Joinpoint Analysis

Background

Understanding the national burdens and trends of micronutrient deficiencies can help guide effective intervention strategies. However, there is a lack of evidence of secular trends and age and sex differences in China. This study aims to elucidate trends in common micronutrient deficiencies, in particular, dietary iron, iodine and vitamin A deficiencies in China, from 1990 to 2019 using Global Burden of Disease (GBD) 2019 study data.

Methods

Prevalence and DALYs trends of common micronutrient deficiencies from 1990 to 2019 were assessed by joinpoint regression analysis. Age, period and cohort effects on the prevalence of common micronutrient deficiencies were estimated by an age-period-cohort model.

Results

From 1990 to 2019, the age-standardized prevalence rates of iodine, vitamin A and dietary iron deficiencies changed by −0.6% (95% CI: −0.7% to −0.5%), −6.3% (−6.6% to −6.0%), and −3.5% (−3.6% to −3.4%) in males and + 0.8% (+ 0.6% to + 1.0%), −4.5% (−4.8% to −4.2%), and −3.3% (−3.4% to −3.2%) in females, respectively. The average annual percent change (AAPC) in the iodine deficiency prevalence increased in females aged 20 years and older. The relative risk (RR) of iodine deficiency associated with the age effect peaked at 30–34 years of age and then decreased with increasing age. The RR of vitamin A deficiency decreased with age. The age distribution of the RR of iron deficiency differed significantly between sexes. The RRs of vitamin A deficiency and dietary iron deficiency decreased over time, whereas the RR of iodine deficiency substantially increased starting in 2004. The RRs of iodine deficiency and dietary iron deficiency associated with the cohort effect decreased, but the vitamin A deficiency prevalence increased in successive birth cohorts.

Conclusion

Micronutrient deficiency prevalence rates and associated DALYs decreased from 1990 to 2019 in China. Young adults, children aged less than 5 years, and older individuals were disproportionately affected by iodine, vitamin A, and dietary iron deficiencies, respectively. The results of this study may help identify individuals who would benefit from interventions to improve micronutrient deficiency.

Serum Vitamin A Nutritional Status of Children and Adolescents Aged 6-17 Years - China, 2016-2017

SUMMARY

What is already known on this topic? Vitamin A deficiency (VAD) in children is still a global public health problem, which needs continuous monitoring and timely intervention.

What is added by this report? Using surveillance data from China Nutrition and Health Surveillance of Children and Lactating Mothers in 2016-2017, the prevalence of VAD and marginal deficiency was 0.96% and 14.71%, respectively. The vitamin A nutritional status of children and adolescents from urban areas and those aged 12-17 years were better than those from rural areas and aged 6-11 years.

What are the implications for public health practice? Marginal VAD was a major form of VAD in Chinese children. The monitoring of vitamin A status in key populations should be continuously strengthened, and the public should be encouraged to consume foods rich in vitamin A or vitamin A supplements.

Systematic Review and Meta-Analysis of the Relative Dose-Response Tests to Assess Vitamin A Status

Vitamin A (VA) is an essential nutrient often lacking in the diets of people in developing countries. Accurate biomarkers of VA status are vital to inform public health policy and monitor interventions. The relative dose-response (RDR) and modified-RDR (MRDR) tests are semi-quantitative screening tests for VA deficiency that have been used in Demographic and Health Surveys and VA intervention studies. A systematic review and meta-analysis of sensitivity and specificity were conducted to summarize the physiological evidence to support the RDR tests as methods to assess VA status and investigate the impact of different pathological and physiological states on the tests. A total of 190 studies were screened for inclusion, with 21 studies comparing the RDR tests with the gold-standard biomarker, liver VA concentration (68% and 80% sensitivity and 85% and 69% specificity for the RDR and MRDR, respectively). Nearly all studies with VA interventions in VA-deficient populations demonstrated a response of the tests to VA intake that would be expected to improve VA status. The impacts of chronic liver disease, protein malnutrition, age, pregnancy and lactation, infection and inflammation, and various other conditions were examined in 51 studies. The RDR and MRDR tests were reported to have been used in 39 observational studies, and the MRDR has been used in at least 6 national micronutrient surveys. The RDR and MRDR are sensitive tests for determining population VA status and assessing VA interventions. Although they are robust to most physiological and pathological states, caution may be warranted when using the tests in neonates, individuals with chronic liver disease, and those with protein or iron malnutrition. Research on further improvements to the tests to increase accessibility, such as sampling breast milk instead of blood or using intramuscular doses in subjects with malabsorption, will allow wider adoption. This review was registered with PROSPERO as CRD42019124180.

Bioaccessibility of Biofortified Sweet Potato Carotenoids in Baby Food: Impact of Manufacturing Process

Orange-fleshed sweet potato (OFSP), a biofortified crop rich in β-carotene, can be used as a component of baby food recipes in order to tackle vitamin A deficiency in children <6 years old. In this work, the impact of formulation (addition of pumpkin, oil, and egg yolk) and industrial heat processing (pasteurization, sterilization) on carotenoid content and bioaccessibility was evaluated in an OFSP-based baby puree. A commercial OFSP baby food product from Brazil and a homemade OFSP puree were used as references. The losses of all-trans-β-carotene ranged from 16 to 21% (pasteurization, homemade) to 32% (sterilization). Because of higher particle sizes and despite a higher content in carotenoids, the homemade puree had a lower bioaccessibility (i.e., micellar transfer using in vitro digestion: 0.50%) compared with the sterilized and commercial purees (5.3-6.2%). Taking into account bioaccessibility and applying a 50% conversion to retinol, a 115 g baby portion of the sterilized OFSP-puree formulated with 2% oil provided 31.4% of the daily vitamin A requirement (RDA) for children under 6 years. In comparison, 115 g of homemade OFSP-puree provided only 3.5% of the RDA. Addition of pumpkin to OFSP did not improve the percentage of RDA. Interestingly, the incorporation of an emulsifier (egg yolk powder) before cooking could improve the percentage of provision by a factor of 2.7. These results showed that reaching a balance between formulation and processing is determinant to maximize carotenoid bioaccessibility of carotenoids from OFSP-based baby food.

Vitamin A deficiency and factors associated with retinol levels in public school students

ABSTRACT Objective To estimate the prevalence of vitamin A deficiency and determine the socioeconomic and demographic factors associated with serum retinol levels in public school students. Methods This cross-sectional study included 245 students from the urban and rural areas of the city of Teresina, Piauí, Brazil. Socioeconomic data were collected using a form. Serum retinol level was determined by high-performance liquid chromatography and classified according to the cut-off points provided by the World Health Organization. All statistical tests had a significance level of 5%. Results The prevalence of vitamin A deficiency (retinol level <0.70µmol/L) was 9.8% (95%CI=7.9-10.0). The prevalences of low and acceptable retinol levels (<1.05mol/L) were higher in students aged 12-14 years living in households without piped water supply (p>0.05). Water well or other untreated water sources were the factors most strongly associated with low retinol levels (OR=3.28; 95%CI=1.48-7.28; p=0.003). Conclusion Vitamin A deficiency was characterized as a mild public health problem in the students, indicating the need of actions that address this issue in schools and of studies with larger samples to investigate the problem at the municipal and state levels. Untreated water intake, a possible source of waterborne illnesses, contributed to lower retinol levels.

Brazilian studies on zinc deficiency and supplementation: emphasis on children

Abstract Objectives: to review the literature of studies developed in Brazil on zinc deficiency and the effects of supplementation. Methods: a literature review based on bibliographic research was carried out in SciELO, LILACS and MEDLINE/PUBMED databases. A total of 133 studies on zinc deficiency and 116 on the effects of supplementation were identified. Thirty-two articles, 16 of which were observational and 16 interventional, were analyzed. Results: the studies focused mainly on children (75.0% of the observational and 81.25% of the experimental studies). Biochemical deficiency of zinc in children presented great variability, from 0.0% to 74.3%, with expressive prevalence in most studies. Dietary inadequacy among children presented variability from 16.6% to 46.0%. Five from seven studies showed a positive effect of zinc supplementation on micronutrient nutritional status. Conclusions: there is evidence of zinc deficiency in children as a public health problem, preventable through micronutrient supplementation.

Comparison on the status of vitamin A in 6- to 13- year-old children between 2002 and 2012 in China

BACKGROUND

Vitamin A deficiency is recognized as a major public-health nutrition issue in the developing countries. Limited hospital sources and sample sizes are available in most of the existing studies associated with healthy school-age children. The aim of this study was to compare vitamin A status of 6- to 13-year-old healthy children in China between 2002 and 2012.

METHODS

According to China National Nutrition and Health Survey 2002 (CHNNS2002) and CHNNS2010-2013, we choose 6- to 13-year-old children as the research object. We measure the serum retinol concentrations of the children using high performance liquid chromatography (HPLC). The children were divided into two groups: 6- to 9-year-old and 10- to 13-year-old. The areas were divided into urban and rural area.

RESULTS

Total number of the children (6- to 13-year old) was 8170 in 2002 survey, and it was 6016 in 2012 survey. In 2012, the vitamin A level of the children was higher than that in 2002 (t = 39.26, p = 0.000). The level of vitamin A in 10- to 13-year-old group was higher than that in 6- to 9-year-old group across areas and genders between 2002 and 2012. There was no difference on the incidence of vitamin A deficiency in all the children between 2002 and 2012, but in 2012 the incidence of vitamin A deficiency in the urban children was higher than that in 2002 (x (2) = 45.456,p = 0.000). The incidence of vitamin A deficiency in 10- to 13-year-old group was lower than that in 10- to 13-year-old group across areas and genders between 2002 and 2012. In 2012, the incidence of marginal vitamin A deficiency in the children was lower than that in 2002 (x (2) = 861.604, p = 0.000). Similar phenomena were also found in across area groups. The incidence of marginal vitamin A deficiency in 10- to 13-year-old group was lower than that in 6- to 9-year-old group across areas and genders between 2002 and 2012. There was no difference in vitamin A status of the children across the area, gender and age groups between 2002 and 2012.

CONCLUSION

Vitamin A nutritional status of the children in 2012 has been significantly improved compared with that in 2002. However, vitamin A deficiency was still a moderate public health problem in Chinese children, especially in younger school-age children. Consequently, controlling the incidence of vitamin a deficiency is imperative for promoting Chinese children's health.

Impact of maternal vitamin A supplementation on the mother-infant pair in Brazil

BACKGROUND/OBJECTIVES

Vitamin A deficiency (VAD) is a major public health problem. The supplementation of lactating women could be an effective strategy to combat it. The objective of this study was to assess the impact of maternal vitamin A supplementation on the mother-infant pair.

SUBJECTS/METHODS

This was a double blind, placebo-controlled randomized clinical assay in which 33 women received 200 000 IU of vitamin A and 33 women received soy oil between 20th and 30th postpartum days. Maternal blood and milk samples were collected immediately before supplementation and 3 months after delivery, when blood was also collected from the babies. Retinol concentrations 0.70 μmol/l in serum and 1.05 μmol/l in milk were considered to indicate VAD.

RESULTS

Increase in serum retinol level was observed in the supplemented group compared with the pre-supplementation levels (1.05 and 1.17 μmol/l, respectively; P=0.026) and to the post-supplementation levels of the control group (1.02 μmol/l; P=0.032). Reduction in breast milk retinol was observed in the control group compared with the pre-supplementation levels (1.93 and 1.34 μmol/l, respectively; P<0.0001) and to the post-supplementation levels of the supplemented group (1.56 μmol/l; P=0.0003). There was significant difference in the prevalence of VAD in breast milk after supplementation, 55.6% (15/27) in the control group and 16.1% (5/31) in the supplemented group (P=0.002). VAD was present in 66.1% (39/59) of infants, with mean serum retinol levels of 0.64±0.30 μmol/l in the control group and of 0.69±0.26 μmol/l in the supplemented group.

CONCLUSIONS

Supplementation had a positive impact on maternal vitamin A status. No effect on infant status was detectable 2 months after supplementation with a single dose.

Are Vitamin A and Iron Deficiencies Re-Emerging in Urban Latin America? A Survey of Schoolchildren in Bogota, Colombia

Background

In Latin America, the burden of vitamin A and iron deficiencies has been documented primarily in preschool-age children. There are few recent reports on the vitamin A and iron status of school-age children.

Objective

We aimed to determine the prevalence and predictors of vitamin A and iron deficiencies in Colombian schoolchildren.

Methods

We examined plasma retinol and ferritin concentrations in relation to socioeconomic and anthropometric factors in a representative sample of 2,811 low- and middle-income children 5 to 12 years of age in Bogotá, Colombia.

Results

The prevalence rates of deficiencies of vitamin A (plasma retinol < 0.70 μmol/L) and iron (plasma ferritin < 15 μg/L) were 14% and 3%, respectively. In multivariate analysis, plasma retinol concentrations were positively associated with child's age and household's socioeconomic stratum, whereas ferritin concentrations were positively related to child's age, number of home assets, and having a nonsingle mother. Ferritin concentrations were much lower among girls than boys in the 11- and 12-year-old age group, whereas there were only small positive differences between girls and boys in younger children (p for interaction < .0001) . Both vitamin A and iron deficiencies were independently associated with lower z-scores for body-mass-index-for-age, after adjustment for sociodemographic factors and C-reactive protein concentrations. Neither vitamin A nor iron status was related to height-for-age.

Conclusions

The prevalence rates of vitamin A and iron deficiencies among schoolchildren from Bogotá, Colombia, are not negligible. Both vitamin A and iron status are positively associated with socioeconomic status and anthropometric indices. The effect of improving vitamin A and iron status on physical growth and other functional outcomes needs to be further examined in this age group.