Liver is widely eaten by preschool children in the Northern Cape province of South Africa: Implications for routine vitamin A supplementation

Vitamin A concentration in bovine liver and milk does not only depend on characteristics of the farming system

The study examined the vitamin A status in commercially managed suckler cows and lactating dairy cows and identified primary influencing factors. Liver retinyl ester concentrations were higher in multiparous than primiparous cows (p < 0.01). Pasture availability was associated with higher β-carotene concentrations (p < 0.001). In dairy cows, pasture access during the dry period did not affect any of the parameters assayed. β-Carotene and retinol in milk increased with parity. No vitamin A deficiency or hypervitaminosis A was detected. Liver and milk retinol and retinyl ester concentrations that were analysed in the present study and data from a recent German total diet study were used to estimate the exposure to preformed vitamin A in vulnerable groups (children, 0.5-5 years). 95th percentiles of preformed vitamin A intake do not exceed tolerable upper intake levels in individuals between 1 year and 5 years, but in infants 6 to 12 months of age.

Liver is widely eaten by preschool children in the Northern Cape province of South Africa: Implications for routine vitamin A supplementation

Previous research has demonstrated a virtual absence of vitamin A deficiency and adequacy of vitamin A intake through consumption of liver in preschool children of a community in the Northern Cape province of South Africa where sheep farming is common, and liver, an exceptionally rich source of vitamin A, is frequently eaten. Only 60-75 g of liver per month is needed to meet the vitamin A requirement of preschool children. Because this may have implications for routine vitamin A supplementation, and because liver consumption for the rest of the province is unknown, the study aim was to establish the prevalence and frequency of liver intake in a provincial-wide survey. An unquantified liver-specific food frequency questionnaire, covering a period of 1 month, complemented by a 1-year recall, was administered to mothers of 2- to 5-year-old children (n = 2,864) attending primary health care facilities in all five districts and 26 subdistricts. A total of 86% of children were reported to eat liver, which was eaten in all districts by at least 80% of children. The overall median frequency of liver intake was 1.0 [25th, 75th percentiles: 0.5, 3.0] times per month and ranged from 1.0 [0.3, 2.0] to 2.0 [1.0, 4.0] for the various districts. Based on a previously reported portion size of 66 g, these results suggest vitamin A dietary adequacy in all districts and possibly also vitamin A intake exceeding the Tolerable Upper Intake Level in some children. Routine vitamin A supplementation in this province may not be necessary and should be reconsidered.