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

Systematic Literature Review of the Nutrient Status, Intake, and Diet Quality of Chinese Children across Different Age Groups

There is a lack of comprehensive reports on nutrient deficiencies and dietary intake among various age groups of children in China. The objective of this review is to provide an overview of the nutrient status, intake, and diet adequacy of Chinese children (0-18 years old). PubMed and Scopus were searched for literature published between January 2010 and July 2022. A systematic review approach with a quality assessment was performed to analyze 2986 identified articles in English and Chinese. Eighty-three articles were included in the analysis. In younger children, anemia and iron and Vitamin A deficiencies remain severe public health problems, despite high Vitamin A and adequate iron intake. In older children, a high prevalence of selenium; Vitamin A and D deficiencies; and inadequate intakes of Vitamins A, D, B, C, selenium, and calcium were reported. Intakes of dairy, soybeans, fruits, and vegetables were below recommended levels. High intakes of iodine, total and saturated fat, and sodium and low dietary diversity scores were also reported. As nutritional concerns vary with age and region, future nutrition interventions should be tailored accordingly.

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.

Dietary vitamin A intakes of chinese children with adequate liver stores as assessed by the retinol isotope dilution technique

BACKGROUND

We attempted to estimate dietary vitamin A requirements based on dietary vitamin A intake in well-nourished Chinese children with adequate liver vitamin A reserves.

METHODS

A cross-sectional study was conducted in a kindergarten and an elementary school in Shiyan city, Hubei province of China from December 2009 to July 2010. After screening, 60 children (22 aged 4 ~ 6 y and 38 aged 7 ~ 9 y) were randomly subjected to a 3-d or 18-d deuterated-retinol-dilution (DRD) procedure to evaluate the vitamin A reserves in the body and liver. Dietary intakes of vitamin A were estimated from two (one in winter and one in summer) consecutive 3-day weighed food records and dietary recalls.

RESULTS

The dietary vitamin A intakes were significantly correlated with vitamin A stores in the body and liver, but not with the serum level of retinol. The dietary vitamin A intakes were 476.9 ± 196.7 µg retinol equivalent (RE) (or 377.7 ± 166.2 µg retinol activity equivalent (RAE)) / day for 4 ~ 6 y children and 529.1 ± 87.2 µg RE/d (or 464.0 ± 81.1 µg RAE/d) for 7 ~ 9 y children with adequate liver vitamin A reserves. The estimated liver stores of vitamin A derived from both time points (3-d and 18-d) were similar.

CONCLUSION

Adequate dietary vitamin A intakes among the well-nourished Chinese children were estimated to be 477 µg RE/d (95%CI 385 ~ 570) or 378 µg RAE/d (95%CI 304 ~ 441) for 4 ~ 6 y children and 529 µg RE/d (95%CI 500 ~ 560) or 464 µg RAE/d (95%CI 437 ~ 491) for 7 ~ 9 y children. Although it needs to be verified in a larger population of different regions in China, our results provide important data to establish the dietary requirement of vitamin A specifically for Chinese children.

Correlation analysis between vitamin A, D, and E status with altitude, seasonal variation, and other factors, among children aged 0-6 years in a Chinese population living in the Tibetan plateau of Ganzi prefecture

OBJECTIVE

We attempted to understand the status of vitamin (Vit) A, D, and E in children aged 0-6 living in the Tibetan plateau areas of Ganzi prefecture, to provide the basis for relevant government departments to carry out physical examinations of these children and to prevent and cure four key diseases (Infantile diarrhea, nutritional anemia, rickets, and infantile pneumonia).

METHODS

Serum retinol and tocopherol levels were detected using high-performance liquid chromatography (HPLC). Serum levels of 25-(OH)D were detected by high-performance liquid chromatography-tandem mass spectrometry (LC-MS). The polynomial logistic regression was used to analyze the effects of age, season, altitude, and gender on Vit A, D, and E levels.

RESULTS

Vit A and D had the lowest mean serum levels before the age of 1 year and with the most significant deficiency rates. The lowest Vit E levels were seen in the Toddlerhood group. The rates of deficiency and insufficiency were the highest. Vit A, D, and E levels were significantly affected by seasonal changes and were significantly higher in the summer than in any other season. Vit A and D were significantly affected by altitude, and their levels were lowest above 4 km.

CONCLUSION

The overall levels of Vit A, D, and E in children aged 0-6 in the Tibetan plateau areas of Ganzi prefecture were lower than those in the plain's areas.

Clinical Monitoring of Serum Levels of Vitamins A, D and E in Children with Recurrent Respiratory Tract Infections of Different Ages: A Clinical Controlled Trial

Objective

To study serum levels of vitamins A, D and E in children with recurrent respiratory tract infections of different ages and the correlation.

Methods

The clinical data of two groups of children of different ages were collected. The serum levels and deficiencies of vitamins A, D and E in children were statistically analyzed.

Results

The proportions of premature infants, low body weight infants, special physique, hospitalization history, hypocalcemia, living in a bungalow, and daily outdoor activities in less than 30 minutes in the case group were higher than those in the control group (χ²=4.507, 5.165, 7.040, 14.907, 4.267, 33.800, 4.507, 8.571, P < 0.05). The serum levels of vitamins A, D and E of children aged 0–1, 2–5, and 6–12 in the case group were lower than those in the control group (P < 0.05). Compared with the control group, the serum vitamin A level of children in the case group was lower (t = 2.631, P < 0.05), and the deficiency rate was higher (χ²=24.200, P < 0.05).

Conclusion

Serum levels of vitamins A, D and E, which are related to birth mode, physical fitness, hospitalization history, hypocalcemia, vitamin deficiency, living environment, and daily outdoor activity time, vary in children with recurrent respiratory tract infections of different ages, and are lower in children with recurrent respiratory tract infections than in healthy children.

Vitamin A Levels Among Pre-School Children of Central and Western China

Objective: To investigate vitamin A deficiency of pre-school children in central and western China for developing strategies to prevent and control vitamin A deficiency (VAD) among children. Design: From November 2018 to September 2019, a total of 2,194 healthy children aged 2-6 years were enrolled. Serum retinol levels in the children were detected by liquid-phase tandem mass spectrometry. In addition, social demographic and dietary questionnaires were collected through interviews with children's caregivers. Setting: The participants were enrolled in 12 cities or their subordinate jurisdictions in the central and western regions of China. Participants: Two thousand one hundred and ninety four healthy children aged 2-6 years old. Results: Overall, 35.51% (779/2,194) of the children were found to be vitamin A insufficient (VAI, serum retinol < 1.05 μmol/L). Elder children had a higher risk to suffer from VAI, with proportions of 25.00% (87/348), 28.92% (142/491), 38.38% (256/667), and 42.73% (294/688) among children aged 2, 3, 4, and 5 years, respectively. Vitamin A levels were also positively correlated with per capita income (AOR = 1.18) and regional economic level (0.71), and the frequency of milk intake (0.91). Conclusions: The incidence of VAI was higher among children aged 2-6 years, and the incidence of VAI increases with age. VA levels were positively correlated with levels of economic development in the family and region. So prevention strategies for VAD need to focus on pre-school children, especially dairy intake and developing regions.

Nutritional status and vitamin A and zinc levels in patients with kala-azar in Piauí, Brazil

INTRODUCTION

Malnutrition and kala-azar (or visceral leishmaniasis) are significant public health problems in different parts of the world. Immunity and susceptibility to infectious and parasitic diseases are directly linked to the host's nutritional state, but little is known about the interaction between nutrition and kala-azar. This study aimed to evaluate nutritional status with kala-azar and correlate these findings with the clinical and laboratory manifestations of the disease, and zinc and retinol levels.

METHODS

This was a cross-sectional study of 139 patients with kala-azar. Nutritional status classification was performed according to international recommendations. Parametric or nonparametric tests were applied whenever indicated in a two-sided test with a 5% significance level.

RESULTS

Weight loss and malnutrition were more frequent in adults. Body mass index-for-age, fat area of the arm, and upper arm muscle area were significantly associated with probability of death. The presence of human immunodeficiency virus, hepatomegaly, and splenomegaly was correlated with nutritional assessment. Blood leukocyte and lymphocyte, serum creatine, and vitamin A levels were significantly higher in adult men. Vitamin A levels were highly associated with the level of hemoglobin and C-reactive protein (CRP) in multivariate analysis. All patients had reduced plasma zinc levels, but this finding had no association with the outcome variables.

CONCLUSIONS

Malnutrition was correlated with severe disease and was more prevalent in older people with kala-azar. Vitamin A deficiency was associated with hemoglobin and CRP. Zinc levels were reduced in patients with kala-azar.

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.

Sociodemographic disparity in the nutritional status among children and adolescents in Zhejiang Province

OBJECTIVE

To explore the sociodemographic disparity in the nutritional status including BMI, vitamin D and vitamin A status among children and adolescents in Zhejiang Province.

METHODS

Weight, height serum 25-hydroxyvitamin D, and serum retinol were assessed in 2818 children and adolescents (6-17 years of age), using ten investigation sites in Zhejiang Province including urban and rural areas data from the China National Nutritional Study 2016-2017, which is a nationally representative cross-sectional study, to form provincial representative sample of Zhejiang Province. Sociodemographic disparity was explored.

RESULTS

The prevalence of low weight, eutrophic, overweight and obese were 6.7%, 70.4%, 11.6%, and 11.2%, respectively. Significant difference was observed on BMI between males and females (P < 0.05), and between urban and rural areas (P < 0.05). The prevalence of vitamin D deficiency, inadequacy, normal and appropriate were 1.8%, 34.9%, 46.4% and 16.9%, respectively. Significant difference was observed on the concentration of 25-hydroxyvitamin D (25(OH)D) both between genders and between living areas (P < 0.05). The prevalence of vitamin A deficiency, marginal deficiency and appropriate were 4.5%, 24.7%, and 70.9%, respectively. Significant difference was observed on the concentration of retinol between living area (P < 0.05).

CONCLUSIONS

Overweight and obesity, deficiency and inadequacy of vitamin D, deficiency and marginal deficiency of vitamin A were prevalent among children and adolescents. There were disparities between genders and between living areas on the nutritional status. Regional and sex-specific guidelines and public health policies for children and adolescent nutrition are needed.

Dietary vitamin a intake among Chinese adults: findings from CNTCS2015

Background

Vitamin A plays an important role in human functions, which mainly come from foods. This study aims to examine dietary vitamin A intake and major food sources of Chinese adults.

Methods

We analyzed the cross-sectional data from 12,246 adult aged 18 to 64 years old in 2015 China Nutritional Transition Cohort Study. Three consecutive 24-h dietary recalls combined with household weighing method were used to assess dietary vitamin A intake.

Results

The average dietary vitamin A intakes were 480.9 μg retinol equivalents (RE) or 307.2 μg retinol activity equivalents (RAE). The carotenes and retinol intake of subjects were 2084.7 μg/day and 133.5 μg/day, respectively. Approximately 87% of adults consumed less vitamin A than the Chinese Estimated Average Requirement (EAR), and only 6% of adults consumed more than Chinese Recommended Nutrient Intake (RNI). Chinese adults derived vitamin A mainly from plant source foods, which is supplied as carotenes (67.4% RE or 56.4% RAE). Dark- and light- vegetables and fruits were major contributors of carotenes (accounted for 84.2%). The most import food sources of retinol were egg, meats and meat products, poultry, fish and milk, representing 94.7% of retinol intake. The major four contributors of total vitamin A (as both RE and RAE) were dark vegetables, egg, light vegetables, and meats and meat products. In conclusion, dietary vitamin A remains a problem for Chinese adults.

Conclusions

Public health actions are needed to increase vitamin A intake in China.

Nutrition assessment of vitamin A and vitamin D in northeast Chinese population based-on SPE/UPLC/PDA

BACKGROUND

The aims of the current study were to assess the nutritional status of 25OHD3 and retinol in a northern Chinese population using our established reliable method for the simultaneous determination of serum 25OHD3 and retinol.

METHOD

We established a reliable method for the simultaneous determination of 25OHD3 and retinol using SPE and UPLC/PDA; measured the serum levels of 25OHD3 and retinol in elementary school students, middle school students, and adults (n = 1181) in northern China; and assessed their nutritional status.

RESULTS

Our method had good precision, detection limit, and linear quantitative range and could process 100 samples within 12 h. The average levels of 25OHD3 and retinol were 16.1 ± 6.7 ng/ml and 328.1 ± 117.1 ng/ml, respectively, in all samples. VD deficiency was common, with a prevalence > 60% in all three age groups, and the high prevalence of VA deficiency (26.1%) was observed only in the elementary school students.

CONCLUSIONS

Vitamin A supplementation should be considered for elementary school students, and vitamin D supplementation is highly recommended for all age groups in Harbin. Our method could be widely adopted in population-based studies and clinical practice.

Low Serum Levels of Vitamins A, D, and E Are Associated with Recurrent Respiratory Tract Infections in Children Living in Northern China: A Case Control Study

Background

This study aimed to investigate the association of serum concentrations of vitamin A, D, and E with recurrent respiratory tract infections (RRTIs).

Methods

A total of 1200 children aged at 0.5–14 years were selected via a face-to-face survey in Harbin, China. Among the participants, 600 children with RRTIs comprised the symptomatic group (RRTI group), whereas 600 healthy children were used as controls (control group). Blood samples were collected to measure serum levels of vitamins A and E by HPLC; the serum level of 25-hydroxycholecalciferol (25(OH)D), was measured by HPLC-MS/MS.

Results

Serum levels of vitamins A and E, as well as 25(OH)D, were significantly lower in the RRTI group than the control group. The conditional logistic regression model and the receiver-operating characteristic curve showed that the insufficiency or deficiency of vitamins A, D, and E was positively correlated with RRTI occurrence (p < 0.05).

Conclusions

Low serum concentrations of vitamins A, D, and E were associated with RRTIs in children from northern China.