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Nankumbi J, Grant F, Sibeko L, Mercado E, O'Neil K, Cordeiro LS. Effects of Food-Based Approaches on Vitamin A Status of Women and Children: A Systematic Review. Adv Nutr 2023; 14:1436-1452. [PMID: 37634852 PMCID: PMC10721510 DOI: 10.1016/j.advnut.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 08/02/2023] [Accepted: 08/15/2023] [Indexed: 08/29/2023] Open
Abstract
Vitamin A deficiency (VAD) increases risk for morbidity and mortality. Food-based approaches offer one strategy to improve vitamin A status. This systematic review assessed evidence of the effects of food-based approaches on the vitamin A status of women and children under 5 y. VAD was defined as clinical ocular symptoms, such as loss of vision, and/or retinol plasma or serum concentration <0.70 μmol/L. Searches on food-based approaches to improve vitamin A status were conducted for the period 2011-2022 on PubMed, CINHAL, Web of Science, and Google Scholar using PRISMA guidelines. English-language publications were included. Case studies, unpublished dissertations, and non-peer-reviewed studies were excluded. This review comprises 24 of 27,322 identified studies; 23 included studies focused on provitamin A carotenoids. There were 17,214 participants across the 24 studies with sample sizes ranging from 8 to 3571 individuals. Intervention studies spanned from 3 wk to 2 y. Fifteen (63%) studies were randomized control trials, 7 were cross-sectional, and 2 were longitudinal studies. Most studies (N = 21) used biochemical measurements, for example, serum retinol, to assess vitamin A status; other studies used clinical symptoms (for example, xerophtalmia) or dietary intake. Thirteen (54%) studies reported a statistically significant effect of food-based interventions (N = 8) or an association of diet (N = 5) on vitamin A status. This systematic review indicated that some food-based interventions improved vitamin A status, thus offering a safe and effective delivery mechanism for vitamin A. There appeared to be significant association between vitamin A status and consumption of foods with high concentrations of preformed vitamin A and provitamin A carotenoids. Differences across studies in regard to the period of evaluation, food approaches used, and statistical power may explain the lack of effectiveness of food-based approaches on vitamin A status in some studies.
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Affiliation(s)
- Joyce Nankumbi
- Department of Nutrition, University of Massachusetts, Amherst, MA, United States
| | | | - Lindiwe Sibeko
- Department of Nutrition, University of Massachusetts, Amherst, MA, United States
| | - Evelyn Mercado
- Department of Psychology and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, United States
| | - Kristina O'Neil
- Department of Nutrition, University of Massachusetts, Amherst, MA, United States
| | - Lorraine S Cordeiro
- Department of Nutrition, University of Massachusetts, Amherst, MA, United States.
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Ford JL, Green MH, Brownell JN, Green JB, Oxley A, Lietz G, Schall JI, Stallings VA. Use of Compartmental Modeling and Retinol Isotope Dilution to Determine Vitamin A Stores in Young People with Sickle Cell Disease Before and After Vitamin A Supplementation. J Nutr 2023; 153:2762-2771. [PMID: 37468045 PMCID: PMC10517228 DOI: 10.1016/j.tjnut.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/18/2023] [Accepted: 07/11/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Suboptimal plasma retinol concentrations have been documented in US children with sickle cell disease (SCD) hemoglobin SS type (SCD-HbSS), but little is known about vitamin A kinetics and stores in SCD. OBJECTIVES The objectives were to quantify vitamin A total body stores (TBS) and whole-body retinol kinetics in young people with SCD-HbSS and use retinol isotope dilution (RID) to predict TBS in SCD-HbSS and healthy peers as well as after vitamin A supplementation in SCD-HbSS subjects. METHODS Composite plasma [13C10]retinol response data collected from 22 subjects with SCD-HbSS for 28 d after isotope ingestion were analyzed using population-based compartmental modeling ("super-subject" approach); TBS and retinol kinetics were quantified for the group. TBS was also calculated for the same individuals using RID, as well as for healthy peers (n = 20) and for the subjects with SCD-HbSS after 8 wk of daily vitamin A supplements (3.15 or 6.29 μmol retinol/d [900 or 1800 μg retinol activity equivalents/d]). RESULTS Model-predicted group mean TBS for subjects with SCD-HbSS was 428 μmol, equivalent to ∼11 mo of stored vitamin A; vitamin A disposal rate was 1.3 μmol/d. Model-predicted TBS was similar to that predicted by RID at 3 d postdosing (mean, 389 μmol; ∼0.3 μmol/g liver); TBS predictions at 3 compared with 28 d were not significantly different. Mean TBS in healthy peers was similar (406 μmol). RID-predicted TBS for subjects with SCD-HbSS was not significantly affected by vitamin A supplementation at either dose. CONCLUSIONS Despite differences in plasma retinol concentrations, TBS was the same in subjects with SCD-HbSS compared with healthy peers. Because 56 d of vitamin A supplementation at levels 1.2 to 2.6 times the Recommended Dietary Allowance did not increase TBS in these subjects with SCD-HbSS, further work will be needed to understand the effects of SCD on retinol metabolism. This trial was registered as NCT03632876 at clinicaltrials.gov.
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Affiliation(s)
- Jennifer Lynn Ford
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, United States
| | - Michael H Green
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, United States.
| | - Jefferson N Brownell
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Joanne Balmer Green
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, United States
| | - Anthony Oxley
- Human Nutrition Research Centre, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Georg Lietz
- Human Nutrition Research Centre, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Joan I Schall
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Virginia A Stallings
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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Van Wayenbergh E, Langenaeken NA, Struyf N, Goos P, Foubert I, Courtin CM. Stabilisation of vitamin A by wheat bran is affected by wheat bran antioxidants, bound lipids and endogenous lipase activity. Food Res Int 2023; 169:112911. [PMID: 37254347 DOI: 10.1016/j.foodres.2023.112911] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 06/01/2023]
Abstract
Food fortification is an efficient strategy to combat vitamin A deficiency. However, the stability of vitamin A during storage is low. Cereal bran can be used as a natural and affordable stabilising agent, but the mechanism behind this stabilisation remains unclear. To unravel this mechanism, vitamin A stabilisation was studied during an accelerated storage experiment (60 °C, 70% relative humidity) using a set of 30 in-house modified wheat bran samples. The characteristics of these samples were linked to vitamin A stabilisation during storage using forward regression modelling. While all wheat bran samples could stabilise vitamin A to a significant extent, the stabilising effect was more pronounced for samples with a high antioxidant capacity, high bound lipid content and low lipase activity. The main effect of lipase activity was more than thrice as large as the main effects of antioxidant capacity and bound lipid content. These results suggest that wheat bran antioxidants and bound lipids protect vitamin A from degradation during storage, while endogenous lipase activity counteracts the stabilising effect. Based on these findings, modified wheat bran mixed with vitamin A can be a cost-effective and healthy aid in food fortification by providing high vitamin A stability.
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Affiliation(s)
- Eline Van Wayenbergh
- Laboratory of Food Chemistry and Biochemistry & Leuven Food Science and Nutrition Research Centre (LFoRCe), KU Leuven, Kasteelpark Arenberg 20, B-3001 Heverlee, Belgium.
| | - Niels A Langenaeken
- Laboratory of Food Chemistry and Biochemistry & Leuven Food Science and Nutrition Research Centre (LFoRCe), KU Leuven, Kasteelpark Arenberg 20, B-3001 Heverlee, Belgium
| | - Nore Struyf
- Laboratory of Food Chemistry and Biochemistry & Leuven Food Science and Nutrition Research Centre (LFoRCe), KU Leuven, Kasteelpark Arenberg 20, B-3001 Heverlee, Belgium
| | - Peter Goos
- Division of Mechatronics, Biostatistics and Sensors (MeBioS), KU Leuven, Kasteelpark Arenberg 30, B-3001 Heverlee, Belgium; Department of Engineering Management, University of Antwerp, Prinsstraat 13, B-2000 Antwerp, Belgium
| | - Imogen Foubert
- Research Unit of Food and Lipids & Leuven Food Science and Nutrition Research Centre (LFoRCe), KU Leuven Kulak, Etienne Sabbelaan 53, B-8500 Kortrijk, Belgium
| | - Christophe M Courtin
- Laboratory of Food Chemistry and Biochemistry & Leuven Food Science and Nutrition Research Centre (LFoRCe), KU Leuven, Kasteelpark Arenberg 20, B-3001 Heverlee, Belgium
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Zeng J, Li Y, Ren Y, Gu W, Li Z, Yang M, Xiang B. Dietary vitamin A intakes of chinese children with adequate liver stores as assessed by the retinol isotope dilution technique. BMC Pediatr 2022; 22:599. [PMID: 36253851 PMCID: PMC9575266 DOI: 10.1186/s12887-022-03660-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/15/2022] [Accepted: 09/28/2022] [Indexed: 12/05/2022] Open
Abstract
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.
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Affiliation(s)
- Jing Zeng
- School of Public Health, Wuhan University of Science and Technology, 430065, Wuhan, Hubei, China.
| | - Yanming Li
- grid.412787.f0000 0000 9868 173XSchool of Public Health, Wuhan University of Science and Technology, 430065 Wuhan, Hubei China
| | - Yan Ren
- grid.412787.f0000 0000 9868 173XSchool of Public Health, Wuhan University of Science and Technology, 430065 Wuhan, Hubei China
| | - Weiwei Gu
- Shiyan Centre for Disease Control and Prevention, 442000 Shiyan, Hubei China
| | - Zhaolin Li
- Shiyan Centre for Disease Control and Prevention, 442000 Shiyan, Hubei China
| | - Mei Yang
- grid.412787.f0000 0000 9868 173XResearch Center for Health Promotion in Women, Youth and Children, Wuhan University of Science and Technology, 430065 Wuhan, Hubei China
| | - Bing Xiang
- grid.412787.f0000 0000 9868 173XResearch Center for Health Promotion in Women, Youth and Children, Wuhan University of Science and Technology, 430065 Wuhan, Hubei China
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Green MH, Lopez-Teros V, Avila-Prado J, Green JB. Use of Compartmental Modeling and Datasets for Theoretical Lactating Women to Determine Conditions under Which Vitamin A-Specific Activity in Breast Milk Provides Accurate Estimates of Vitamin A Total Body Stores by Retinol Isotope Dilution. J Nutr 2022; 152:1629-1634. [PMID: 35389495 DOI: 10.1093/jn/nxac085] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/13/2022] [Accepted: 04/04/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Vitamin A concentrations in breast milk are related to maternal vitamin A intake and status. OBJECTIVES Our objective was to identify conditions under which vitamin A specific activity in breast milk (SAm) could be used instead of retinol specific activity in plasma (SAp) to predict vitamin A total body stores (TBS) by retinol isotope dilution (RID). METHODS We used 12 previously-studied theoretical lactating women with assigned values for TBS (219-1348 μmol) and retinol kinetic parameters; we assumed subjects ingested a dose of stable isotope-labeled vitamin A. We expanded a 9-compartment steady state tracer model to include a parallel model for tracee (unlabeled retinol) and then adapted that model so vitamin A intake entered the system in 3 meals each day. Using compartmental analysis, we first simulated SAm and SAp after an overnight fast (as in actual RID experiments) and then with vitamin A intake also restricted in sequential meals on the day before sampling for RID. RESULTS After an overnight fast, SAm at day 21 postdosing was lower than SAp. However, if vitamin A intake was also restricted in 1, 2, or 3 meals before sampling, SAm/SAp (mean ± SD) was 0.92 ± 0.042, 0.96 ± 0.016, or 0.99 ± 0.004, respectively; results for days 14 and 28 were similar. When either SAp or SAm was used to predict TBS by RID on day 21 after 1-d restriction, predictions for all subjects were within 25% of assigned TBS. CONCLUSIONS Results indicate that, for theoretical lactating women with a wide range of vitamin A status, SAm will accurately predict TBS by RID at 2-4 wk postdosing if vitamin A intake is restricted for 1 d before sampling. If confirmed in community settings, results suggest that vitamin A status in lactating women can be determined without collecting blood.
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Affiliation(s)
- Michael H Green
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Veronica Lopez-Teros
- Department of Chemical and Biological Sciences, Universidad de Sonora, Hermosillo, Sonora, Mexico
| | - Jessica Avila-Prado
- Department of Chemical and Biological Sciences, Universidad de Sonora, Hermosillo, Sonora, Mexico
| | - Joanne Balmer Green
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
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Hooper L, Esio-Bassey C, Brainard J, Fynn J, Jennings A, Jones N, Tailor BV, Abdelhamid A, Coe C, Esgunoglu L, Fallon C, Gyamfi E, Hill C, Howard Wilsher S, Narayanan N, Oladosu T, Parkinson E, Prentice E, Qurashi M, Read L, Getley H, Song F, Welch AA, Aggett P, Lietz G. Evidence to Underpin Vitamin A Requirements and Upper Limits in Children Aged 0 to 48 Months: A Scoping Review. Nutrients 2022; 14:nu14030407. [PMID: 35276767 PMCID: PMC8840537 DOI: 10.3390/nu14030407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/31/2021] [Accepted: 01/10/2022] [Indexed: 02/04/2023] Open
Abstract
Vitamin A deficiency is a major health risk for infants and children in low- and middle-income countries. This scoping review identified, quantified, and mapped research for use in updating nutrient requirements and upper limits for vitamin A in children aged 0 to 48 months, using health-based or modelling-based approaches. Structured searches were run on Medline, EMBASE, and Cochrane Central, from inception to 19 March 2021. Titles and abstracts were assessed independently in duplicate, as were 20% of full texts. Included studies were tabulated by question, methodology and date, with the most relevant data extracted and assessed for risk of bias. We found that the most recent health-based systematic reviews and trials assessed the effects of supplementation, though some addressed the effects of staple food fortification, complementary foods, biofortified maize or cassava, and fortified drinks, on health outcomes. Recent isotopic tracer studies and modelling approaches may help quantify the effects of bio-fortification, fortification, and food-based approaches for increasing vitamin A depots. A systematic review and several trials identified adverse events associated with higher vitamin A intakes, which should be useful for setting upper limits. We have generated and provide a database of relevant research. Full systematic reviews, based on this scoping review, are needed to answer specific questions to set vitamin A requirements and upper limits.
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Affiliation(s)
- Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
- Correspondence: ; Tel.: +44-1603-591268
| | - Chizoba Esio-Bassey
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Julii Brainard
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Judith Fynn
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Amy Jennings
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Natalia Jones
- School of Environmental Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK;
| | - Bhavesh V. Tailor
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Asmaa Abdelhamid
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Calvin Coe
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Latife Esgunoglu
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Ciara Fallon
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Ernestina Gyamfi
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Claire Hill
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Stephanie Howard Wilsher
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Nithin Narayanan
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Titilopemi Oladosu
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Ellice Parkinson
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK;
| | - Emma Prentice
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Meysoon Qurashi
- Department of Medicine, Luton and Dunstable Hospital NHS Foundation Trust, Lewsey Road, Luton LU4 0DZ, UK;
| | - Luke Read
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Harriet Getley
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Fujian Song
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Ailsa A. Welch
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Peter Aggett
- Lancashire School of Postgraduate Medicine and Health, University of Central Lancashire, Preston PR1 2HE, UK;
| | - Georg Lietz
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne NE2 4HH, UK;
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Green MH, Lopez-Teros V, Green JB. Does the Amount of Stable Isotope Dose Influence Retinol Kinetic Responses and Predictions of Vitamin A Total Body Stores by the Retinol Isotope Dilution Method in Theoretical Children and Adults? J Nutr 2022; 152:86-93. [PMID: 34549295 DOI: 10.1093/jn/nxab337] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/03/2021] [Accepted: 09/16/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND To minimize both cost and perturbations to the vitamin A system, investigators limit the amount of stable isotope administered when estimating vitamin A total body stores (TBS) by retinol isotope dilution (RID). OBJECTIVES We hypothesized that reasonable increases in the mass of stable isotope administered to theoretical subjects would have only transient impacts on vitamin A kinetics and minimal effects on RID-predicted TBS. METHODS We adapted previously used theoretical subjects (3 children, 3 adults) with low, moderate, or high assigned TBS and applied compartmental analysis to solve a steady state model for tracer and tracee using assigned values for retinol kinetic parameters and plasma retinol. To follow retinol trafficking when increasing amounts of stable isotope were administered [1.39-7 (children) and 2.8-14 μmol retinol (adults)], we added assumptions to an established compartmental model so that plasma retinol homeostasis was maintained. Using model-simulated data, we plotted retinol kinetics versus time and applied the RID equation TBS = FaS/SAp [Fa, fraction of dose in stores; S, retinol specific activity (SA) in plasma/SA in stores; SAp, SA in plasma] to calculate vitamin A stores. RESULTS The model predicted that increasing the stable isotope dose caused transient early increases in hepatocyte total retinol; increases in plasma tracer were accompanied by decreases in tracee to maintain plasma retinol homeostasis. Despite changes in kinetic responses, RID accurately predicted assigned TBS (98-105%) at all loads for all theoretical subjects from 1 to 28 d postdosing. CONCLUSIONS Results indicate that, compared with doses of 1.4-3.5 μmol used in recent RID field studies, doubling the stable isotope dose should not affect the accuracy of TBS predictions, thus allowing for experiments of longer duration when including a super-subject design (Ford et al., J Nutr 2020;150:411-8) and/or studying retinol kinetics.
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Affiliation(s)
- Michael H Green
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Veronica Lopez-Teros
- Department of Chemical and Biological Sciences, Universidad de Sonora, Hermosillo, Sonora, Mexico
| | - Joanne Balmer Green
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
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8
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Lopez-Teros V, Green MH, Haskell MJ, Green JB. Influence of Vitamin A Status on the Choice of Sampling Time for Application of the Retinol Isotope Dilution Method in Theoretical Children. J Nutr 2021; 151:3874-3881. [PMID: 34587254 DOI: 10.1093/jn/nxab310] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/21/2021] [Accepted: 08/19/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Vitamin A status may influence the choice of a blood sampling time for applying the retinol isotope dilution (RID) equation to predict vitamin A total body stores (TBS) in children. OBJECTIVES We aimed to identify time(s) after administration of labeled vitamin A that provide accurate estimates of TBS in theoretical children with low or high TBS. METHODS We postulated 2- to 5-y-old children (12/group) with low (<200 μmol) or high TBS (≥700 μmol) and used compartmental analysis to simulate individual subject values for the RID equation TBS = FaS/SAp (Fa, fraction of dose in stores; S, retinol specific activity in plasma/in stores; SAp, retinol specific activity in plasma). Using individual SAp and group geometric mean FaS values from 1-28 d, we calculated individual and group mean TBS and compared them to assigned values. RESULTS Mean TBS was accurately predicted for both groups at all times. For individuals, predicted and assigned TBS were closest when the CV% for FaS was low [12-14%; 4-13 d (low), 12-28 d (high)]. The mean percentage error for TBS was <10% from 2-19 d (low) and 7-28 d (high). Predicted TBS was within 25% of assigned TBS for ≥80% of children from 3-23 d (low) and 9-28 d (high). Within groups, RID tended to overestimate lower TBS and underestimate higher TBS. CONCLUSIONS Using a good estimate for FaS, accurate RID predictions of TBS for individuals will be obtained at many times. If vitamin A status is low, results indicate that early sampling (e.g., 4-13 d) is optimal; if vitamin A status is high, sampling at 12-28 d is indicated. When vitamin A status is unknown, sampling at 14 d is recommended, or a super-subject design can be used to obtain the group mean FaS at various times for RID prediction of TBS in individuals.
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Affiliation(s)
- Veronica Lopez-Teros
- Department of Chemical and Biological Sciences, Universidad de Sonora, Hermosillo, Sonora, Mexico
| | - Michael H Green
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Marjorie J Haskell
- Institute for Global Nutrition, Department of Nutrition, University of California-Davis, Davis, CA, USA
| | - Joanne Balmer Green
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
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Palmer AC, Jobarteh ML, Chipili M, Greene MD, Oxley A, Lietz G, Mwanza R, Haskell MJ. Biofortified and fortified maize consumption reduces prevalence of low milk retinol, but does not increase vitamin A stores of breastfeeding Zambian infants with adequate reserves: a randomized controlled trial. Am J Clin Nutr 2021; 113:1209-1220. [PMID: 33693468 DOI: 10.1093/ajcn/nqaa429] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 12/16/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Replacement of conventional staples with biofortified or industrially fortified staples in household diets may increase maternal breast milk retinol content and vitamin A intakes from complementary foods, improving infant total body stores (TBS) of vitamin A. OBJECTIVES To determine whether biofortified or industrially fortified maize consumption by Zambian women and their breastfeeding infants could improve milk retinol concentration and infant TBS. METHODS We randomly assigned 255 lactating women and their 9-mo-old infants to a 90-d intervention providing 0 µg retinol equivalents (RE)/d as conventional maize or ∼315 µg RE/d to mothers and ∼55 µg RE/d to infants as provitamin A carotenoid-biofortified maize or retinyl palmitate-fortified maize. Outcomes were TBS, measured by retinol isotope dilution in infants (primary), and breast milk retinol, measured by HPLC in women (secondary). RESULTS The intervention groups were comparable at baseline. Loss to follow-up was 10% (n = 230 mother-infant pairs). Women consumed 92% of the intended 287 g/d and infants consumed 82% of the intended 50 g/d maize. The baseline geometric mean (GM) milk retinol concentration was 1.57 μmol/L (95% CI: 1.45, 1.69 μmol/L), and 24% of women had milk retinol <1.05 μmol/L. While mean milk retinol did not change in the biofortified arm (β: 0.11; 95% CI: -0.02, 0.24), the intervention reduced low milk retinol (RR: 0.42; 95% CI: 0.21, 0.85). Fortified maize increased mean milk retinol (β: 0.17; 95% CI: 0.04, 0.30) and reduced the prevalence of low milk retinol (RR: 0.46; 95% CI: 0.25, 0.82). The baseline GM TBS was 178 μmol (95% CI: 166, 191 μmol). This increased by 24 µmol (± 136) over the 90-d intervention period, irrespective of treatment group. CONCLUSIONS Both biofortified and fortified maize consumption improved milk retinol concentration. This did not translate into greater infant TBS, most likely due to adequate TBS at baseline. This trial was registered at clinicaltrials.gov as NCT02804490.
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Affiliation(s)
- Amanda C Palmer
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Modou L Jobarteh
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, CA, USA
| | | | - Matthew D Greene
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anthony Oxley
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Georg Lietz
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rose Mwanza
- Provincial Medical Office for Central Province, Kabwe, Zambia
| | - Marjorie J Haskell
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, CA, USA
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Hoang NTD, Orellana L, Gibson RS, Le TD, Worsley A, Sinclair AJ, Hoang NTT, Szymlek-Gay EA. Multiple micronutrient supplementation improves micronutrient status in primary school children in Hai Phong City, Vietnam: a randomised controlled trial. Sci Rep 2021; 11:3728. [PMID: 33580103 PMCID: PMC7881239 DOI: 10.1038/s41598-021-83129-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 01/28/2021] [Indexed: 01/21/2023] Open
Abstract
We aimed to determine the efficacy of multiple micronutrient supplementation on the biomarkers of iron, zinc, and vitamin A status across anthropometric status categories in Vietnamese school children. In this 22-week randomised controlled trial, 347 undernourished, normal weight, or overweight/obese children aged 6–9 years were allocated to receive every school day a multiple micronutrient supplement (10 mg iron, 10 mg zinc, 400 µg vitamin A) or a placebo. Haematological indices; circulating ferritin, zinc, and retinol (corrected for inflammation); and C-reactive protein were measured at baseline and 22 weeks. At week 22, linear mixed models showed that mean corpuscular volume increased by 0.3 fL, serum ferritin by 9.1 µg/L, plasma zinc by 0.9 µmol/L, and plasma retinol by 15%, and the prevalence of zinc deficiency decreased by 17.3% points in the intervention group compared to placebo. No intervention effects were found for other haematological indices, or the prevalence of anaemia. Multiple micronutrient supplementation for 22 weeks improved the biomarkers of zinc and vitamin A status and some biomarkers of iron status, and reduced the prevalence of zinc deficiency in Vietnamese school children. Trial registration: This trial was registered on 06/09/2016 at www.anzctr.org.au as ACTRN12616001245482.
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Affiliation(s)
- Ngan T D Hoang
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Liliana Orellana
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Australia
| | - Rosalind S Gibson
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Tuyen D Le
- National Institute of Nutrition, Hanoi, Vietnam
| | - Anthony Worsley
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | | | | | - Ewa A Szymlek-Gay
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
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11
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Afolami I, Mwangi MN, Samuel F, Boy E, Ilona P, Talsma EF, Feskens E, Melse-Boonstra A. Daily consumption of pro-vitamin A biofortified (yellow) cassava improves serum retinol concentrations in preschool children in Nigeria: a randomized controlled trial. Am J Clin Nutr 2020; 113:221-231. [PMID: 33184647 PMCID: PMC7779233 DOI: 10.1093/ajcn/nqaa290] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/22/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Vitamin A deficiency is a public health problem in sub-Saharan Africa. Pro-vitamin A biofortified (yellow) cassava has the potential to contribute significantly to improve vitamin A status, especially in populations that are difficult to reach with other strategies. OBJECTIVES The study aimed at determining the efficacy of biofortified cassava to improve vitamin A status of Nigerian preschool children. METHODS An open-label randomized controlled trial was conducted in southwestern Nigeria. In total, 176 preschool children (aged 3-5 y) were randomized into 2 parallel arms comprising an experimental group (n = 88), fed foods prepared from biofortified (yellow) cassava, and a control group (n = 88), fed foods prepared from white cassava, twice a day, 6 d a week for 93 d. RESULTS A total of 159 children completed the trial (yellow cassava group, n = 80; white cassava group, n = 79). Children consumed 221 and 74 µg/d retinol activity equivalents from intervention foods in the yellow and white cassava groups, respectively. The treatment effect on serum retinol concentrations at the end of the feeding trial was 0.06 µmol/L (95% CI: 0.004, 0.124 µmol/L), after adjustment for baseline retinol concentrations, inflammation, and asymptomatic malaria status. No significant treatment effects were detected for serum β-carotene (adjusted effect: 3.9%; 95% CI: -0.6%, 8.6%) and gut permeability (adjusted effect: 0.002; 95% CI: -0.089, 0.092), but a significant effect was detected for hemoglobin concentrations (adjusted effect: 3.08 g/L; 95% CI: 0.38, 5.78 g/L). CONCLUSIONS Daily consumption of β-carotene from biofortified cassava improved serum retinol and hemoglobin concentrations modestly in Nigerian preschool children. This study was registered with clinicaltrials.gov as NCT02627222.
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Affiliation(s)
- Ibukun Afolami
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands,Department of Human Nutrition and Dietetics, University of Ibadan, Ibadan, Nigeria
| | - Martin N Mwangi
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands,Training and Research Unit of Excellence, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Folake Samuel
- Department of Human Nutrition and Dietetics, University of Ibadan, Ibadan, Nigeria
| | | | | | - Elise F Talsma
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Edith Feskens
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
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12
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Gannon BM, Colt S, Rogers LM, Garcia-Casal MN, Martinez RX, Lopez-Perez L, Ghezzi-Kopel K, Mehta S. Selected laboratory-based biomarkers for assessing vitamin A deficiency in at-risk individuals. Hippokratia 2020. [DOI: 10.1002/14651858.cd013742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Bryan M Gannon
- Division of Nutritional Sciences; Cornell University; Ithaca New York USA
| | - Susannah Colt
- Division of Nutritional Sciences; Cornell University; Ithaca New York USA
| | - Lisa M Rogers
- Evidence and Programme Guidance, Department of Nutrition for Health and Development; World Health Organization; Geneva Switzerland
| | | | | | | | | | - Saurabh Mehta
- Division of Nutritional Sciences; Cornell University; Ithaca New York USA
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13
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Ford JL, Lopez-Teros V. Prediction of Vitamin A Stores in Young Children Provides Insights into the Adequacy of Current Dietary Reference Intakes. Curr Dev Nutr 2020; 4:nzaa119. [PMID: 32818165 PMCID: PMC7419538 DOI: 10.1093/cdn/nzaa119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/25/2020] [Accepted: 07/09/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Limited data were available in infants and children when vitamin A (VA) DRIs were established; recommendations were developed based on average breast milk VA intake and extrapolation of data from adults. OBJECTIVES Our objective was to evaluate whether DRIs and reported intakes, with and without VA from intervention programs, would be sufficient to develop adequate VA stores from birth to age 5 y in Bangladeshi, Filipino, Guatemalan, and Mexican children. METHODS A mathematical relationship was established, defined by a series of equations, to predict VA total body stores (TBS) as a function of age based on VA intake and utilization. TBS calculated using reported VA intakes, with and without additional VA from intervention programs, were compared to those predicted using DRIs (specifically, Adequate Intake and RDA). Liver VA concentrations were also estimated. RESULTS Our predictions showed that for these 4 groups, DRIs were sufficient to attain liver VA concentrations >0.07 μmol/g by 1 wk of age and sustain positive VA balance for 5 y. Using reported intakes, which were lowest in Bangladeshis from 1 y on and highest in Guatemalans, predicted VA stores in Bangladeshi and Filipino children increased until ∼2-3 y, then TBS stabilized and liver VA concentrations decreased with age. When VA interventions were included, stores exceeded those predicted using DRIs by 12-18 mo. In contrast, reported intakes alone in Guatemalan and Mexican children resulted in VA stores that surpassed those calculated using DRIs. For all populations, reported intakes were sufficient to build liver concentrations >0.07 μmol/g by 3 mo. CONCLUSIONS Although more information is needed to better define dietary VA requirements in children, our results suggest that for an average, generally healthy child in a low- or middle-income country, current DRIs are sufficient to maintain positive VA balance during the first 5 y of life.
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Affiliation(s)
- Jennifer Lynn Ford
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Veronica Lopez-Teros
- Posgrado en Ciencias de la Salud, Universidad de Sonora, Hermosillo, Sonora, Mexico
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14
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Lopez-Teros V, Ford JL, Green MH, Monreal-Barraza B, García-Miranda L, Tanumihardjo SA, Valencia ME, Astiazaran-Garcia H. The "Super-Child" Approach Is Applied To Estimate Retinol Kinetics and Vitamin A Total Body Stores in Mexican Preschoolers. J Nutr 2020; 150:1644-1651. [PMID: 32135013 DOI: 10.1093/jn/nxaa048] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/08/2020] [Accepted: 02/12/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Retinol isotope dilution (RID) and model-based compartmental analysis are recognized techniques for assessing vitamin A (VA) status. Recent studies have shown that RID predictions of VA total body stores (TBS) can be improved by using modeling and that VA kinetics and TBS in children can be effectively studied by applying population modeling ("super-child" approach) to a composite data set. OBJECTIVES The objectives were to model whole-body retinol kinetics and predict VA TBS in a group of Mexican preschoolers using the super-child approach and to use model predictions of RID coefficients to estimate TBS by RID in individuals. METHODS Twenty-four healthy Mexican children (aged 3-6 y) received an oral dose (2.96 μmol) of [13C10]retinyl acetate in corn oil. Blood samples were collected from 8 h to 21 d after dosing, with each child sampled at 4 d and at 1 other time. Composite data for plasma labeled retinol compared with time were analyzed using a 6-component model to obtain group retinol kinetic parameters and pool sizes. Model-predicted TBS was compared with mean RID predictions at 4 d; RID estimates at 4 d were compared with those calculated at 7-21 d. RESULTS Model-predicted TBS was 1097 μmol, equivalent to ∼2.4 y-worth of VA; using model-derived coefficients, group mean RID-predicted TBS was 1096 μmol (IQR: 836-1492 μmol). TBS at 4 d compared with a later time was similar (P = 0.33). The model predicted that retinol spent 1.5 h in plasma during each transit and recycled to plasma 13 times before utilization. CONCLUSIONS The super-child modeling approach provides information on whole-body VA kinetics and can be used with RID to estimate TBS at any time between 4 and 21 d postdose. The high TBS predicted for these children suggests positive VA balance, likely due to large-dose VA supplements, and warrants further investigation.
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Affiliation(s)
- Veronica Lopez-Teros
- Posgrado en Ciencias de la Salud (PCS), Universidad de Sonora, Hermosillo, Sonora, Mexico
| | - Jennifer L Ford
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Michael H Green
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Brianda Monreal-Barraza
- Department of Nutrition, Research Center for Food and Development, Hermosillo, Sonora, Mexico
| | - Lilian García-Miranda
- Posgrado en Ciencias de la Salud (PCS), Universidad de Sonora, Hermosillo, Sonora, Mexico
| | - Sherry A Tanumihardjo
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Mauro E Valencia
- Posgrado en Ciencias de la Salud (PCS), Universidad de Sonora, Hermosillo, Sonora, Mexico
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15
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Hombali AS, Solon JA, Venkatesh BT, Nair NS, Peña‐Rosas JP. Fortification of staple foods with vitamin A for vitamin A deficiency. Cochrane Database Syst Rev 2019; 5:CD010068. [PMID: 31074495 PMCID: PMC6509778 DOI: 10.1002/14651858.cd010068.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Vitamin A deficiency is a significant public health problem in many low- and middle-income countries, especially affecting young children, women of reproductive age, and pregnant women. Fortification of staple foods with vitamin A has been used to increase vitamin A consumption among these groups. OBJECTIVES To assess the effects of fortifying staple foods with vitamin A for reducing vitamin A deficiency and improving health-related outcomes in the general population older than two years of age. SEARCH METHODS We searched the following international databases with no language or date restrictions: Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 6) in the Cochrane Library; MEDLINE and MEDLINE In Process OVID; Embase OVID; CINAHL Ebsco; Web of Science (ISI) SCI, SSCI, CPCI-exp and CPCI-SSH; BIOSIS (ISI); POPLINE; Bibliomap; TRoPHI; ASSIA (Proquest); IBECS; SCIELO; Global Index Medicus - AFRO and EMRO; LILACS; PAHO; WHOLIS; WPRO; IMSEAR; IndMED; and Native Health Research Database. We also searched clinicaltrials.gov and the International Clinical Trials Registry Platform to identify ongoing and unpublished studies. The date of the last search was 19 July 2018. SELECTION CRITERIA We included individually or cluster-randomised controlled trials (RCTs) in this review. The intervention included fortification of staple foods (sugar, edible oils, edible fats, maize flour or corn meal, wheat flour, milk and dairy products, and condiments and seasonings) with vitamin A alone or in combination with other vitamins and minerals. We included the general population older than two years of age (including pregnant and lactating women) from any country. DATA COLLECTION AND ANALYSIS Two authors independently screened and assessed eligibility of studies for inclusion, extracted data from included studies and assessed their risk of bias. We used standard Cochrane methodology to carry out the review. MAIN RESULTS We included 10 randomised controlled trials involving 4455 participants. All the studies were conducted in low- and upper-middle income countries where vitamin A deficiency was a public health issue. One of the included trials did not contribute data to the outcomes of interest.Three trials compared provision of staple foods fortified with vitamin A versus unfortified staple food, five trials compared provision of staple foods fortified with vitamin A plus other micronutrients versus unfortified staple foods, and two trials compared provision of staple foods fortified with vitamin A plus other micronutrients versus no intervention. No studies compared staple foods fortified with vitamin A alone versus no intervention.The duration of interventions ranged from three to nine months. We assessed six studies at high risk of bias overall. Government organisations, non-governmental organisations, the private sector, and academic institutions funded the included studies; funding source does not appear to have distorted the results.Staple food fortified with vitamin A versus unfortified staple food We are uncertain whether fortifying staple foods with vitamin A alone makes little or no difference for serum retinol concentration (mean difference (MD) 0.03 μmol/L, 95% CI -0.06 to 0.12; 3 studies, 1829 participants; I² = 90%, very low-certainty evidence). It is uncertain whether vitamin A alone reduces the risk of subclinical vitamin A deficiency (risk ratio (RR) 0.45, 95% CI 0.19 to 1.05; 2 studies; 993 participants; I² = 33%, very low-certainty evidence). The certainty of the evidence was mainly affected by risk of bias, imprecision and inconsistency.It is uncertain whether vitamin A fortification reduces clinical vitamin A deficiency, defined as night blindness (RR 0.11, 95% CI 0.01 to 1.98; 1 study, 581 participants, very low-certainty evidence). The certainty of the evidence was mainly affected by imprecision, inconsistency, and risk of bias.Staple foods fortified with vitamin A versus no intervention No studies provided data for this comparison.Staple foods fortified with vitamin A plus other micronutrients versus same unfortified staple foods Fortifying staple foods with vitamin A plus other micronutrients may not increase the serum retinol concentration (MD 0.08 μmol/L, 95% CI -0.06 to 0.22; 4 studies; 1009 participants; I² = 95%, low-certainty evidence). The certainty of the evidence was mainly affected by serious inconsistency and risk of bias.In comparison to unfortified staple foods, fortification with vitamin A plus other micronutrients probably reduces the risk of subclinical vitamin A deficiency (RR 0.27, 95% CI 0.16 to 0.49; 3 studies; 923 participants; I² = 0%; moderate-certainty evidence). The certainty of the evidence was mainly affected by serious risk of bias.Staple foods fortified with vitamin A plus other micronutrients versus no interventionFortification of staple foods with vitamin A plus other micronutrients may increase serum retinol concentration (MD 0.22 μmol/L, 95% CI 0.15 to 0.30; 2 studies; 318 participants; I² = 0%; low-certainty evidence). When compared to no intervention, it is uncertain whether the intervention reduces the risk of subclinical vitamin A deficiency (RR 0.71, 95% CI 0.52 to 0.98; 2 studies; 318 participants; I² = 0%; very low-certainty evidence) . The certainty of the evidence was affected mainly by serious imprecision and risk of bias.No trials reported on the outcomes of all-cause morbidity, all-cause mortality, adverse effects, food intake, congenital anomalies (for pregnant women), or breast milk concentration (for lactating women). AUTHORS' CONCLUSIONS Fortifying staple foods with vitamin A alone may make little or no difference to serum retinol concentrations or the risk of subclinical vitamin A deficiency. In comparison with provision of unfortified foods, provision of staple foods fortified with vitamin A plus other micronutrients may not increase serum retinol concentration but probably reduces the risk of subclinical vitamin A deficiency.Compared to no intervention, staple foods fortified with vitamin A plus other micronutrients may increase serum retinol concentration, although it is uncertain whether the intervention reduces the risk of subclinical vitamin A deficiency as the certainty of the evidence has been assessed as very low.It was not possible to estimate the effect of staple food fortification on outcomes such as mortality, morbidity, adverse effects, congenital anomalies, or breast milk vitamin A, as no trials included these outcomes.The type of funding source for the studies did not appear to distort the results from the analysis.
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Affiliation(s)
- Aditi S Hombali
- Institute of Mental HealthDepartment of ResearchBlock 7, Buangkok View, Buangkok Green Medical ParkSingaporeSingapore539747
| | | | - Bhumika T Venkatesh
- Prasanna School of Public Health, Manipal Academy of Higher EducationPublic Health Evidence South Asia (PHESA)ManipalUdupiIndia
| | - N Sreekumaran Nair
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) (Institution of National Importance Under Ministry of Health and Family Welfare, Government of India)Department of Medical Biometrics & Informatics (Biostatistics)4th Floor, Administrative BlockDhanvantri NagarPuducherryIndia605006
| | - Juan Pablo Peña‐Rosas
- World Health OrganizationEvidence and Programme Guidance, Department of Nutrition for Health and Development20 Avenue AppiaGenevaGESwitzerland1211
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Sheftel J, Loechl C, Mokhtar N, Tanumihardjo SA. Use of Stable Isotopes to Evaluate Bioefficacy of Provitamin A Carotenoids, Vitamin A Status, and Bioavailability of Iron and Zinc. Adv Nutr 2018; 9:625-636. [PMID: 30239582 PMCID: PMC6140444 DOI: 10.1093/advances/nmy036] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 02/25/2018] [Accepted: 05/14/2018] [Indexed: 01/25/2023] Open
Abstract
The ability of nutrition scientists to measure the status, bioavailability, and bioefficacy of micronutrients is affected by lack of access to the parts of the body through which a nutrient may travel before appearing in accessible body compartments (typically blood or urine). Stable isotope-labeled tracers function as safe, nonradioactive tools to follow micronutrients in a quantitative manner because the absorption, distribution, metabolism, and excretion of the tracer are assumed to be similar to the unlabeled vitamin or mineral. The International Atomic Energy Agency (IAEA) supports research on the safe use of stable isotopes in global health and nutrition. This review focuses on IAEA's contributions to vitamin A, iron, and zinc research. These micronutrients are specifically targeted by the WHO because of their importance in health and worldwide prevalence of deficiency. These 3 micronutrients are included in food fortification and biofortification efforts in low- and middle-income regions of the world. Vitamin A isotopic techniques can be used to evaluate the efficacy and effectiveness of interventions. For example, total body retinol stores were estimated by using 13C2-retinol isotope dilution before and after feeding Zambian children maize biofortified with β-carotene to determine if vitamin A reserves were improved by the intervention. Stable isotopes of iron and zinc have been used to determine mineral bioavailability. In Thailand, ferrous sulfate was better absorbed from fish sauce than was ferrous lactate or ferric ammonium citrate, determined with the use of different iron isotopes in each compound. Comparisons of one zinc isotope injected intravenously with another isotope taken orally from a micronutrient powder proved that the powder increased total absorbed zinc from a meal in Pakistani infants. Capacity building by the IAEA with appropriate collaborations in low- and middle-income countries to use stable isotopes has resulted in many advancements in human nutrition.
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Affiliation(s)
- Jesse Sheftel
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin–Madison, Madison, WI
| | | | | | - Sherry A Tanumihardjo
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin–Madison, Madison, WI
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Lopez-Teros V, Ford JL, Green MH, Tang G, Grusak MA, Quihui-Cota L, Muzhingi T, Paz-Cassini M, Astiazaran-Garcia H. Use of a "Super-child" Approach to Assess the Vitamin A Equivalence of Moringa oleifera Leaves, Develop a Compartmental Model for Vitamin A Kinetics, and Estimate Vitamin A Total Body Stores in Young Mexican Children. J Nutr 2017; 147:2356-2363. [PMID: 28931584 DOI: 10.3945/jn.117.256974] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 07/28/2017] [Accepted: 08/21/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Worldwide, an estimated 250 million children <5 y old are vitamin A (VA) deficient. In Mexico, despite ongoing efforts to reduce VA deficiency, it remains an important public health problem; thus, food-based interventions that increase the availability and consumption of provitamin A-rich foods should be considered.Objective: The objectives were to assess the VA equivalence of 2H-labeled Moringa oleifera (MO) leaves and to estimate both total body stores (TBS) of VA and plasma retinol kinetics in young Mexican children.Methods: β-Carotene was intrinsically labeled by growing MO plants in a 2H2O nutrient solution. Fifteen well-nourished children (17-35 mo old) consumed puréed MO leaves (1 mg β-carotene) and a reference dose of [13C10]retinyl acetate (1 mg) in oil. Blood (2 samples/child) was collected 10 times (2 or 3 children each time) over 35 d. The bioefficacy of MO leaves was calculated from areas under the composite "super-child" plasma isotope response curves, and MO VA equivalence was estimated through the use of these values; a compartmental model was developed to predict VA TBS and retinol kinetics through the use of composite plasma [13C10]retinol data. TBS were also estimated with isotope dilution.Results: The relative bioefficacy of β-carotene retinol activity equivalents from MO was 28%; VA equivalence was 3.3:1 by weight (0.56 μmol retinol:1 μmol β-carotene). Kinetics of plasma retinol indicate more rapid plasma appearance and turnover and more extensive recycling in these children than are observed in adults. Model-predicted mean TBS (823 μmol) was similar to values predicted using a retinol isotope dilution equation applied to data from 3 to 6 d after dosing (mean ± SD: 832 ± 176 μmol; n = 7).Conclusions: The super-child approach can be used to estimate population carotenoid bioefficacy and VA equivalence, VA status, and parameters of retinol metabolism from a composite data set. Our results provide initial estimates of retinol kinetics in well-nourished young children with adequate VA stores and demonstrate that MO leaves may be an important source of VA.
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Affiliation(s)
- Veronica Lopez-Teros
- Nutritional Sciences, Department of Chemical and Biological Sciences, University of Sonora, Hermosillo, Sonora, Mexico
| | - Jennifer Lynn Ford
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA
| | - Michael H Green
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA
| | - Guangwen Tang
- Former Carotenoids and Health Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA
| | - Michael A Grusak
- USDA Agricultural Research Service, Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Luis Quihui-Cota
- Department of Nutrition, Research Center for Food and Development, Hermosillo, Sonora, Mexico; and
| | - Tawanda Muzhingi
- International Potato Centre (CIP), International Livestock Research Institute Campus, Nairobi, Kenya
| | - Mariela Paz-Cassini
- Department of Nutrition, Research Center for Food and Development, Hermosillo, Sonora, Mexico; and
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Engle-Stone R, Perkins A, Clermont A, Walker N, Haskell MJ, Vosti SA, Brown KH. Estimating Lives Saved by Achieving Dietary Micronutrient Adequacy, with a Focus on Vitamin A Intervention Programs in Cameroon. J Nutr 2017; 147:2194S-2203S. [PMID: 28904117 DOI: 10.3945/jn.116.242271] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 11/30/2016] [Accepted: 02/15/2017] [Indexed: 11/14/2022] Open
Abstract
Background: We previously compared the potential effects of different intervention strategies for achieving dietary vitamin A (VA) adequacy. The Lives Saved Tool (LiST) permits estimates of lives saved through VA interventions but currently only considers periodic VA supplements (VASs).Objective: We aimed to adapt the LiST method for estimating the mortality impact of VASs to estimate the impact of other VA interventions (e.g., food fortification) on child mortality and to estimate the number of lives saved by VA interventions in 3 macroregions in Cameroon.Methods: We used national dietary intake data to predict the effects of VA intervention programs on the adequacy of VA intake. LiST parameters of population affected fraction and intervention coverage were replaced with estimates of prevalence of inadequate intake and effective coverage (proportion achieving adequate VA intake). We used a model of liver VA stores to derive an estimate of the mortality reduction from achieving dietary VA adequacy; this estimate and a conservative assumption of equivalent mortality reduction for VAS and VA intake were applied to projections for Cameroon.Results: There were 2217-3048 total estimated VA-preventable deaths in year 1, with 58% occurring in the North macroregion. The relation between effective coverage and lives saved differed by year and macroregion due to differences in total deaths, diarrhea burden, and prevalence of low VA intake. Estimates of lives saved by VASs (the intervention common to both methods) were similar with the use of the adapted method (in 2012: North, 743-1021; South, 280-385; Yaoundé and Douala, 146-202) and the "usual" LiST method (North: 697; South: 381; Yaoundé and Douala: 147).Conclusions: Linking effective coverage estimates with an adapted LiST method permits estimation of the effects of combinations of VA programs (beyond VASs only) on child mortality to aid program planning and management. Rigorous program monitoring and evaluation are necessary to confirm predicted impacts.
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Affiliation(s)
| | - Amanda Perkins
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and
| | - Adrienne Clermont
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and
| | - Neff Walker
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and
| | | | - Stephen A Vosti
- Agricultural and Resource Economics, University of California, Davis, Davis, CA
| | - Kenneth H Brown
- Departments of Nutrition and.,Nutrition and Global Development, Bill & Melinda Gates Foundation, Seattle, WA
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Lopez-Teros V, Limon-Miro AT, Astiazaran-Garcia H, Tanumihardjo SA, Tortoledo-Ortiz O, Valencia ME. 'Dose-to-Mother' Deuterium Oxide Dilution Technique: An Accurate Strategy to Measure Vitamin A Intake in Breastfed Infants. Nutrients 2017; 9:nu9020169. [PMID: 28230781 PMCID: PMC5331600 DOI: 10.3390/nu9020169] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/24/2017] [Accepted: 02/16/2017] [Indexed: 11/22/2022] Open
Abstract
In Mexico, infants (0–2 years old) show the highest prevalence of vitamin A deficiency (VAD), measured by serum retinol concentrations. Thus, we consider that low vitamin A (VA) intake through breast milk (BM) combined with poor weaning practices are the main factors that contribute to VAD in this group. We combined the assessment of VA status in lactating women using BM retinol and a stable isotope ‘dose-to-mother’ technique to measure BM production in women from urban and agricultural areas. Infants’ mean BM intake was 758 ± 185 mL, and no difference was observed between both areas (p = 0.067). Mean BM retinol concentration was 1.09 μmol/L, which was significantly lower for the agricultural area (p = 0.028). Based on BM retinol concentration, 57% of women were VAD; although this prevalence fell to 16% when based on fat content. Regardless of the VA biomarker used here, infants from the urban and agricultural areas cover only 66% and 49% of their dietary adequate intake from BM, respectively (p = 0.054). Our data indicate that VAD is still a public health concern in Mexico. Adopting both methods to assess VA transfer from the mother to the breastfed child offers an innovative approach towards the nutritional assessment of vulnerable groups.
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Affiliation(s)
- Veronica Lopez-Teros
- Nutritional Sciences, Department of Chemical and Biological Sciences, University of Sonora, Hermosillo, Sonora 83000, Mexico.
| | - Ana Teresa Limon-Miro
- Department of Nutrition, Research Center for Food and Development (CIAD, AC), Hermosillo, Sonora 83304, Mexico.
| | - Humberto Astiazaran-Garcia
- Department of Nutrition, Research Center for Food and Development (CIAD, AC), Hermosillo, Sonora 83304, Mexico.
| | - Sherry A Tanumihardjo
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI 53706, USA.
| | - Orlando Tortoledo-Ortiz
- Department of Nutrition, Research Center for Food and Development (CIAD, AC), Hermosillo, Sonora 83304, Mexico.
| | - Mauro E Valencia
- Nutritional Sciences, Department of Chemical and Biological Sciences, University of Sonora, Hermosillo, Sonora 83000, Mexico.
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Rosales A, Agama-Acevedo E, Arturo Bello-Pérez L, Gutiérrez-Dorado R, Palacios-Rojas N. Effect of Traditional and Extrusion Nixtamalization on Carotenoid Retention in Tortillas Made from Provitamin A Biofortified Maize (Zea mays L.). JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2016; 64:8289-8295. [PMID: 27758103 DOI: 10.1021/acs.jafc.6b02951] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Provitamin A (proVA) enhanced maize was developed to help alleviate vitamin A deficiency in maize-consuming populations. Nixtamalization (lime-cooking process) is the most commonly used maize-preparation method in Mexico and Central America. In this study, the effect of traditional nixtamalization (TN) and nixtamalized extrusion (NE) on proVA retention was evaluated. Kernel conversion to TN dough led to high proVA apparent retention (>100%), while kernel conversion to NE flour led to lower retention (85%). However, TN tortilla proVA carotenoid concentration was similar to the kernels' original concentration and slightly higher in NE tortillas. Genotypic variation has a strong effect on proVA retention in TN dough and NE flour, but no such variation in proVA retention was observed in tortillas. Tortillas prepared with proVA-enhanced maize, using either TN or NE, are a good source of proVA carotenoids. Also, dough made using TN and proVA-enhanced maize is a high proVA-content ingredient for other food products.
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Affiliation(s)
- Aldo Rosales
- Centro de Desarrollo de Productos Bióticos del Instituto Politécnico Nacional , Kilometer 8.5 Carretera Yautepec-Jojutla, Colonia San Isidro, Apartado Postal 24, 62731 Yautepec, Morelos, Mexico
- Global Maize Program, International Maize and Wheat Improvement Center (CIMMYT), CIMMYT Research Station , Kilometer 45 Carretera Mexico-Veracruz, El Batan, Texcoco, CP 56237, Estado de México, Mexico
| | - Edith Agama-Acevedo
- Centro de Desarrollo de Productos Bióticos del Instituto Politécnico Nacional , Kilometer 8.5 Carretera Yautepec-Jojutla, Colonia San Isidro, Apartado Postal 24, 62731 Yautepec, Morelos, Mexico
| | - Luis Arturo Bello-Pérez
- Centro de Desarrollo de Productos Bióticos del Instituto Politécnico Nacional , Kilometer 8.5 Carretera Yautepec-Jojutla, Colonia San Isidro, Apartado Postal 24, 62731 Yautepec, Morelos, Mexico
| | - Roberto Gutiérrez-Dorado
- Programa Regional del Noroeste para el Doctorado en Biotecnología, Facultad de Ciencias Químico-Biológicas, Universidad Autónoma de Sinaloa , Culiacán, Sinaloa 80010, Mexico
| | - Natalia Palacios-Rojas
- Global Maize Program, International Maize and Wheat Improvement Center (CIMMYT), CIMMYT Research Station , Kilometer 45 Carretera Mexico-Veracruz, El Batan, Texcoco, CP 56237, Estado de México, Mexico
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Green MH, Ford JL, Green JB, Berry P, Boddy AV, Oxley A, Lietz G. A Retinol Isotope Dilution Equation Predicts Both Group and Individual Total Body Vitamin A Stores in Adults Based on Data from an Early Postdosing Blood Sample. J Nutr 2016; 146:2137-2142. [PMID: 27511937 PMCID: PMC5037874 DOI: 10.3945/jn.116.233676] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 06/23/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Retinol isotope dilution (RID) is used to determine vitamin A total body stores (TBS) after an oral dose of a vitamin A stable isotope. The generally accepted prediction equation proposed by Olson's group in 1989 (Furr et al. Am J Clin Nutr 1989;49:713-6) includes factors related to dose absorption and retention, isotope equilibration in plasma compared with stores, catabolism during the mixing period, and the optimal time for measuring plasma isotope enrichment. OBJECTIVES The objectives were 1) to develop a modified RID equation and identify an earlier sampling time for predicting TBS and 2) to improve prediction in individuals as well as groups. METHODS To develop a modified RID equation, we used results of model-based compartmental analysis [the Simulation, Analysis and Modeling software (WinSAAM version 3.0.8; http://www.WinSAAM.org)] of plasma [13C10]retinol kinetic data from 32 previously studied, healthy young adults of European ancestry who had moderate vitamin A intakes and who ingested 2.95 μmol [13C10]retinyl acetate. RESULTS We examined the time dependence of factors in the prediction equation related to absorption/retention (Fa) and isotope equilibration (S) and determined that 4 or 5 d postdosing was the optimal sampling time. TBS calculated by the equation TBS = Fa x S x (1/SAp), where SAp is plasma retinol specific activity (fraction of dose/μmol), were highly correlated with model-predicted TBS (r = 0.95 and 0.96 for 4 and 5 d, respectively; P < 0.001); predictions for individuals were also highly correlated (Rs = 0.94 and 0.94; P < 0.001). CONCLUSION The equation TBS ≈ 0.5 × (1/SAp) accurately predicted vitamin A TBS in this group of 32 healthy young adults and its individual members with the use of data from 1 blood sample taken 4 d after isotope administration.
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Affiliation(s)
- Michael H Green
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA; and
| | - Jennifer Lynn Ford
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA; and
| | - Joanne Balmer Green
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA; and
| | | | | | - Anthony Oxley
- Human Nutrition Research Centre, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Georg Lietz
- Human Nutrition Research Centre, Newcastle University, Newcastle Upon Tyne, United Kingdom
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Lietz G, Furr HC, Gannon BM, Green MH, Haskell M, Lopez-Teros V, Novotny JA, Palmer AC, Russell RM, Tanumihardjo SA, Van Loo-Bouwman CA. Current Capabilities and Limitations of Stable Isotope Techniques and Applied Mathematical Equations in Determining Whole-Body Vitamin A Status. Food Nutr Bull 2016; 37:S87-S103. [PMID: 27053491 DOI: 10.1177/0379572116630642] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Retinol isotope dilution (RID) methodology provides a quantitative estimate of total body vitamin A (VA) stores and is the best method currently available for assessing VA status in adults and children. The methodology has also been used to test the efficacy of VA interventions in a number of low-income countries. Infections, micronutrient deficiencies (eg, iron and zinc), liver disease, physiological age, pregnancy, and lactation are known or hypothesized to influence the accuracy of estimating total body VA stores using the isotope dilution technique. OBJECTIVE Our objectives were to review the strengths and limitations of RID methods, to discuss what is known about the impact of various factors on results, and to summarize contributions of model-based compartmental analysis to assessing VA status. METHODS Relevant published literature is reviewed and discussed. RESULTS Various equations and compartmental modeling have been used to estimate the total body VA stores using stable isotopes, including a newer 3-day equation that provides an estimate of total body VA stores in healthy adults. At present, there is insufficient information on absorption of the isotope tracer, and there is a need to further investigate how various factors impact the application of RID techniques in field studies. CONCLUSIONS Isotope dilution methodology can provide useful estimates of total body VA stores in apparently healthy populations under controlled study conditions. However, more research is needed to determine whether the method is suitable for use in settings where there is a high prevalence of infection, iron deficiency, and/or liver disease.
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Affiliation(s)
- Georg Lietz
- Newcastle University, Newcastle, United Kingdom
| | | | | | - Michael H Green
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Marjorie Haskell
- Program in International and Community Nutrition and Department of Nutrition, University of California, Davis, CA, USA
| | | | - Janet A Novotny
- Beltsville Human Nutrition Research Center, United States Department of Agriculture, Beltsville, MD, USA
| | - Amanda C Palmer
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Tanumihardjo SA, Mokhtar N, Haskell MJ, Brown KH. Assessing the Safety of Vitamin A Delivered Through Large-Scale Intervention Programs: Workshop Report on Setting the Research Agenda. Food Nutr Bull 2016; 37:S63-74. [PMID: 26893060 DOI: 10.1177/0379572116630480] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Vitamin A (VA) deficiency (VAD) is still a concern in many parts of the world, and multiple intervention strategies are being implemented to reduce the prevalence of VAD and associated morbidity and mortality. Because some individuals within a population may be exposed to multiple VA interventions, concerns have been raised about the possible risk of hypervitaminosis A. OBJECTIVES A consultative meeting was held in Vienna, Austria, in March 2014 to (1) review current knowledge concerning the safety and effectiveness of large-scale programs to control VAD, (2) develop a related research agenda, and (3) review current available methods to assess VA status and risk of hypervitaminosis A. METHODS Multiple countries were represented and shared their experiences using a variety of assessment methods, including retinol isotope dilution (RID) techniques. Discussion included next steps to refine assessment methodology, investigate RID limitations under different conditions, and review programmatic approaches to ensure VA adequacy and avoid excessive intakes. RESULTS Fortification programs have resulted in adequate VA status in Guatemala, Zambia, and parts of Cameroon. Dietary patterns in several countries revealed that some people may consume excessive preformed VA from fortified foods. CONCLUSION Additional studies are needed to compare biomarkers of tissue damage to RID methods during hypervitaminosis A and to determine what other biomarkers can be used to assess excessive preformed VA intake.
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Affiliation(s)
- Sherry A Tanumihardjo
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Najat Mokhtar
- Technical Cooperation Department, International Atomic Energy Agency, Vienna, Austria
| | - Marjorie J Haskell
- Program in International and Community Nutrition and Department of Nutrition, University of California-Davis, Davis, CA, USA
| | - Kenneth H Brown
- Program in International and Community Nutrition and Department of Nutrition, University of California-Davis, Davis, CA, USA Nutrition Team, Bill & Melinda Gates Foundation, Seattle, WA, USA
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Engle-Stone R, Nankap M, Ndjebayi AO, Vosti SA, Brown KH. Estimating the Effective Coverage of Programs to Control Vitamin A Deficiency and Its Consequences Among Women and Young Children in Cameroon. Food Nutr Bull 2015; 36:S149-71. [PMID: 26385984 DOI: 10.1177/0379572115595888] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND To compare the cost-effectiveness of nutrition programs, the anticipated nutritional benefits of each intervention must be expressed using a common metric. OBJECTIVE We present the methodology for estimating the benefits of vitamin A (VA)-related interventions among women and children in Cameroon. METHODS We estimated "reach" (proportion of the population that receives a program), "coverage" (proportion that is deficient and receives a program), and "effective coverage" (proportion that "converts" from inadequate to adequate VA intake following an intervention) using dietary data collected during a national survey in 3 macro-regions of Cameroon (North, South, and Yaoundé/Douala). Effective coverage of programs such as (bio)fortification and micronutrient powders was estimated by adding the dietary VA contributed by the intervention to baseline VA intakes, including the contribution of increased maternal VA intake to infant VA intake through increases in breast milk VA. For interventions that provide VA-related benefits through other pathways (eg, periodic high-dose VA supplements and deworming), we developed alternative methods of estimating "daily VA intake equivalents. " RESULTS Baseline VA intakes and intervention reach varied by geographic macro-region. On average, estimates of program reach were greater than the effective coverage estimates by ∼50%. Effective coverage varied by intervention package and macro-region, ranging from <20 000 (deworming, Yaoundé/Douala) to >400 000 (micronutrient powder or VA supplement, North) children effectively covered per year. CONCLUSION These estimates of effective coverage, along with macro-region-specific information on the costs of each intervention package, serve as inputs into an economic optimization model to identify the most cost-effective package of VA interventions for each macro-region of Cameroon.
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Affiliation(s)
- Reina Engle-Stone
- Department of Nutrition, University of California-Davis, Davis, CA, USA
| | | | | | - Stephen A Vosti
- Department of Agricultural and Resource Economics, University of California-Davis, Davis, CA, USA
| | - Kenneth H Brown
- Department of Nutrition, University of California-Davis, Davis, CA, USA Bill & Melinda Gates Foundation, Seattle, WA, USA
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Gannon BM, Tanumihardjo SA. Comparisons among Equations Used for Retinol Isotope Dilution in the Assessment of Total Body Stores and Total Liver Reserves. J Nutr 2015; 145:847-54. [PMID: 25809683 PMCID: PMC6619684 DOI: 10.3945/jn.114.208132] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 02/20/2015] [Indexed: 11/14/2022] Open
Abstract
Vitamin A plays an essential role in animal biology and has negative effects associated with both hypo- and hypervitaminosis A. Many notable interventions are being done globally to eliminate vitamin A deficiency, including supplementation, fortification, and biofortification. At the same time, it is important to monitor vitamin A status in nations where preformed vitamin A intake is high because of consumption of animal source foods (e.g., liver, dairy, eggs), fortified foods (e.g., milk, cereals, oil, sugar, margarine), or vitamin supplements (e.g., one-a-day multivitamins) to ensure the population does not reach hypervitaminosis A. To accurately assess population status and evaluate interventions aimed at improving vitamin A status, accurate assessment methods are needed. The primary storage site of vitamin A is the liver; however, routinely obtaining liver samples from humans is impractical and unethical. Isotope dilution using deuterium- or (13)C-labeled retinol is currently the most sensitive indirect biomarker of vitamin A status across a wide range of liver reserves. The major drawback to its application is the increased technicality in sample analysis and data calculations when compared to less sensitive methodology, such as serum retinol concentrations and dose response tests. Two main equations have emerged for calculating vitamin A body pool size or liver concentrations from isotope dilution data: the "Olson equation" and the "mass balance equation." Different applications of these equations can lead to confusion and lack of consistency if the underlying principles and assumptions used are not clarified. The purpose of this focused review is to describe the evolution of the equations used in retinol stable-isotope work and the assumptions appropriate to different applications of the test. Ultimately, the 2 main equations are shown to be fundamentally the same and differ only in assumptions made for each specific research application.
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Affiliation(s)
- Bryan M Gannon
- Interdepartmental Graduate Program in Nutritional Sciences, Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI
| | - Sherry A Tanumihardjo
- Interdepartmental Graduate Program in Nutritional Sciences, Department of
Nutritional Sciences, University of Wisconsin-Madison, Madison, WI
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Genetic and environmental factors associated with vitamin B12status in Amazonian children. Public Health Nutr 2015; 18:2202-10. [DOI: 10.1017/s1368980014003061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveTo evaluate the prevalence of vitamin B12deficiency and factors associated with vitamin B12status in Amazonian children.DesignGenetic risk score (GRS), socio-economic and nutritional status, and morbidity data were the independent variables used in multiple linear regression models to evaluate factors associated with vitamin B12status in a population-based cross-sectional study. GRS was created by summing a number of known risk alleles for low serum vitamin B12.SettingAcrelândia, western Brazilian Amazon.SubjectsChildren (n988) aged <10 years.ResultsOverall prevalence of vitamin B12deficiency (<150 pmol/l) was 4·2 (95 % CI 3·0, 5·6) % and was highest in children aged <24 months: 13·6 (95 % CI % 8·8, 19·7) %. For children <24 months, wealth index (β=0·017,P=0·030) and animal protein intake(β=0·219,P=0·003) were positively associated with vitamin B12status. GRS (β=−0·114,P<0·001) and serum homocysteine (β=–0·049,P<0·001) were negatively associated. Among children aged ≥24 months, vitamin B12status was positively associated with wealth index (β=0·012,P<0·001), height-for-ageZ-score (β=0·024, P=0·033) and serum vitamin A (β=0·089,P<0·001). Age≥60 months(β=–0·118,P<0·001), GRS (β=–0·048, P<0·001), maternal schooling <5 years (β=–0·083,P<0·001), low intake of animal-derived foods (β=–0·050,P=0·030), serum homocysteine (β=–0·053,P<0·001), serum folate ≥23·6 nmol/l (β=–0·055,P=0·012) and geohelminth infection (β=–0·141,P=0·017) were negatively associated with vitamin B12status.ConclusionsGRS, poverty, low intake of animal-derived foods, geohelminth infection, vitamin A and folate status were important factors associated with vitamin B12status of children in our study.
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Gannon B, Kaliwile C, Arscott SA, Schmaelzle S, Chileshe J, Kalungwana N, Mosonda M, Pixley K, Masi C, Tanumihardjo SA. Biofortified orange maize is as efficacious as a vitamin A supplement in Zambian children even in the presence of high liver reserves of vitamin A: a community-based, randomized placebo-controlled trial. Am J Clin Nutr 2014; 100:1541-50. [PMID: 25411289 PMCID: PMC4232019 DOI: 10.3945/ajcn.114.087379] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 09/08/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Biofortification is a strategy to relieve vitamin A (VA) deficiency. Biofortified maize contains enhanced provitamin A concentrations and has been bioefficacious in animal and small human studies. OBJECTIVE The study sought to determine changes in total body reserves (TBRs) of vitamin A with consumption of biofortified maize. DESIGN A randomized, placebo-controlled biofortified maize efficacy trial was conducted in 140 rural Zambian children. The paired (13)C-retinol isotope dilution test, a sensitive biomarker for VA status, was used to measure TBRs before and after a 90-d intervention. Treatments were white maize with placebo oil (VA-), orange maize with placebo (orange), and white maize with VA in oil [400 μg retinol activity equivalents (RAEs) in 214 μL daily] (VA+). RESULTS In total, 133 children completed the trial and were analyzed for TBRs (n = 44 or 45/group). Change in TBR residuals were not normally distributed (P < 0.0001); median changes (95% CI) were as follows: VA-, 13 (-19, 44) μmol; orange, 84 (21, 146) μmol; and VA+, 98 (24, 171) μmol. Nonparametric analysis showed no statistical difference between VA+ and orange (P = 0.34); both were higher than VA- (P = 0.0034). Median (95% CI) calculated liver reserves at baseline were 1.04 (0.97, 1.12) μmol/g liver, with 59% >1 μmol/g, the subtoxicity cutoff; none were <0.1 μmol/g, the deficiency cutoff. The calculated bioconversion factor was 10.4 μg β-carotene equivalents/1 μg retinol by using the middle 3 quintiles of change in TBRs from each group. Serum retinol did not change in response to intervention (P = 0.16) but was reduced with elevated C-reactive protein (P = 0.0029) and α-1-acid glycoprotein (P = 0.0023) at baseline. CONCLUSIONS β-Carotene from maize was efficacious when consumed as a staple food in this population and could avoid the potential for hypervitaminosis A that was observed with the use of preformed VA from supplementation and fortification. Use of more sensitive methods other than serum retinol alone, such as isotope dilution, is required to accurately assess VA status, evaluate interventions, and investigate the interaction of VA status and infection. This trial was registered at clinicaltrials.gov as NCT01814891.
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Affiliation(s)
- Bryan Gannon
- From the Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI (BG, SAA, SS, and SAT); National Food and Nutrition Commission of Zambia, Lusaka, Zambia (CK, MM, and CM); Tropical Diseases Research Centre, Ndola, Zambia (JC and NK); and International Maize and Wheat Improvement Center, Texcoco, Mexico (KP)
| | - Chisela Kaliwile
- From the Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI (BG, SAA, SS, and SAT); National Food and Nutrition Commission of Zambia, Lusaka, Zambia (CK, MM, and CM); Tropical Diseases Research Centre, Ndola, Zambia (JC and NK); and International Maize and Wheat Improvement Center, Texcoco, Mexico (KP)
| | - Sara A Arscott
- From the Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI (BG, SAA, SS, and SAT); National Food and Nutrition Commission of Zambia, Lusaka, Zambia (CK, MM, and CM); Tropical Diseases Research Centre, Ndola, Zambia (JC and NK); and International Maize and Wheat Improvement Center, Texcoco, Mexico (KP)
| | - Samantha Schmaelzle
- From the Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI (BG, SAA, SS, and SAT); National Food and Nutrition Commission of Zambia, Lusaka, Zambia (CK, MM, and CM); Tropical Diseases Research Centre, Ndola, Zambia (JC and NK); and International Maize and Wheat Improvement Center, Texcoco, Mexico (KP)
| | - Justin Chileshe
- From the Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI (BG, SAA, SS, and SAT); National Food and Nutrition Commission of Zambia, Lusaka, Zambia (CK, MM, and CM); Tropical Diseases Research Centre, Ndola, Zambia (JC and NK); and International Maize and Wheat Improvement Center, Texcoco, Mexico (KP)
| | - Ngándwe Kalungwana
- From the Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI (BG, SAA, SS, and SAT); National Food and Nutrition Commission of Zambia, Lusaka, Zambia (CK, MM, and CM); Tropical Diseases Research Centre, Ndola, Zambia (JC and NK); and International Maize and Wheat Improvement Center, Texcoco, Mexico (KP)
| | - Mofu Mosonda
- From the Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI (BG, SAA, SS, and SAT); National Food and Nutrition Commission of Zambia, Lusaka, Zambia (CK, MM, and CM); Tropical Diseases Research Centre, Ndola, Zambia (JC and NK); and International Maize and Wheat Improvement Center, Texcoco, Mexico (KP)
| | - Kevin Pixley
- From the Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI (BG, SAA, SS, and SAT); National Food and Nutrition Commission of Zambia, Lusaka, Zambia (CK, MM, and CM); Tropical Diseases Research Centre, Ndola, Zambia (JC and NK); and International Maize and Wheat Improvement Center, Texcoco, Mexico (KP)
| | - Cassim Masi
- From the Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI (BG, SAA, SS, and SAT); National Food and Nutrition Commission of Zambia, Lusaka, Zambia (CK, MM, and CM); Tropical Diseases Research Centre, Ndola, Zambia (JC and NK); and International Maize and Wheat Improvement Center, Texcoco, Mexico (KP)
| | - Sherry A Tanumihardjo
- From the Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI (BG, SAA, SS, and SAT); National Food and Nutrition Commission of Zambia, Lusaka, Zambia (CK, MM, and CM); Tropical Diseases Research Centre, Ndola, Zambia (JC and NK); and International Maize and Wheat Improvement Center, Texcoco, Mexico (KP)
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