ABSTRACT
Objectives: Anaemia is a major nutritional problem in Myanmar and it is important to improve the preconceptional iron status of young women. In this study we assessed the beneficial effect of iron, folate and vitamin A supplementation on anaemia of adolescent girls. Methods: A randomized, double-blinded, placebo-controlled study (NCT: 01198574) was conducted among anaemic adolescent schoolgirls (n=402) in Ayeyarwady region, Myanmar. The schoolgirls were recruited from 6 schools after screening for anemia (Hb<120g/L) among 1269 subjects. They were assigned into one of four groups: all groups received folate (F, 2.5 mg of folate), other groups received Vitamin A (FVA, 15,000 IU), Iron (IF, 60 mg elemental iron and folate) and IF+Vitamin A (IFVA). Supplementation was done once a week for 12 weeks. Iron, vitamin A, folate and inflammation status were measured. Serum ferritin (SF) and retinol (SR) were corrected for inflammation. Results: The prevalence of iron deficiency (ID) (SF<15μg/L), low vitamin A status (SR<1.05μmol/L) and folate deficiency (serum folate<6.6nmol/L) were ~20%, 30% and 52% respectively at baseline. Compared with folate, ID was reduced significantly by IF (OR 0.24; 95%CI 0.06, 0.92) and IFA (OR 0.15; 95%CI 0.04, 0.57) respectively. Although Hb significantly increased in all groups, risk of anaemia did not differ between groups that received iron and those who received folate alone or folate plus vitamin A. Conclusions: Multiple micronutrient deficiencies coexist among adolescent girls. Weekly iron supplementation combined with folate and vitamin A alleviated only some of the anaemia and should be implemented but other causes also need to be urgently investigated.
ABSTRACT
Aim: Vitamin A defi ciency among children is still a public health problem in Indonesia. Serum/plasma retinol concentration is the best indicator in assessing vitamin A status. However, there is growing concern that infection/ infl ammation lowers serum retinol concentration, thus creating potential misinterpretation of vitamin A status, which could affect policy makers in planning suitable nutrition programs targeted at community. The aim of this study was to highlight the importance of applying correction factors, to better interpret serum retinol as a nutritional status biomarker. Methods: A cross sectional study involving 54 apparently healthy school children was conducted in East Nusa Tenggara. Height, body weight, concentrations of serum retinol, CRP and AGP were assessed. Based on concentrations of serum CRP and AGP, four infl ammation groups were determined, namely reference, incubation, early convalescence and late convalescence groups. Correction factor was obtained by dividing serum retinol concentration of reference group by that of the other three groups. Correction factors were then used to correct serum retinol concentration without any infl uence of infection/infl ammation. Results: The prevalence of stunting and underweight were 43% and 22% respectively, but there was no wasting among the school children. Applying correction factor lowered the prevalence of vitamin A defi ciency from 20.4% to 18.5%; thus changing vitamin A defi ciency from a severe public health problem to a moderate public health problem. Conclusion: Correcting serum retinol concentration for the infl uence of infection reduced the apparent severity of vitamin A defi ciency. This could affect policy for planning nutrition programs designed for communities.