Vitamin A Status Monitoring in Women and Children in Rural Indonesia: Serum Retinol and Retinolbinding Protein and their Correlation.

Objectives: To assess retinol binding protein (RBP) as an indicator of vitamin A status in children and women, during a pilot program fortifying cooking oil with retinyl palmitate in West Java. Methods: Surveys measured serum retinol using High-Performance Liquid Chromatography (as gold standard), and RBP using Enzyme-Linked Immunosorbent Sandwich Assay, among children 6-59 months (n=753) and 5-9 years (n=175), women 15-29 years not reportedly pregnant (n=170) and lactating mothers (n=303). C-reactive protein and α-1-acid glycoprotein were measured to adjust serum retinol for sub-clinical inflammation using established correction factors. Results: At baseline, serum retinol concentrations (μg/dL, mean and standard deviation) were 33.2±14.0, 33.0±0.91, 40.9±18.7, and 44.2±18.5 for children 6-59 months, 5-9 years, women and lactating mothers. Prevalences of vitamin A deficiency (retinol <20μg/dL) were 14.9%, 10.9%, 10.0% and 5.3%. Mean RBP concentrations (mg/kg) were 1.00±0.24, 1.01±0.22, 1.24±0.35, 1.34±0.37, respectively. Serum retinol and RBP concentrations correlated positively (Pearson's correlation coefficient r=0.54, 0.50, 0.51, and 0.48 in the four groups). In the 2nd survey a year later, retinol and RBP averages were 3.2-17.4% and 3.7-13.7% increased among groups; correlation patterns were similar. Using RBP<0.80 μmol/L as cut-off (lacking a WHO recommendation), deficiency prevalence, sensitivity and specificity of RBP were 15%, 36% and 88% in children 6-59 months. Conclusions: RBP can be an indicator of vitamin A status in child and woman populations, saving cost compared to serum retinol-based monitoring. The lesser retinol-RBP concordance compared to earlier studies suggest that precision of measurements in this study may have been less than typical.

Fortifying Cooking Oil with Vitamin A in Two Rural Districts of Indonesia: Impact on Vitamin A Status of Mothers and Children.

Objectives: To measure impact of fortifying unbranded palm oil with retinyl palmitate on vitamin A status in poor households through two surveys, just before fortification started (four months after the twice-yearly vitamin A capsule supplementation for children 6-59 months) and a year later. Methods: 24 villages from a pilot area on West Java were randomly selected, and poor families sampled. Serum retinol (adjusted for sub-clinical infections) was analyzed in lactating mothers and their infants 6-11 months, children 12-59 months and 5-9 years and women 15-29 years, in relation to socio-economic conditions, oil consumption, and food intake. Fortified oil was sold through existing market channels. Results: Fortified oil improved vitamin A intakes, contributing an estimated 34%, 77%, 55%, 42%, 50% of Recommended Nutrient Intake (RNI) for children 12-23 months, 24-59 months, 5-9 years, lactating and non-lactating women, respectively. Serum retinol increased by 13-17% across groups (p<0.02 except in 12-23 months). Deficiency prevalence (retinol <20 mg/dL) decreased by 67%, 64%, 96%, 89%, 79%, and 89% in infants 6-11 months, children 12-23 months, 24-59 months, 5-9 years, lactating and non-lactating women (p<0.011, all groups). Households' non-food expenditures, housing conditions and capital assets also improved from baseline to endline. However, in multivariate regressions, socio-economic variables did not independently influence retinol status, whereas RNI contributions from oil positively predicted improving retinol for children 6-59 months (p=0.003) and 5-9 years (p=0.03). Conclusions: Fortification of cooking oil proved an effective way to reduce the vitamin A intake gap in underprivileged women and children in rural communities.

Effect of Demographic Variables on 25(OH)D Level and on the Risk of Vitamin D Insufficiency in SEANUTS Countries.

Objectives: Vitamin D insufficiency is endemic in western countries. Emerging evidence suggests this may be true also for countries with abundant sunshine. This study aimed to evaluate the vitamin D status and associated risk factors in a sub-sample of children from the South East Asian Nutrition Surveys (SEANUTS). Methods: SEANUTS was conducted in Indonesia, Malaysia, Thailand and Vietnam in a country representative sample of 16744 children aged 0.5 to 12 years. Information on socio-demographic variables, lifestyle habits and anthropometric measures were collected. In a sub-sample of 2016 children, serum 25-hydroxyvitamin D [25(OH)D] levels were determined. Data were analysed using SPSS complex sample with weight factors to report population representative data. Results: In Malaysia and Thailand, urban children had lower 25(OH)D levels than rural children. Except Vietnam, boys in all countries had higher 25(OH)D levels and older children had lower 25(OH)D levels. Regional differences persisted in all countries even after correcting for age, sex and area of residence. In Malaysia and Thailand, 25(OH)D status was also associated with religion. The percentage of children with adequate 25(OH)D levels (>75nmol/L) ranged from as low as 5% (Indonesia) to 20% (Vietnam). Vitamin D insufficiency (<50nmol/L) was noted in nearly 40% to 50% of children in all countries. Girls, urban area, region and religion significantly increased the odds of being vitamin D insufficient. Conclusions: The high prevalence of vitamin D insufficiency in SEANUTS countries suggests a need for a tailored approach to successfully combat this problem. Promoting active and outdoor lifestyle along with food fortification can be feasible options.