ABSTRACT
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.
ABSTRACT
Objectives: To describe prospects of successful fortification of unbranded cooking oil with vitamin A in Indonesia through public-private cooperation, based on a pilot program in 2 districts on West Java. Methods: Collaborating with Ministries of Health, Industry and Trade, Indonesia's Food Fortification Foundation and Food & Drug Agency, and GAIN, two producers covering a large market share on West Java piloted fortification of cooking oil with 45 IU/g retinyl palmitate, the National Standard (SNI) for oil at factory-level. For quality control, vitamin A in cooking oil was measured at a factory, distributors and retailers, and from households. Household surveys measured oil consumption. Results: Oil consumption among children 12-23 and 24-59 months averaged 12.5 and 22.3 g/day, and 29 g/day in women 15-29 years, similar before and after start of fortification. Oil samples contained retinyl palmitate at averages of 43.6 IU/g at the factory (68 samples), 33.8 IU/g among distributors (2 stores, 28 samples), 33.3 IU/g at retail shops (24 shops, 64 samples) and 19.2 IU/g among households (339 households, 6376 samples). Vitamin A content in oil varied over the 12 months of the pilot. Further work should determine if variations reflect degradation of vitamin A during storage (including varying storage times of samples before measurement), or mixing of fortified oil with non-fortified oil by retailers. Conclusions: Quality control and enforcement of compliance throughout the distribution chain of cooking oil by the Government, and a mandatory fortification standard supported by all stakeholders are essential for this program to be sustained and expanded.
ABSTRACT
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.