The national Vitamin A Supplementation Program and subclinical vitamin A deficiency among preschool children in the philippines.

The prevalence of vitamin A deficiency (serum retinol [SR] < 20 microg/dl) in children from one to five years of age in the Philippines rose from 35.8% to 38% between 1993 and 1998, despite a twice-yearly universal vitamin A capsule distribution program. The Philippines 1998 National Nutrition Survey, with one-time SR measurements from 11,620 children from one to four years of age, collected over an eight-month period from one month to more than six months after distribution of vitamin A capsules, was an opportunity to examine the impact of the program on the children's vitamin A status, using post hoc analysis. Overall, a detectable impact of vitamin A capsules on SR was limited to groups with the highest prevalence of vitamin A deficiency and lasted up to four months after dose administration. In highly urban cities in Visayas, where very high prevalences of deficient SR (SR < 10 microg/dl) were found, the prevalence of deficient SR was reduced from 27% to 9% one to two months after distribution of vitamin A capsules, and to 16% at three to four months. In Mindanao, a statistically significant reduction from 38% to 32% was seen in the prevalence of deficient to low SR (SR < 20 microg/dl) one to four months after distribution of vitamin A capsules. There was no overall reduction in the prevalence of vitamin A deficiency or deficient and low SR (SR < 20 microg/dl) in Luzon, but a significant interaction with stunting was observed in Luzon non-highly urbanized cities. Two aspects are of concern. First, the magnitude of the effect of high-dose vitamin A capsules on SR, and hence on the extent of reduction in deficiency, is limited. Second, the effect does not persist for six months, which is the interval between doses. Thus there is no decrease in the prevalence of deficiency over time. With more frequent dosing (especially to those most deficient in SR), a progressive reduction in vitamin A deficiency could, however, be expected; this hypothesis could be tested. The policy implication arising from these results is that a shift in resources is warranted. In areas of low prevalence of vitamin A deficiency, distribution of vitamin A capsules should be targeted to stunted children. In areas of high prevalence, vitamin A capsules should be distributed to children one to five years old at least three times a year.

Riboflavin requirements of Filipino children and non-pregnant, pregnant and lactating women: Studied by the erthrocyte glutathione reductase activation test.

Riboflavin requirements were studied in six non-pregnant, 12 pregnant, 11 lactating women, 20 children aged 4-6 years and 14 children aged 10-12 years. All subjects initially were riboflavin-deficient with erythrocyte glutathione reductase activation coefficient (EGR-AC) of >=1.3, confined in a metabolic ward and repleted with increasing doses of riboflavin during four 10 or 8 day feeding periods. The repletion diet simulated the usual basal diet of the subjects but were modified to contain adequate energy and protein in the pregnant group. Minimum riboflavin requirements determined by regression analysis as intakes required to obtain an EGR-AC value of < 1.3 were: 0.72 ± 0.09 (non-pregnant); 1.36 ± 0.37 (pregnant); 1.31 ± 0.16 (lactating); 0.58 ± 0.10 (children 4-6 years), and 0.70 ± 0.18 mg/d (children 10-12 years). Riboflavin requirements in mg/d, mg/1000 kcal, mg/g protein or mg/kg metabolic body size for the groups varied. Because of the large variability, the use of a single value relating riboflavin requirement to either energy,protein requirements or metabolic body size to calculate requirements for different age groups or gender is deemed inappropriate. It is recommended that riboflavin requirements be expressed in mg/d as determined experimentally for different population groups. Estimated recommended dietary allowances for the groups studied, obtained by adding 30% to the mean minimum riboflavin requirement, are presented.

Vitamin A status of Filipino preschool children given a massive oral dose.

The protection period of a 200,000 IU of vitamin A on Filipino children was determined. Subjects were 105 children aged 1-5 years given a single massive dose during the "Araw ng Sangkap Pinoy" (ASAP) in March 1995. Serum retinol was measured by HPLC at baseline, one, two, four and six months after the administration of the dose. Results showed that baseline serum retinol levels were significantly lower than all follow-up values. Serum retinol values were maintained at levels higher than pre-supplementation values although the values decreased on the second month after supplementation. The proportions of deficient and low (< 20 microg/dl) levels were significantly lower one and six months after supplementation. All follow-up serum retinol levels of children with deficient and low values at baseline were significantly lower (p < 0.001) than those with normal values. The WHO recommendation of 200,000 IU was effective in increasing serum retinol concentrations and maintaining it above pre-supplementation levels up to 6 months after administration of the dose. It also replenished organic vitamin A reserves as shown by the dose response (S30DR) approach. Incidence of infection also decreased among the children. Supplementation with vitamin A has likewise resulted in an increase in hemoglobin values and a decrease in the proportion of anemics (Hb < 11.0 g/dl) among the children.

Iron status of Filipino infants and preschoolers using plasma ferritin and transferrin receptor levels.

Iron status of 1,861 Filipino infants and preschoolers was evaluated by measurements of plasma ferritin (PF), transferrin receptor (TR) and hemoglobin (Hb). One group of subjects (Group I) consisted of all anemic subjects together with a systematic subsample from the Fourth National Nutrition Survey-Biochemical Phase. Results showed that depleted iron stores based on PF (< 12.0 ng/ml) was present in 70.0% of infants and 60.5% of preschoolers. Tissue iron deficiency based on TR (> 8.5 mg/l) was present in higher proportion (80.0% and 73.7% for infants and preschoolers) which was comparable to the proportion of anemia (80.3%). In a subgroup of subjects from the Country Program for Children IV (Group 2) elevated TR was present in 61.4% of infants and 46.5% of preschoolers. A lower proportion of depleted iron stores of 22.7% in infants and 15.2% in preschoolers was observed. Correlation test showed that there was a closer relationship between Hb and TR (r = -0.42) than Hb and PF (r = 0.20) even if PF was expected to give a higher proportion of values below normal. The occurrence of anemia in the presence of elevated TR without any decrease in PF values suggest that the diagnostic ability of PF could be limited in the presence of infection. Therefore, future studies should include biochemical tests such as C-reactive proteins (CRP) to determine the extent of association between anemia and infection.

Assessment of iron status of Filipino pregnant women.

Plasma ferritin (PF), erythrocyte protoporphyrin (EP) and hemoglobin (Hb) were used to assess the iron status of 158 Filipino pregnant women included as subjects in the third national nutrition survey conducted by the Food and Nutrition Research Institute in 1987. The prevalence of iron depletion was 39.9% based on PF (less than 12 ng/ml). Iron deficient erythropoiesis was present in 36.1% based on EP of greater than 28 micrograms/dl whole blood and 40.5% based on EP/Hb ratio of greater than 2.4. When the criterion of iron deficiency was that both PF and EP were abnormal, the prevalence of deficiency was lower and only 16.4%. Iron deficiency anemia was present in 14.6% based on Hb less than 11 g/dl in addition to abnormal PF and EP. Significantly lower mean values for PF were obtained in women on the 2nd and 3rd trimesters of pregnancy indicating decreasing iron stores and the need for iron therapy to prevent anemia during those periods. The iron status of 38 women who reported taking iron supplements was not significantly different from those who did not take supplements.