Vitamin A deficiency during pregnancy of HIV infected and non-infected women in tropical settings of Northwest Ethiopia.

BACKGROUND: Vitamin A deficiency (VAD) is known to be a major public health problem among women of reproductive age in South East Asia and Africa. In Ethiopia, there are no studies conducted on serum vitamin A status of HIV-infected pregnant women. Therefore, the present study was aimed at determining the level of serum vitamin A and VAD among pregnant women with and without HIV infection in tropical settings of Northwest Ethiopia. METHODS: In this cross-sectional study, blood samples were collected from 423 pregnant women and from 55 healthy volunteers who visited the University of Gondar Hospital. Serum concentration of vitamin A was measured by high performance liquid chromatography. RESULTS: After controlling for total serum protein, albumin and demographic variables, the mean ± SD serum vitamin A in HIV seropositive pregnant women (0.96 ± 0.42 µmol/L) was significantly lower than that in pregnant women without HIV infection (1.10 ± 0.45 µmol/L, P < 0.05). Likewise, the level of serum vitamin A in HIV seropositive non-pregnant women (0.74 ± 0.39) was significantly lower than that in HIV negative non-pregnant women (1.18 ± 0.59 µmol/L, P < 0.004). VAD (serum retinol < 0.7 µmol/L) was observed in 18.4% and 17.7% of HIV infected and uninfected pregnant women, respectively. Forty six percent of non-pregnant women with HIV infection had VAD while only 28% controls were deficient for vitamin A (P = 0.002). CONCLUSION: The present study shows that VAD is a major public health problem among pregnant women in the tropical settings of Northwest Ethiopia. Considering the possible implications of VAD during pregnancy, we recommend multivitamin (which has a lower level of vitamin A) supplementation in the care and management of pregnant women with or without HIV infection.

Difructose anhydride III enhances bioavailability of water-insoluble iron in anemic Vietnamese women.

Difructose anhydride III (DFAIII) is an indigestible disaccharide and has been shown to enhance iron absorption in animal studies; however, the effect has not been investigated in anemic subjects. We investigated the efficacy of co-administration of DFAIII with water-insoluble iron in the treatment of iron deficiency anemia in Vietnamese women. One hundred sixty-eight moderately anemic women (80 g/L

Nutritional status, feeding practice and incidence of infectious diseases among children aged 6 to 18 months in northern mountainous Vietnam.

OBJECTIVE: To assess the prevalence of undernutrition, incidence of infectious diseases and the situation of feeding practices to determine the risk factors for undernutrition among children aged 6 to 18 months in rural Vietnam. DESIGN: A cross-sectional study was conducted among one hundred eighty-eight mother-child pairs in Bac Giang, Vietnam. Weight and height of the children were measured and referred to data from the WHO/CDC/NCHS. Incidence of infectious diseases was diagnosed based on the WHO Recommended Surveillance Standards. Data on socio-demographic variables and feeding practices were obtained through a structured questionnaire. RESULT: The prevalence of underweight, stunting and wasting was 19.7%, 23.4% and 5.3%, respectively. The incidence of diarrhea and acute respiratory infections (ARIs) during the last 14 days of the interview was 12.2% and 20.2%, respectively. Although 99% of the children were breastfed, the prevalence of exclusive breastfeeding in the first 4 mo was 21.3%. Non-exclusive breastfeeding in the first 4 month (OR 3.95, p=0.025) and low birth weight (OR 4.38, p=0.009) were associated with underweight in the children, while incidence of infectious disease was not (OR 1.16, p=0.734). CONCLUSION: Undernutrition is highly prevalent in the study site and non-exclusive breast feeding is one of the risk factors.

Daily calcium intake and physical activity status in urban women living on low incomes in Davao, Philippines: a primary study for osteoporosis prevention.

Low calcium intake and physical inactivity are modifiable risk factors of osteoporosis; however, little information is available about the prevalence of these risk factors among urban Filipino women living on low-incomes. The present study, therefore, investigated daily calcium intake, main calcium sources, and physical activity status in this population. The study group comprised healthy women aged in their 30 s who had participated in our previous survey using heel speed of sound (SOS) measurement in Davao, Philippines. The women were stratified into three groups based on SOS score and 20 were randomly selected from each, giving 60 in total. Calcium intake was measured by direct analysis of the food samples collected from 3-days 24 hour-food duplicate method. Physical activity was estimated based on pedometer determined walking steps over 5 days. The median [25%, 75%] calcium intake per day was 289 [225, 434] mg. Traditional foods derived from local small fish and plants were the main calcium sources. The median walking steps per day was 8750 [6920, 10836]. Although three groups did not show significantly different calcium intakes and walking steps, consumption of low-cost small fish and plant foods could be encouraged along with walking in urban Filipino women living on low-incomes.

Nutritional status of lactating mothers and their breast milk concentration of iron, zinc and copper in rural Vietnam.

Breast milk is considered to be the best nutrient source for infants. However, nutritional compositions of breast milk in developing countries, especially among malnourished women, have not been fully investigated. This study aimed to assess nutritional status and nutrient composition of breast milk in lactating mothers in rural Vietnam. Sixty breastfeeding mothers at 6 to 12 mo postpartum, free from any medical disorder and/or medication, and not pregnant were randomly selected in Yen The, Bac Giang, Vietnam. Their nutritional status, breast milk concentration and dietary intakes were assessed. Among the study participants, anemia (39.0%) and low serum zinc concentration (55.4%) were frequently observed. Dietary assessment revealed lower intakes of iron (10.2+/-2.5 mg/d) and zinc (10.4+/-2.2 mg/d) than estimated requirements. The breast milk concentration of iron, zinc and copper was 0.43+/-0.15 mg/L, 0.56 (0.37, 0.82) mg/L and 0.19+/-0.05 mg/L, respectively. The breast milk concentration of iron, zinc and copper was not correlated to the serum concentration or dietary intakes. In conclusion, we uncovered a high prevalence of anemia and zinc deficiency in lactating mothers in rural Vietnam. The findings demonstrate a low breast milk zinc concentration among the participants, but need further investigation.

Effect of community-based nutrition education intervention on calcium intake and bone mass in postmenopausal Vietnamese women.

OBJECTIVE: To examine the effect of community-based nutrition education intervention on calcium intake and bone mass in Vietnamese postmenopausal women. DESIGN: A controlled trial was conducted in two groups as intervention and control. The intervention group was given nutrition education during 18 months to improve calcium intake, while the control subjects had the usual diet. Calcium intake and bone mass were evaluated every 6 months. Bone mass was assessed by speed of sound (SOS) at calcaneus, referred to as quantitative ultrasound measurement. Anthropometric indices and serum parathyroid hormone (PTH) were determined at baseline and at the end of intervention. SETTING: Two rural communes of Hai Duong province located in the Red River Delta in Vietnam. SUBJECTS: A total of 140 women aged 55-65 years, who were more than 5 years postmenopausal and with low calcium intake (<400 mg/d), were recruited. After 18 months of intervention, 108 women completed the study. RESULTS: Calcium intake in the intervention group had increased significantly (P < 0.01) while it had no significant changes in controls. SOS values were not changed significantly in the intervention subjects while it decreased significantly by 0.5 % in the controls (P < 0.01). The intervention led to a decrease in serum PTH by 12 % (P < 0.01). In the controls, there was an increase in serum PTH by 32 % (P < 0.001). CONCLUSION: Nutrition education intervention was effective in improving calcium intake and retarding bone loss in the studied subjects.

Development and validation of food frequency questionnaire to assess calcium intake in postmenopausal Vietnamese women.

This study was done to develop a Food Frequency Questionnaire (FFQ) for assessing calcium intake in Vietnamese based on data from the National Nutrition Survey in 2000. From the data, a total of 36 calcium-rich food items were selected for the FFQ by ranking food items according to their contribution to the population intake of nutrients. The FFQ was validated in 140 postmenopausal women by comparing estimates of calcium intake from the FFQ with those from multi-pass 24 h recalls. The results showed that the Pearson correlation coefficient between the 2 methods was 0.84 (p<0.001), and that the weighted kappa value was 0.44. Cross-classification analysis indicated that 82.1% of subjects were classified into the same or adjacent quartile by both methods. No subject was grossly misclassified by the FFQ. There is no significant difference of calcium intake between the 2 methods (by paired t test, p>0.05). A reproducibility study also presented good correlation between 2 administrations of the FFQ, with Pearson correlation coefficient being 0.93 (p<0.001) and weighted kappa value being 0.67. In conclusion, this FFQ is useful and reliable for estimating calcium intake in population-based epidemiological studies in postmenopausal Vietnamese women.

Resting metabolic rate of elderly Vietnamese.

BACKGROUND/AIMS: To evaluate the FAO/WHO/UNU equations for predicting resting metabolic rate (RMR) in elderly Vietnamese. METHODS: A cross-sectional study involving healthy and elderly subjects was carried out at the Basic Nutrition Department, National Institute of Nutrition, Vietnam. A total of 75 subjects who had a normal body mass index (BMI) were divided into two groups according to sex. The RMR was measured by indirect calorimetry and anthropometric indices were recorded. Equations derived by linear regression of RMR and body weight were compared to the FAO/WHO/UNU (1985) predictive equations. RESULTS: The mean age of males and females were 65.03 +/- 4.0 and 66.48 +/- 4.61 years, respectively. Mean RMRs (MJ/kg/day) were 0.0963 +/- 0.0121 for males and 0.0925 +/- 0.0117 for females. Compared to the FAO/WHO/UNU equations, our findings were 10.9 and 11.1% lower in males and females, respectively (p < 0.05). CONCLUSION: Our findings suggest that the FAO/WHO/UNU equations may overestimate RMR in elderly Vietnamese. Further studies to find out the most appropriate equation or to establish new predictive equations for RMR in elderly Vietnamese should be conducted.

Vitamin A deficiency in patients with diarrhea and HIV infection in Ethiopia.

Diarrhea, micronutrient deficiencies and HIV/AIDS are major public health problems in developing countries, especially in sub-Saharan Africa. This study was aimed to investigate serum levels of vitamin A in diarrheic patients with and without HIV co-infection compared to healthy controls. Two hundred eleven diarrheic patients (110 HIV infected), 87 apparently healthy controls and 41 asymptomatic HIV seropositive blood donors who visited the University of Gondar Hospital, in Gondar, Ethiopia were included. Stool samples were examined for enteropathogens following the standard procedures. Serum vitamin A levels were measured by high performance liquid chromatography. Shigella species were isolated from 8.5% of the patients while intestinal parasites were detected in 32.2% without significant difference by HIV serostatus. The mean+/-SD serum vitamin A in diarrheic patients with (0.82+/-0.59 micromol/L) and without (0.84+/-0.54 micromol/L) HIV co-infection and in asymptomatic HIV infected blood donors (0.96+/-0.52 micromol/L) was significantly lower than that in healthy controls (1.52+/-0.71 micromol/L), p<0.001. Vitamin A deficiency (VAD, serum retinol < 0.70 micromol/L) was observed in 52.7% and 45.5% of diarrheic patients with and without HIV co-infection, respectively. About 13% of healthy controls and 29.3% of asymptomatic HIV infected blood donors were deficient in vitamin A. The levels of serum vitamin A were not associated with the presence of intestinal parasites or Shigella species. The findings demonstrate that VAD is a severe public health problem among diarrheic patients in Gondar, Ethiopia. Intervention programmes involving health and nutrition education and supplementation of vitamin A might help in reducing morbidity in such patients.

Association of estrogen receptor alpha gene polymorphisms and lifestyle factors with calcaneal quantitative ultrasound and osteoporosis in postmenopausal Vietnamese women.

Genetic and lifestyle factors are important in the pathogenesis of osteoporosis. We investigated the relationships of PvuII and XbaI polymorphisms of the estrogen receptor alpha (ER-alpha) gene, lifestyle factors with speed of sound at the calcaneus (calcaneal SOS) and osteoporosis in a population-based study of 140 healthy postmenopausal women. By an analysis of covariates, women with higher copies of P or X alleles had higher calcaneal SOS compared with others (P=0.012, PP vs. pp; P=0.045, Xx vs. xx). Women with lower copies of px or higher copies of PX haplotypes had higher calcaneal SOS compared with others (P=0.021, 0 px vs. 2 px; P=0.011, 1 PX vs. 0 PX). The px and PX haplotypes, age and years since menopause were found to be independent predictors of calcaneal SOS in multiple linear regression models. Using logistic regression, we found an increased osteoporosis risk with evidence for a px haplotype dose effect (OR=2.82, 95% CI=1.50-5.31, P=0.001) and for a PX haplotype dose effect (OR=0.42, 95% CI=0.19-0.93, P=0.033). An increased educational level was associated with a reduced risk of osteoporosis (P=0.035 in the model with px, P=0.044 in the model with PX). In conclusion, the present study suggests that PvuII and XbaI polymorphims of the ER-alpha gene, age, years since menopause and educational level are associated with bone density, as assessed by calcaneal SOS, and osteoporosis in postmenopausal Vietnamese women.

Increased nerve growth factor by zinc supplementation with concurrent vitamin A deficiency does not improve memory performance in mice.

We investigated the effects of dietary supplementation of zinc (Zn) with or without vitamin A (Vit. A), to elucidate any cross activity between the two micronutrients, on memory and nerve growth factor (NGF) production in ddY male mice depleted for the two elements. After 3 mo-feeding with a Zn and Vit. A deficient (VAD) diet, mice were divided into three groups and replenished with normal Zn with VAD diet (NZ-VAD), high Zn with VAD diet (HZ-VAD) or normal Zn + normal Vit. A (NZ-NVA) for additional 2 mo. One more group was made and given the normal diet for the same period (Control group). Levels of NGF were measured from extracts of hippocampus, cerebellum and cortex at the end of the 3rd and 5th month. In addition, a radial arm maze task was performed at the end of the 5th month. The two Zn supplemented groups (NZ-VAD and HZ-VAD) tended to show high NGF concentration but memory was not improved. However, improved memory was observed in the NZ-NVA group. From these results we concluded that Zn may increase NGF; however, memory was improved only when Vit. A was sufficient.

Determining the prevalence of osteoporosis and related factors using quantitative ultrasound in Vietnamese adult women.

In 2003, the authors conducted a population-based, cross-sectional survey to determine the prevalence of osteoporosis and related factors in Vietnamese adult women by using quantitative ultrasound at the heel bone (calcaneus). A total of 2,232 adult women aged > or =20 years, living in Hanoi City, and free of illnesses affecting bone metabolism were randomly selected to participate in the study. Subjects' bone mass was assessed by speed of sound at the calcaneus, referred to as quantitative ultrasound measurement. The T-score threshold, defined as < or =-1.8, was used to identify subjects with osteoporosis. The crude prevalence of osteoporosis in Hanoi City was 15.4%; after adjustment for age, it was 9.0%. Among premenopausal women, the crude prevalence of osteoporosis was higher in the urban areas compared with the rural areas. By contrast, postmenopausal women in the rural areas had a higher prevalence of osteoporosis. Multiple logistic regression analysis revealed that factors associated with low speed of sound were age, menopause, educational level, lifelong occupation, recreational weight-bearing exercise, number of births, and height. Results suggest that osteoporosis is a noteworthy problem in Vietnam, and intervention strategies should be considered to control it, especially in high-risk populations.

Recommendations to develop an intervention for Japanese youth on weight management.

In the last 20 years the average change in BMI among Japanese youth is minimal, but significant changes appear when the categories of overweight/obesity and underweight are investigated within gender. Now intervention programs for Japanese youth on weight management need to be developed. To address the issue, there are a series of steps that could be undertaken utilizing theory of behavior change. Using the Transtheoretical Model-Stages of Change as the health promotion theory an intervention could be developed that would tailor messages to the level of the stage of readiness to weight change that exists among youth. Different aspects of the intervention could be developed and targeted to groups of youth by their needs. To assist with planning and development of the intervention principles of Intervention Mapping could be used to guide development using data from a needs assessment survey to: a) determine youths' knowledge, attitudes and beliefs about body size, b) determine youth's barriers to change in body size, c) determine parental knowledge, attitudes and beliefs about body size, d) determine parental barriers to change in youth body size, e) determine the prevalence of health problems from low and high BMI of young females and males, f) determine which youth are at risk-rural/urban areas, socioeconomic status.

Oolong tea increases energy metabolism in Japanese females.

Oolong tea is a traditional Chinese tea that has long been believed to be beneficial to health such as decreasing body fat. We were interested in this assertion and tried to evaluate the effect of oolong tea on energy expenditure (EE) in comparison with green tea. The subjects were eleven healthy Japanese females (age 20+/-1 y; body mass index (BMI) 21.2+/-2.5 kg/m2) who each consumed of three treatments in a crossover design: 1) water, 2) oolong tea, 3) green tea. Resting energy expenditure (REE) and EE after the consumption of the test beverage for 120 min were measured using an indirect calorimeter. The cumulative increases of EE for 120 min were significantly increased 10% and 4% after the consumption of oolong tea and green tea, respectively. EE at 60 and 90 min were significantly higher after the consumption of oolong tea than that of water (P<0.05). In comparison with green tea, oolong tea contained approximately half the caffeine and epigallocatechin galate, while polymerized polyphenols were double. These results suggest that oolong tea increases EE by its polymerized polyphenols.