Prevalence and Determinants of the Co-Occurrence of Overweight or Obesity and Micronutrient Deficiencies among Adults in the Philippines: Results from a National Representative Survey.

The double burden of malnutrition (DBM) affects many low- and middle-income countries. However, few studies have examined DBM at the individual level, or undernutrition and overnutrition co-occurring within the same person. This study aims to investigate the prevalence and determinants of DBM among adults in the Philippines. Data from the 2013 National Nutrition Survey were used. The sample size in the analysis was 17,010 adults aged ≥20 years old, after excluding pregnant and lactating women. DBM was defined as the co-occurrence of overweight/obesity and anemia (definition #1), overweight/obesity and anemia or vitamin A deficiency (definition #2), and overweight/obesity and anemia or vitamin A deficiency or iodine insufficiency (definition #3). Anthropometric measurements and biochemical markers were used for DBM assessment. Data were analyzed using descriptive statistics, the chi-square test, and logistic regression by R software. Results showed that definition #3 is the predominant type of DBM (7.0%) in the general population, whereas the prevalence of DBM has increased to 23.7% in overweight/obese persons. Sex, age, educational attainment, marital status, household size, wealth quintile, and smoking status were the determinants of DBM. This study revealed that Filipino adults experience malnutrition critically and must be addressed through food and nutrition interventions.

Disproportionate Vitamin A Deficiency in Women of Specific Ethnicities Linked to Differences in Allele Frequencies of Vitamin A-Related Polymorphisms.

Background: While the current national prevalence rate of vitamin A deficiency (VAD) is estimated to be less than 1%, it is suggested that it varies between different ethnic groups and races within the U.S. We assessed the prevalence of VAD in pregnant women of different ethnic groups and tested these prevalence rates for associations with the vitamin A-related single nucleotide polymorphism (SNP) allele frequencies in each ethnic group. Methods: We analyzed two independent datasets of serum retinol levels with self-reported ethnicities and the differences of allele frequencies of the SNPs associated with vitamin A metabolism between groups in publicly available datasets. Results: Non-Hispanic Black and Hispanic pregnant women showed high VAD prevalence in both datasets. Interestingly, the VAD prevalence for Hispanic pregnant women significantly differed between datasets (p = 1.973 × 10-10, 95%CI 0.04-0.22). Alleles known to confer the risk of low serum retinol (rs10882272 C and rs738409 G) showed higher frequencies in the race/ethnicity groups with more VAD. Moreover, minor allele frequencies of a set of 39 previously reported SNPs associated with vitamin A metabolism were significantly different between the populations of different ancestries than those of randomly selected SNPs (p = 0.030). Conclusions: Our analysis confirmed that VAD prevalence varies between different ethnic groups/races and may be causally associated with genetic variants conferring risk for low retinol levels. Assessing genetic variant information prior to performing an effective nutrient supplementation program will help us plan more effective food-based interventions.

Low plasma vitamin A concentration is associated with tuberculosis in Moroccan population: a preliminary case control study.

BACKGROUND: Vitamin A plays numerous roles in immune system. Its deficiency alters both the innate and adaptive immunity. Previous results reported that the micronutrients deficiency, particularly vitamin A, is observed in patients with tuberculosis. Thus, we aimed in this study to assess vitamin A concentrations in Moroccan patients with tuberculosis to set up a large efficacy study of vitamin A supplementation for TB infected patients. Plasma retinol concentration was measured by HPLC in 44 recently diagnosed TB patients and 40 healthy controls. RESULTS: We showed that plasma vitamin A is significantly lower in tuberculosis patients as compared to healthy controls (p < 0.0001). Moreover, no significant association was found between vitamin A deficiency and, TB severity and patients' ages. CONCLUSION: Our study confirms the association between low vitamin A levels and tuberculosis disease.

Trends in Iron, Zinc, and Vitamin A Status Biomarkers Among Colombian Children: Results From 2 Nationally Representative Surveys.

BACKGROUND: Micronutrient deficiencies are still highly prevalent in countries undergoing the nutrition transition, but nationally representative data documenting their burden in children are exceedingly rare. OBJECTIVE: To examine the distribution and recent trends in micronutrient status biomarkers of Colombian children. METHODS: We compared the distributions of plasma ferritin, serum zinc, and vitamin A in Colombian children between 2005 and 2010 using 2 cross-sectional, nationally representative surveys overall and by categories of sociodemographic variables. Analysis for ferritin included boys and nonpregnant girls aged 1 to 17 years. Analyses for zinc and vitamin A included children aged 1 to 4 years. RESULTS: The mean 2010 to 2005 differences in ferritin, zinc, and vitamin A were 2.5 µg/L (95% confidence interval [CI]: 1.3 to 3.7), -34.9 µg/dL (95% CI: -39.6 to -30.2), and -11.5 µg/dL (95% CI: -12.3 to -10.7), respectively, after adjusting for sociodemographic characteristics. These differences varied significantly by region of residence. In 2010, region of residence was a significant correlate for all 3 micronutrients. Other important correlates included age and maternal education for ferritin and body mass index-for-age Z score, maternal education, wealth index, food insecurity, and urbanicity for vitamin A. CONCLUSIONS: Plasma ferritin was slightly higher in 2010 than in 2005, whereas serum zinc and vitamin A were substantially lower in 2010. In the absence of obvious causal explanations, it is uncertain whether this decline represents a worsening of micronutrient status in Colombian children or an artifact due to systematic laboratory or data management errors incurred in the surveys.

[Vitamin A nutritional status of Chinese rural children and adolescents in 2010-2012].

OBJECTIVE: To analysis the vitamin A nutritional status of 6-to 17-year-old children and adolescents between 2010-2012 in rural China. METHODS: Based on the China Health and Nutrition Survey 2010-2012 project, the serum vitamin A samples of children and adolescents from survey sites of rural area were selected by random sampling method, and 5888 cases of samples were detected using the high performance liquid chromatography method to evaluate their vitamin A nutritional status. RESULTS: The serum retinol concentration of children and adolescents in rural area was( 1. 44 ± 0. 58) µmol/L, and were( 1. 40 ± 0. 56) µmol/L in general rural areas and( 1. 46 ± 0. 60) µmol/L in poverty rural areas respectively( t = 1. 88, P < 0. 05). The serum retinol concentration of6-to 11-year-old were( 1. 31 ± 0. 53) µmol/L and( 1. 37 ± 0. 60) µmol/L, and serumretinol concentration of 12-to 17-year-old were( 1. 52 ± 0. 57) µmol/L and( 1. 52 ±0. 60) µmol/L( t = 11. 90 and t = 5. 54, P < 0. 05). The prevalence of vitamin A deficiency was 5. 53%, and were 6. 14% in general rural areas and 4. 55% in poverty rural areas, respectively( P > 0. 05). The prevalence of marginal vitamin A deficiency were 18. 75%, and were 19. 17% in general rural areas and 18. 07% in poverty rural areas, respectively( P > 0. 05). CONCLUSION: The situation of vitamin A deficiency in rural China are still widespread, the high prevalence of marginal vitamin A deficiency is more prominent.

[Vitamin A nutritional status of Chinese rural fertile women in 2010-2012].

OBJECTIVE: To evaluate nutritional status of vitamin A( VA) among Chinese rural fertile women in 2010-2012. METHODS: A multi-stage stratified sampling and population proportional stratified random sampling method was used and the participants of rural fertile women who were 18-44 years old and had completed personal information data during the 2010-2012 National Nutrition and Health Survey were included( n = 1279). The level of serum retinol, rate of VA marginal deficiency anddeficiency among the fertile women were analyzed. RESULTS: In 2010-2012, the P50( P25-P75) level of serum retinol was 1. 63( 1. 28-2. 10) µmol/L for Chinese rural fertile women, 1. 60( 1. 25-2. 05) µmol/L for fertile women from ordinary rural area and1. 70( 1. 32-2. 17) µmol/L for fertile women from poverty rural area. The level of serum retinol of fertile women from poverty rural area was statistically higher than that of ordinary rural area( P = 0. 007). The rate of VA marginal deficiency and deficiency among the Chinese rural fertile women was 9. 46% and 3. 05%, respectively. The rate of VA marginal deficiency and deficiency among the fertile women from ordinary rural area and poverty rural area was 9. 82%, 4. 13%, 9. 03% and 1. 74%, respectively. The rate of VA deficiency among the fertile women from ordinary rural was statistically higher than that of poverty rural( P = 0. 013), but no statistically differences in the rate of VA marginal deficiency were found( P > 0. 05). Moreover, the statistically differences of rate of VA marginal deficiency and deficiency were also observed in the different regions and educational level( only VA deficiency). There were no statistically differences of VA marginal deficiency and deficiency were found in the other variables. CONCLUSION: The different extent of VA deficiency still present and more popular for the VA marginal deficiency among Chinese fertile women.

[Serum retinol concentrations of Chinese rural elderly residents in 2010-2012].

OBJECTIVE: To assess the vitamin A status of Chinese rural elderly population by analyzing the serum retinol levels of Chinese rural elderly residents in 2010-2012. METHODS: Data were from the Chinese National Nutrition and Health Survey in2010-2012. Using the multistage stratified cluster sampling method, serum samples from the elderly residents aged above 60 years old( including), were obtained from 45 general rural and 30 poor rural. The basic situation of the survey object was collected by the questionnaire survey. The concentration of serum retinol was determined by high performance liquid chromatography( HPLC). The vitamin A deficiency( VAD) was judged by the related standard recommended by WHO. A total of 2 413 elderly residents were included in the study. The levels of serum retinol and the prevalence of vitamin A deficiency and marginal vitamin A deficiency were also compared. RESULTS: The level of serum retinol for rural elderly residents was 1. 88( 1. 45-2. 45) µmol/L. The serum retinol level of poor rural resident was( 1. 92( 1. 46-2. 48) µmol/L), which was significant for the ordinary rural residents( 1. 86( 1. 44-2. 41) µmol/L)( χ~2= 5. 1428, P = 0. 0233). The serum retinol of male elderly( 1. 97( 1. 48-2. 54)) was statistically higher than female( 1. 82( 1. 42-2. 33))( χ~2= 22. 3383, P < 0. 0001). The prevalence of VAD among Chinese rural elderly residents was 2. 28%, 2. 79% for ordinary rural residents and 1. 53% for poor rural residents. The marginal VAD rate of Chinese rural elderly residents was 6. 30%, 6. 84% for ordinary rural residents and 5. 51% for poor rural residents. The prevalence of VAD and marginal VAD for male was 2. 18% and5. 57%, respectively. The prevalence of VAD and marginal VAD for female was 2. 38%and 7. 21%, respectively. No statistically difference was observed between different genders. The prevalence of VAD was 1. 93%, 3. 17% and 1. 47% for different age groups( 60 ~ 69, 70 ~ 79 and above 80 years old), and no statistically difference was observed between different age groups. The prevalence of marginal VAD was 5. 87%, 6. 20% and 11. 74% for different age groups, and statistically difference was observed between different age groups( χ~2= 7. 3858, P = 0. 039). CONCLUSION: Chinese rural elderly population has a certain degree of vitamin A deficiency and marginal deficiency, the marginal deficiency of the elderly over 80 years old is more common.

[The anemia and vitamin A, vitamin D nutritional status of Chinese rural pregnant women in 2010-2012].

OBJECTIVE: By analyzing the levels of hemoglobin, vitamin A and vitamin D in Chinese rural pregnant women during 2010-2012, the changes of the prevalence of anemia were evaluated, and the nutritional status of vitamin A and vitamin D were evaluated. METHODS: All the data in this study came from the China Nutrition and Health Survey in 2010-2012. By using multi-stage stratified sampling and population proportional stratified random sampling method, pregnant women from 45 ordinary ruralareas and 30 poor rural areas were included in this study. 1 763 cases of blood hemoglobin concentration were determined by cyanmethemoglobin method. 601 cases of retinol level were determined by high performance liquid chromatography method. 979 cases of 25-hydroxy vitamin D level were determined by enzyme linked immunosorbent assay. The level of blood hemoglobin and the prevalence of anemia, the level of vitamin A and the prevalence of VAD, the level of vitamin D and the prevalence of vitamin D deficiency were analyzed. RESULTS: In 2010-2012, the level of blood hemoglobin of Chinese city pregnant women was 123. 60( 113. 80-133. 50) g/L, 123. 10( 114. 00-132. 20) g/L for ordinary rural area and 125. 40( 113. 30-136. 80) g/L for poor rural area. The level of blood hemoglobin of ordinary rural area was statistically higher than that of poor rural area( P = 0. 020). The anemia prevalence of Chinese rural pregnant women was 17. 58%, 16. 10% for ordinary rural area and 20. 19% for poor rural area. Statistically difference was found between different areas( P = 0. 029). The level of vitamin A of Chinese rural pregnant women was 1. 53( 1. 18-1. 98) µmol/L. The prevalence of VAD of Chinese county pregnant women was 3. 49%, the marginal deficiency rate was 12. 81%. The level of vitamin D of Chinese city pregnant women was 15. 55( 11. 94-19. 90) ng/m L. The prevalence of vitamin D deficiency of Chinese rural pregnant women was up to 75. 38%, 65. 36% for ordinary rural area and 87. 42% for poor rural area. Significant difference was observed in the prevalence of vitamin D deficiency between ordinary and poor rural areas( P < 0. 001). CONCLUSION: The prevalence of anemia in Chinese rural pregnant women improve from 2002 to 2012, but still higher than other populations. The prevalence of vitamin D deficiency in pregnant women is generally more serious, while there is a certain percentage of vitamin A marginal deficiency.

Mother and child nutrition among the Chakhesang tribe in the state of Nagaland, North-East India.

Despite the importance of the nutritional status and food systems of Indigenous Peoples, the subject has received very little attention, especially in North-East India. Therefore, a community-based cross-sectional descriptive study was carried out among Chakhesang mothers with children under 5 years of age to evaluate their nutritional status and prevalence of chronic diseases in the context of their dietary habits. From 558 households (HHs), 661 children and 540 mothers were covered using standard anthropometric measurements as well as blood collection for haemoglobin and vitamin A. Data were collected from mothers on HH socio-demographic particulars and infant and young child feeding practices. The results showed that the prevalence of underweight, stunting, and wasting among children <5 years of age was 14%, 22%, and 7%, respectively. The prevalence of anaemia and vitamin A deficiency was 26% and 33% among children <5 years, whereas it was 33% and 26%, respectively, among mothers. Hypertension was observed in 16% of women, whereas diabetes was seen in 0.8%. Approximately 35% and 24% of HHs suffered mild or moderate food insecurity, respectively, which was associated with literacy of the parents, per capita income, and family size. Utilization of the rich agrobiodiversity and wild foods by the Chakhesangs appears to be a strong reason for their better nutritional and health status as compared to the rest of India. Therefore, this Indigenous knowledge and food system must be documented and kept vital, especially in policies and intervention programmes addressing food and nutrition security among the Chakhesangs.

Nutritional status, food insecurity, and biodiversity among the Khasi in Meghalaya, North-East India.

A community-based cross-sectional study was carried out with 603 children ages 5 and under and 500 of their mothers from 510 households to examine the prevalence of undernutrition and chronic diseases among the Khasis of North-East India. Anthropometric measurements including Mid-Upper Arm Circumference, height, and weight were taken. Dry blood spots to estimate haemoglobin and vitamin A were collected from children and women separately by finger prick. Mothers provided data about household socio-demographic particulars and infant and young child feeding practices. The prevalence in children of underweight was 31%, stunting was 57%, and wasting was 10%. Undernutrition was higher among boys as compared to girls. Nutrient intakes were below recommended levels. The prevalence of anaemia among children ages 1 to 5 years old was 68%, and vitamin A deficiency was 59%, and they were 83% and 48%, respectively, among women. Hypertension was observed in 15% of women, whereas diabetes was less than 1%. Only about 20% of households were food secure, and this was associated with parental literacy, per capita income, and family size. Undernutrition was unacceptably high among the Khasis despite rich food biodiversity. Proper implementation of nutritional intervention programs such as Integrated Child Development Services, Mid Day Meal, and the Public Distribution System will improve the nutrient intake and nutritional status of the population. Additionally, preservation of forest lands and products paired with judicious use of the rich food biodiversity available will promote dietary diversity and ultimately better nutrition and health.

Biofortified ß-carotene rice improves vitamin A intake and reduces the prevalence of inadequacy among women and young children in a simulated analysis in Bangladesh, Indonesia, and the Philippines.

BACKGROUND: Vitamin A deficiency continues to be a major public health problem affecting developing countries where people eat mostly rice as a staple food. In Asia, rice provides up to 80% of the total daily energy intake. OBJECTIVE: We used existing data sets from Bangladesh, Indonesia, and the Philippines, where dietary intakes have been quantified at the individual level to 1) determine the rice and vitamin A intake in nonpregnant, nonlactating women of reproductive age and in nonbreastfed children 1-3 y old and 2) simulate the amount of change that could be achieved in the prevalence of inadequate intake of vitamin A if rice biofortified with ß-carotene were consumed instead of the rice consumed at present. DESIGN: We considered a range of 4-20 parts per million (ppm) of ß-carotene content and 10-70% substitution levels for the biofortified rice. Software was used to estimate usual rice and vitamin A intake for the simulation analyses. RESULTS: In an analysis by country, the substitution of biofortified rice for white rice in the optimistic scenario (20 ppm and 70% substitution) decreased the prevalence of vitamin A inadequacy from baseline 78% in women and 71% in children in Bangladesh. In Indonesia and the Philippines, the prevalence of inadequacy fell by 55-60% in women and dropped by nearly 30% in children from baseline. CONCLUSIONS: The results of the simulation analysis were striking in that even low substitution levels and modest increases in the ß-carotene of rice produced a meaningful decrease in the prevalence of inadequate intake of vitamin A. Increasing the substitution levels had a greater impact than increasing the ß-carotene content by >12 ppm.

Comparing and Contrasting Three Cultural Food Customs from Nigeria and Analyzing the Nutrient Content of Diets from These Cultures with the Aim of Proffering Nutritional Intervention.

Nigeria is a multicultural country with a diverse cultural food. Most Nigerians' cultural diet is based on staple food accompanied by stew. In the South West and Eastern region (where Yorubas and Igbos are the dominant ethnic groups), staple foods are yam and cassava by-product (garri, fufu and lafun) with vegetables prepared as stew, often over cooked, thereby losing essential micronutrients. In Northern Nigeria (where the Hausas and Fulanis are the dominant ethnic groups), grains such as sorghum, millet form the main diet; these are served with palm oil based soup made with tomatoes and okra. Meat is sometimes added. Among the Hausas, meat is usually reserved for special occasions. Various types of malnutrition prevalent in developing countries such as Nigeria are iron deficiency anemia (ID/A), protein-energy malnutrition (PEM), Vitamin A deficiency (VAD), iodine deficiency disorder (IDD). The proposed long-term measure by the Federal government of Nigeria for the resolution of these various types of malnutrition is dietary diversification. A review of the literature on Nigerian cultural diets identified gaps in knowledge with respect to the nutritional values of Nigerian ethnic diets.

High provitamin A carotenoid serum concentrations, elevated retinyl esters, and saturated retinol-binding protein in Zambian preschool children are consistent with the presence of high liver vitamin A stores.

BACKGROUND: Biomarkers of micronutrient status are needed to best define deficiencies and excesses of essential nutrients. OBJECTIVE: We evaluated several supporting biomarkers of vitamin A status in Zambian children to determine whether any of the biomarkers were consistent with high liver retinol stores determined by using retinol isotope dilution (RID). DESIGN: A randomized, placebo-controlled, biofortified maize efficacy trial was conducted in 140 rural Zambian children from 4 villages. A series of biomarkers were investigated to better define the vitamin A status of these children. In addition to the assessment of total-body retinol stores (TBSs) by using RID, tests included analyses of serum carotenoids, retinyl esters, and pyridoxal-5'-phosphate (PLP) by using high-pressure liquid chromatography, retinol-binding protein by using ELISA, and alanine aminotransferase (ALT) activity by using a colorimetric assay. RESULTS: Children (n = 133) were analyzed quantitatively for TBSs by using RID. TBSs, retinyl esters, some carotenoids, and PLP differed by village site. Serum carotenoids were elevated above most nonintervened reference values for children. α-Carotene, ß-carotene, and lutein values were >95th percentile from children in the US NHANES III, and 13% of children had hypercarotenemia (defined as total carotenoid concentration >3.7 µmol/L). Although only 2% of children had serum retinyl esters >10% of total retinol plus retinyl esters, 16% of children had >5% as esters, which was consistent with high liver retinol stores. Ratios of serum retinol to retinol-binding protein did not deviate from 1.0, which indicated full saturation. ALT activity was low, which was likely due to underlying vitamin B-6 deficiency, which was confirmed by very low serum PLP concentrations. CONCLUSIONS: The finding of hypervitaminosis A in Zambian children was supported by high circulating concentrations of carotenoids and mildly elevated serum retinyl esters. ALT-activity assays may be compromised with co-existing vitamin B-6 deficiency. Nutrition education to improve intakes of whole grains and animal-source foods may enhance vitamin B-6 status in Zambians.

Estimating the impact of vitamin A-fortified vegetable oil in Bangladesh in the absence of dietary assessment data.

OBJECTIVE: Vitamin A deficiency is a serious health problem in Bangladesh. The 2011-12 Bangladesh Micronutrient Survey found 76·8% of children of pre-school age were vitamin A deficient. In the absence of nationally representative, individual dietary assessment data, we use an alternative--household income and expenditure survey data--to estimate the potential impact of the introduction of vitamin A-fortified vegetable oil in Bangladesh. DESIGN: Items in the household income and expenditure survey were matched to food composition tables to estimate households' usual vitamin A intakes. Then, assuming (i) the intra-household distribution of food is in direct proportion to household members' share of the household's total adult male consumption equivalents, (ii) all vegetable oil that is made from other-than mustard seed and that is purchased is fortifiable and (iii) oil fortification standards are implemented, we modelled the additional vitamin A intake due to the new fortification initiative. SETTING: Nationwide in Bangladesh. SUBJECTS: A weighted sample of 12,240 households comprised of 55,580 individuals. RESULTS: Ninety-nine per cent of the Bangladesh population consumes vegetable oil. The quantities consumed are sufficiently large and, varying little by socio-economic status, are able to provide an important, large-scale impact. At full implementation, vegetable oil fortification will reduce the number of persons with inadequate vitamin A intake from 115 million to 86 million and decrease the prevalence of inadequate vitamin A intake from 80% to 60%. CONCLUSIONS: Vegetable oil is an ideal fortification vehicle in Bangladesh. Its fortification with vitamin A is an important public health intervention.

The influence of vitamin A status on iron-deficiency anaemia in anaemic adolescent schoolgirls in Myanmar.

OBJECTIVE: The present study was conducted to investigate reasons for the high prevalence of anaemia among adolescent schoolgirls and to elucidate the role of vitamin A in contributing to Fe-deficiency anaemia (IDA). DESIGN: Among 1269 schoolgirls who were previously screened for anaemia (Hb < 120 g/l), 391 anaemic girls were further assessed for Fe, vitamin A and subclinical inflammation status. Fe and vitamin A indicators were corrected for inflammation and were compared in the Fe-deficient and non-deficient groups as well as between those with and without inflammation. Logistic regression was done to determine whether vitamin A status and subclinical inflammation were risk factors for Fe deficiency. The differences in Fe status among tertiles of vitamin A concentrations were assessed using ANOVA. SETTING: Myanmar. SUBJECTS: Adolescent schoolgirls (n 391). RESULTS: One-third of the anaemia (30·4%) was IDA. Prevalence of low vitamin A status (serum retinol <1·05 µmol/l) was 31·5%. Fe and vitamin A status were significantly different between the IDA and non-IDA groups and also based on their inflammation status. Logistic regression showed that low vitamin A status was a significant predictor for being Fe deficient (OR = 1·81; 95% CI 1·03, 3·19 and OR = 2·31; 1·31, 4·07 in the middle (1·056-1·298 µmol/l) and low (≤1·056 µmol/l) vitamin A tertiles, respectively). ANOVA showed that better Fe status was associated with a higher concentration of serum retinol but only in IDA. CONCLUSIONS: Fe deficiency was not the main cause of anaemia in the present population. The role of vitamin A as well as other micronutrients should be taken into account in addressing the problem of anaemia.

Fatores associados à hipovitaminose A em crianças menores de cinco anos / Factors associated with hypovitaminosis A in children aged under five years

Identificar os fatores associados à hipovitaminose A em crianças da região semiárida de Alagoas. MÉTODOS: estudo transversal com amostra probabilística de 551 crianças menores de cinco anos. Os níveis séricos de retinol foram aferidos usando-se cromatografia líquida de alta eficiência. Na identificação da associação entre as variáveis independentes e hipovitaminose A (retinol <20 µg/dL) utilizou-se a razão de prevalência (RP) e respectivo IC95 por cento calculados por regressão de Poisson com ajuste robusto da variância, tanto na análise bruta quanto na ajustada. Nesta, foram incluídas todas as variáveis que naanálise bruta atingiram p<0,1. Associações foram consideradas estatisticamente significantes quando p<0,05. RESULTADOS: a prevalência de hipovitaminose A foi de 45,4 por cento e as variáveis que se mantiveram associadas após análise multivariável foram a baixa escolaridade materna (RP=1,66; IC95 por cento: 1,12-2,44), obaixo peso ao nascer (RP=1,41; IC95 por cento: 1,01-1,98) eter de 12,1 a 24 meses (RP=1,45; IC95 por cento: 1,04-2,02). CONCLUSÕES: evidencia-se a relevância epidemiológica da hipovitaminose A em crianças do semiárido alagoano. Crianças nascidas com baixo peso, com mães de baixa escolaridade e no segundo ano de vida devem receber atenção prioritária...

To identify the factors associated with hypovitaminosis A in children in the semi-arid region of the Brazilian State of Alagoas. METHODS: a cross-sectional study was carried outwith a probabilistic sample of 551 children aged under five years. Serum levels of retinol were measured using high-efficiency liquid chromatography. In order to identify any associations between the independent variables and hypovitaminosis A (retinol <20 µg/dL) the prevalence ration (PR) was used with a confidence interval of 95 percent calculated using the Poisson regression, with a robust adjustment for variance, both in the raw analysis and in theadjusted one. The latter included all the variables from the raw analysis for which p<0.1. Associations were considered statistically significant when p<0.05. RESULTS: the prevalence of hypovitaminosis A was 45.4 percent and the variables that remained associated in the multivariable analysis were low maternal schooling (PR=1.66; CI95 percent: 1.12-2.44), low birthweight (RP=1,41; IC95 percent: 1,01-1,98) and being agedbetween 12.1 and 24 months (PR=1.45; CI95 percent: 1.04-2.02). CONCLUSIONS: this reveals that hypovitaminosis A is epidemiologically significant in children in the semi-arid region of Alagoas. Low birth weight newborns in the second year of life, born to mothers with a low level of education, should therefore receive priority health care...

Prevalence and determinants of micronutrient deficiencies among rural children of eight states in India.

BACKGROUND/AIMS: Micronutrient deficiencies continue to be a major public health problem in India. The aim of this study was to assess the prevalence and determinants of micronutrient deficiencies among rural children. METHODS: A community-based cross-sectional study was carried out by adopting a multistage stratified random sampling procedure. A total of 71,591 preschool children were included for ocular signs, 3,291 preschool children and 6,616 adolescents for hemoglobin, and 28,437 school-age children for iodine deficiency disorders. RESULTS: The prevalence of Bitot's spots was 0.8% (CI = 0.6-0.9) and anemia among preschool children and adolescents was 67% (CI = 64.4-69.5) and 69% (CI = 67.0-71.4), respectively. The prevalence of total goiter was 3.9% (CI = 3.4-4.6). The risk of Bitot's spots was 2.4 times higher among preschool children of Scheduled Caste (SC) or Scheduled Tribes (ST) than others and risk of anemia was twice as high (CI = 1.5-2.6) among adolescents of SC and ST. The micronutrient deficiencies were significantly lower in children who used sanitary latrines. CONCLUSIONS: Micronutrient malnutrition is a public health problem among rural children, and it was higher among children of SC/ST, illiterate parents and those not possessing a sanitary latrine. Thus, there is a need to improve environmental sanitation; fortification of foods could also help in mitigating the problem.

Determinants of vitamin a deficiency in children between 6 months and 2 years of age in Guinea-Bissau.

BACKGROUND: The World Health Organization (WHO) classifies Guinea-Bissau as having severe vitamin A deficiency (VAD). To date, no national survey has been conducted. We assessed vitamin A status among children in rural Guinea-Bissau to assess status and identify risk factors for VAD. METHODS: In a vitamin A supplementation trial in rural Guinea-Bissau, children aged 6 months to 2 years who were missing one or more vaccines were enrolled, vaccinated and randomized to vitamin A or placebo. Provided consent, a dried blood spot (DBS) sample was obtained from a subgroup of participants prior to supplementation. Vitamin A status and current infection was assessed by an ELISA measuring retinol-binding protein (RBP) and C-reactive protein (CRP). VAD was defined as RBP concentrations equivalent to plasma retinol <0.7 µmol/L; infection was defined as CRP >5 ml/L. In Poisson regression models providing prevalence ratios (PR), we investigated putative risk factors for VAD including sex, age, child factors, maternal factors, season (rainy: June-November; dry: December-May), geography, and use of health services. RESULTS: Based on DBS from 1102 children, the VAD prevalence was 65.7% (95% confidence interval 62.9-68.5), 11% higher than the WHO estimate of 54.7% (9.9-93.0). If children with infection were excluded, the prevalence was 60.2% (56.7-63.7). In the age group 9-11 months, there was no difference in prevalence of VAD among children who had received previous vaccines in a timely fashion and those who had not. Controlled for infection and other determinants of VAD, the prevalence of VAD was 1.64 (1.49-1.81) times higher in the rainy season compared to the dry, and varied up to 2-fold between ethnic groups and regions. Compared with having an inactivated vaccine as the most recent vaccine, having a live vaccine as the most recent vaccination was associated with lower prevalence of VAD (PR=0.84 (0.74-0.96)). CONCLUSIONS: The prevalence of VAD was high in rural Guinea-Bissau. VAD varied significantly with season, ethnicity, region, and vaccination status. TRIAL REGISTRATION: Clinicaltrials.gov NCT00514891.

Association of high-sensitivity C-reactive protein with cardiometabolic risk factors and micronutrient deficiencies in adults of Ouagadougou, Burkina Faso.

Increasing evidence suggests that high-sensitivity C-reactive protein (hs-CRP) is associated with cardiometabolic risk factors (CMRF) while being also related to micronutrient deficiencies. As part of a project on the double burden of under- and overnutrition in sub-Saharan Africa, we assessed the relationship between hs-CRP and both CMRF and micronutrient deficiencies in a population-based cross-sectional study carried out in the Northern district of Ouagadougou, the capital city of Burkina Faso. We randomly selected 330 households stratified by income tertile. In each income stratum, 110 individuals aged 25-60 years and having lived in Ouagadougou for at least 6 months were randomly selected, and underwent anthropometric measurements and blood sample collection. The prevalence of high hs-CRP was 39.4 %, with no sex difference. Vitamin A-deficient subjects (12.7 %) exhibited significant risk of elevated hs-CRP (OR 2.5; P= 0.015). Serum ferritin was positively correlated with log hs-CRP (r 0.194; P= 0.002). The risk of elevated hs-CRP was significant in subjects with BMI ≥ 25 kg/m² (OR 6.9; 95 % CI 3.6, 13.3), abdominal obesity (OR 4.6; 95 % CI 2.2, 7.3) and high body fat (OR 10.2; 95 % CI 5.1, 20.3) (P< 0.001, respectively). Independent predictors of hs-CRP in linear regression models were waist circumference (ß = 0.306; P= 0.018) and serum TAG (ß = 0.158; P= 0.027). In this sub-Saharan population, hs-CRP was consistently associated with adiposity. Assuming that plasma hs-CRP reflects future risk of cardiovascular events, intervention which reduces CRP, or chronic and acute nutrition conditions associated with it, could be effective in preventing their occurrence particularly in sub-Saharan Africa.

Several 'problem nutrients' are identified in complementary feeding of Guatemalan infants with continued breastfeeding using the concept of 'critical nutrient density'.

BACKGROUND/OBJECTIVES: The World Health Organization (WHO) recommends nutritionally adequate complementary feeding (CF) through the introduction of indigenous foodstuffs and local foods while breastfeeding for at least 2 years. To determine the adequacy of the contribution of CF to the diets of Guatemalan infants at the 7th-12th month of life receiving high-intensity continued breastfeeding. SUBJECTS/METHODS: Critical nutrient densities for CF were modelled using age- and sex-specific energy and protein requirements assuming children to be at the 50th weight percentile of local peers and 15th weight percentiles of the 2006 WHO standards. Nutrient requirements for the total diet were determined using the recommended nutrient intakes. Breast milk was assumed to provide 75% of total energy at the 7th-9th month and 50% at the 10th-12th month. Gaps between computed critical nutrient densities and the CF consumption of 128 Guatemalan infants based on data collected by means of three nonconsecutive 24-h quantitative intake recalls were examined. Locally consumed foods with nutrient densities above the modelled critical densities were identified. RESULTS: Observed non-breast milk complementation would result in total diets providing inadequate nutrient density for vitamin A, niacin and vitamin C in some age groups. Major gaps for calcium, iron and zinc were ubiquitous across all groups. Few foods commonly consumed among Guatemalan infants had adequate densities of 'problem nutrients'. CONCLUSIONS: The critical nutrient density concept is useful to evaluate the nutrient adequacy of the infant's diet. Fortified foods are essential sources of the main 'problem nutrients', namely calcium, iron and zinc, given that natural sources are scarce.