Abstract
Objective: To investigate vitamin A deficiency of pre-school children in central and western China for developing strategies to prevent and control vitamin A deficiency (VAD) among children.Design: From November 2018 to September 2019, a total of 2,194 healthy children aged 2–6 years were enrolled. Serum retinol levels in the children were detected by liquid-phase tandem mass spectrometry. In addition, social demographic and dietary questionnaires were collected through interviews with children's caregivers.Setting: The participants were enrolled in 12 cities or their subordinate jurisdictions in the central and western regions of China.Participants: Two thousand one hundred and ninety four healthy children aged 2–6 years old.Results: Overall, 35.51% (779/2,194) of the children were found to be vitamin A insufficient (VAI, serum retinol < 1.05 μmol/L). Elder children had a higher risk to suffer from VAI, with proportions of 25.00% (87/348), 28.92% (142/491), 38.38% (256/667), and 42.73% (294/688) among children aged 2, 3, 4, and 5 years, respectively. Vitamin A levels were also positively correlated with per capita income (AOR = 1.18) and regional economic level (0.71), and the frequency of milk intake (0.91).Conclusions: The incidence of VAI was higher among children aged 2–6 years, and the incidence of VAI increases with age. VA levels were positively correlated with levels of economic development in the family and region. So prevention strategies for VAD need to focus on pre-school children, especially dairy intake and developing regions.
Highlights
An essential micronutrient, vitamin A, essentially functions as a vision regulator, anti-infective, maintaining the integrity of epithelial cells, tissue growth and metabolism, and reproductive function [1]
Among the 1,437 (65.50%) children who were measured for height and weight, the height-for-age (HAZ) and weightfor-age (WAZ) Z scores were similar between boys and girls, while the weight-for-height (WHZ) Z scores were higher among boys (0.27 ± 1.18) than among girls (0.11 ± 1.00) (p = 0.006)
The prevalence of VAD is at a low level, many children remain under marginal vitamin A deficiency [20, 21]
Summary
Vitamin A, essentially functions as a vision regulator, anti-infective, maintaining the integrity of epithelial cells, tissue growth and metabolism, and reproductive function [1]. About 250 million pre-school children and 19.1 million pregnant women suffered from VAD worldwide as of 2009 [1], which accounts for a significant public health problem in developing countries, where epidemiological studies on the vitamin A nutritional status of children have been conducted [3,4,5,6]. MVAD leads to an inadequate vitamin A level, which likely causes anemia, respiratory, and digestive tract infections, besides affecting children’s growth and development. China exhibits a high prevalence of VAD among children and adolescents, caused by factors such as poor economic status and dietary habits, especially in rural areas. The Chinese Nutrition Society, in 2002, conducted a national prevalence survey and reported that 9.3% of children aged 3–12 years were affected by VAD and 45.1% by MVAD, demonstrating a low prevalence of VAD throughout the country [11]. Thereafter, for about 10 years, no large scale epidemiological investigations on vitamin A levels have been conducted in China, owing to which national representative data on vitamin A for children aged 1–6 years are lacking [14]
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