Vitamin E Deficiency Is Associated with Reduced Handgrip Strength in Rural Nepalese Children

Abstract

Abstract Objectives Vitamin E deficiency (VED), common in areas of rural South Asia, can affect neuromuscular health. This study determined the extent of VED and its association with neuromuscular function, indicated by hand grip strength, in Nepalese school aged children. Methods This cross-sectional study was conducted in a birth cohort of 6–8 year old children, born during an earlier maternal micronutrient trial, in Sarlahi District in the southern plains (Tarai) of Nepal. Assessments included anthropometry (height, weight, MUAC), handgrip strength by hydraulic dynamometry, plasma α- and γ-tocopherol concentrations by HPLC, other nutritional and inflammatory biomarkers, diet and SES. Data were analyzed using descriptive, bivariate and multivariable regression analyses. Results In 998 children, mean (+SD) α- and γ-tocopherol levels were 12.21 (+3.27) μmol/L and 1.50 (+0.70), μmol/L respectively. α-Tocopherol distributions were comparable in females (12.34 ± 3.29 μmol/L) and males (12.09 ± 3.24), with 51.9% of all children classified as VED (plasma α-tocopherol < 12 μmol/L). Plasma γ-tocopherol was higher in females than males (1.56 ± 0.72 vs 1.44 ± 0.67, P < 0.01). Handgrip strength (in kg) was higher in males (7.25 ± 2.14) than females (6.44 ± 2.00) (P < 0.001), which also increased with age. In a continuous multivariable model, adjusted for sex and age, handgrip strength increased with plasma α-tocopherol (βα = 0.054 kg/μmol/L (95% CI: 0.0149–0.0926), P < 0.001). Age-sex adjusted handgrip strength was 0.328 (95% CI: 0.015–0.093) kg lower in VED vs non-deficient children (P < 0.01), but was unrelated to plasma γ-tocopherol. There were no interactions in handgrip strength and vitamin E status by sex. Conclusions Vitamin E deficiency is common and is associated with neuromuscular weakness in young, school aged children in southern Nepal, evident by a lower handgrip strength. Funding Sources Funded by The Bill and Melinda Gates Foundation (GH614, OPP5241), Seattle, WA with assistance from the Sight and Life Global Nutrition Research Institute, Baltimore, MD.