Prevalence Of Vitamin A Deficiency Research Articles

Prevalence of Xerophthalmia in Rural Children of Latur, Maharashtra

Purpose To ascertain the prevalence of Vitamin A deficiency (VAD) among rural children in Latur, Maharashtra.  Methods The study was conducted in a community setting and used a cross-sectional design, meaning data was collected at a single point in time. A total of 1,604 children aged 0- 15 years from rural areas in Latur, Maharashtra, participated in the study. Participants were chosen using a simple random sampling method, ensuring each child in the population had an equal chance of being selected. Data collection involved a pretested structured questionnaire, which helps ensure consistency and reliability in the responses, and ophthalmic examinations to check for Vitamin A deficiency.  Results The study found an overall Xerophthalmia prevalence of 5.6%. In children under six years old, the prevalence of Bitot's spots was 2.1%, compared to 4.2% in children over six. Older children were more frequently affected by Xerophthalmia. Factors contributing to Xerophthalmia included low income, poor consumption of fruits and vegetables, febrile illnesses, and lack of immunization. Additionally, the study noted that dietary patterns and economic status significantly influenced the prevalence of VAD. Children from lower-income families and those with limited access to nutritious foods were at a higher risk.  Conclusion The findings suggest a declining trend in Vitamin A deficiency, with a milder form of Xerophthalmia and a 2.1% prevalence of Bitot's spots among children under six years old. The higher prevalence of Xerophthalmia in older children highlights the need to strengthen Vitamin A prophylaxis programs and promote health education to improve dietary diversity. It is essential to ensure the inclusion of vegetables and fruits in children's diets to maintain better Vitamin A status across all age groups.

Prevalence of Vitamin A Deficiency in Children Aged 6 to 17 Years - Western and Central Rural Areas, China, 2012-2021.

Vitamin A deficiency (VAD) is a leading global nutritional concern, ranking among the top four major nutritional deficiencies worldwide. The prevalence of VAD is unevenly distributed across various regions, both within China and globally. The report adds valuable insights into the vitamin A nutritional status of rural students aged 6-17 years who participated in the Nutrition Improvement Programme for Rural Compulsory Education Students (NIPRCES). Over the decade from 2012 to 2021, there was a modest improvement in vitamin A status. The prevalence of VAD and sub-clinical VAD (SVAD) declined as the students aged. Throughout the majority of the survey years, the incidence of VAD was higher among males and western regions compared to females and central regions, respectively. A comprehensive approach, incorporating dietary diversification, nutrition education, and food fortification, should be implemented to prevent VAD and SVAD especially in males, younger children and children in western areas.

SNP-based marker-assisted selection for high provitamin A content in African cassava genetic background

Vitamin A deficiency (VAD) contributes to significant levels of mortality and morbidity, particularly among children and women in Africa. Cassava is a major staple crop whose biofortification with betacarotene can contribute to reducing the VAD prevalence in a cost-effective and sustainable approach. Developing high provitamin A content (pVAC) cassava varieties through the conventional approach is a laborious and slow process, partly due to the breeding bottlenecks caused by the biology of the crop. To complement the phenotypic screening for pVAC and increase selection efficiency as well as accuracy, we employed four Kompetitive Allele-Specific PCR (KASP) assays to predict the level of carotenoids in a cassava population developed from open-pollinated crosses. There was significant correlation (r= 0.88) between total carotenoid content (TCC) and root tissue colour score in the study population. Marker S1_24155522 at the phytoene synthase gene explained most of the phenotypic variation in TCC and root colour (R2= 0.37 and 0.55, respectively) among the genotypes evaluated in this study. The other markers did not individually account for much phenotypic variation in the trait in our study population. Three genotypes – namely UIC-17-679, UIC-17-1713, and UIC-17-2823 – had higher TCCs, ranging from 10.07 μg/g to 10.88 μg/g, than the national yellow check variety IITA-IBA-TMS070593 (9.20 μg/g). Marker PSY572/S124155522 is therefore recommended for routine use in marker-assisted selection for pVAC enhancement in African cassava germplasm. Significance: We evaluated the performance of the SNP markers associated with provitamin A content in a cassava population and draw relevant conclusions that will foster the applications of these markers in different cassava improvement programmes with similar interests. Marker-assisted selection was sufficiently accurate for an early screening of individuals for carotenoid content, especially when thousands of genotypes are usually handled. This screening will reduce efficiently the challenges and burden attached to the use of sophisticated instruments for carotenoid quantification (e.g. HPLC and I-check) for the benefit of breeders and researchers in the field.

A comparative study on indicators of vitamin A status and risk factors for sensitivity and specificity of the methods to detect vitamin A deficiency

BackgroundSerum retinol (SR) and retinol-binding protein (RBP) are commonly used indicators, but they are affected by infections and inflammation. This study aimed to assess the sensitivity and specificity of VA indicators to detect vitamin A deficiency (VAD) in 36–59-month-old children living in a rural area in Burkina Faso.MethodsIn a community-based study, two cross-sectional surveys were carried out from November 2016 to September 2017 in the health district of Dandé in Burkina Faso. The surveys included 115 children 36–59 months old. Indicators of VA and inflammation assessed in all children included SR, RBP and total liver VA reserves (TLR) estimated by retinol isotope dilution, and inflammation markers (C-reactive protein (CRP) and alpha 1-acid glycoprotein (AGP)). We calculated the sensitivity, specificity, positive and negative predictive values. In addition, the effects of inflammation, helminth infection, and season on sensitivity and specificity were assessed.ResultsThe prevalence of VAD assessed by SR (< 0.7 µmol/L), RBP (< 0.7 µmol/L), and TLR (< 0.1 µmol/g liver) were, respectively, 30.9%, 33.3%, and 0%. Compared to TLR, the specificity, positive predictive value, and negative predictive value of SR were 71.1%, 0%, and 100%, and of RBP, were 68.9%, 0%, and 100%, respectively. The sensitivity was indeterminable for SR and RBP. The specificity of SR and RBP was lower during the dry season. Elevated CRP (> 5.0 mg/L) and AGP (> 1.0 g/L) were detected in 1.9% and 28.6% of children, respectively. The adjustment of VA indicators for inflammation improved SR’s specificity to 75.9% and decreased RBP’s specificity to 67.8%.ConclusionNo cases of VAD were identified by TLR. However, (inflammation-adjusted) SR and RBP had varying accuracy in the estimation of VAD.Trial registrationThe study was registered, retrospectively, on 22 March 2018 as a clinical trial with the Pan African Clinical Trials Registry under the number Cochrane South Africa; PACTR201803002999356.

Immune Impairment Associated with Vitamin A Deficiency: Insights from Clinical Studies and Animal Model Research.

Vitamin A (VA) is critical for many biological processes, including embryonic development, hormone production and function, the maintenance and modulation of immunity, and the homeostasis of epithelium and mucosa. Specifically, VA affects cell integrity, cytokine production, innate immune cell activation, antigen presentation, and lymphocyte trafficking to mucosal surfaces. VA also has been reported to influence the gut microbiota composition and diversity. Consequently, VA deficiency (VAD) results in the imbalanced production of inflammatory and immunomodulatory cytokines, intestinal inflammation, weakened mucosal barrier functions, reduced reactive oxygen species (ROS) and disruption of the gut microbiome. Although VAD is primarily known to cause xerophthalmia, its role in the impairment of anti-infectious defense mechanisms is less defined. Infectious diseases lead to temporary anorexia and lower dietary intake; furthermore, they adversely affect VA status by interfering with VA absorption, utilization and excretion. Thus, there is a tri-directional relationship between VAD, immune response and infections, as VAD affects immune response and predisposes the host to infection, and infection decreases the intestinal absorption of the VA, thereby contributing to secondary VAD development. This has been demonstrated using nutritional and clinical studies, radiotracer studies and knockout animal models. An in-depth understanding of the relationship between VAD, immune response, gut microbiota and infections is critical for optimizing vaccine efficacy and the development of effective immunization programs for countries with high prevalence of VAD. Therefore, in this review, we have comprehensively summarized the existing knowledge regarding VAD impacts on immune responses to infections and post vaccination. We have detailed pathological conditions associated with clinical and subclinical VAD, gut microbiome adaptation to VAD and VAD effects on the immune responses to infection and vaccines.

Vitamin A supplementation among 9-59 month old children in India: geospatial perspectives and implications for targeted coverage

IntroductionVitamin A supplementation (VAS) is yet to reach all Indian children aged 9-59 months, despite guidelines for universal coverage. This study mapped geospatial patterns underlying VAS coverage across two policy-relevant...

The status of Uganda’s food-based Vitamin A deficiency mitigation strategies

Vitamin A deficiency (VAD) threatens public health especially among children in developing countries. Various interventions and their efficacy have been much discussed at a global level to alleviate VAD. Yet, studies indicate individual countries afflicted with VAD may be running relevant programs without adequately updated data or evidence from situational analyses. This study takes Uganda as a case to examine the status of its existing VAD mitigation programs, focusing on food-based interventions. To review the VAD mitigation programs, nationally representative data from the Ugandan public institutions, policy documents from the government and VAD-relevant data from the United Nations agencies were mainly examined. Also analyzed in detail were published studies and working papers directly or indirectly related to Uganda’s VAD and/or VA issues. The results from the review pointed to some evidence on the existing issues with the country’s VAD mitigation strategies. First, gauging a temporal trend of VAD prevalence in the target population was not possible due to changes and inconsistencies in the survey formats and methodologies. This implies the present VAD interventions might rely on unsynchronized VAD assessments in the first place. Second, of the ongoing food-based VAD interventions, effectiveness of food fortification with VA seemed constrained by questionable food vehicle choices, reluctant food industries, low stakeholder engagement, and weak public supervision. Third, for biofortification, wide adoption/utilization of the VA-biofortified orange sweet potato appeared to be complicated by farmer and consumer preferences, social factors, and immature value chains of the crop. But adoption/utilization of the genetically modified VA-biofortified banana seems to have been even more complicated by additional issues around the relevant biotechnology law of the country and public concerns about the genetic modification. Collectively, these VAD interventions in Uganda appeared to be continued without sufficiently updated documents and monitoring frameworks. This suggests that Uganda should review its current VAD interventions for more effective and efficient VAD mitigation. Key words: Biofortification, Food fortification, Public health, Vitamin A deficiency, Uganda

Genetic Variations of Vitamin A-Absorption and Storage-Related Genes, and Their Potential Contribution to Vitamin A Deficiency Risks Among Different Ethnic Groups.

Vitamin A, an essential fat-soluble micronutrient, plays a critical role in the body, by regulating vision, immune responses, and normal development, for instance. Vitamin A deficiency (VAD) is a major cause of xerophthalmia and increases the risk of death from infectious diseases. It is also emerging that prenatal exposure to VAD is associated with disease risks later in life. The overall prevalence of VAD has significantly declined over recent decades; however, the rate of VAD is still high in many low- and mid-income countries and even in high-income countries among specific ethnic/race groups. While VAD occurs when dietary intake is insufficient to meet demands, establishing a strong association between food insecurity and VAD, and vitamin A supplementation is the primary solution to treat VAD, genetic contributions have also been reported to effect serum vitamin A levels. In this review, we discuss genetic variations associated with vitamin A status and vitamin A bioactivity-associated genes, specifically those linked to uptake of the vitamin in the small intestine and its storage in the liver, as well as their potential contribution to vitamin A deficiency risks among different ethnic groups.

Vitamin A status and its hematological correlates among preschool children in Beijing, China.

Vitamin A is vital for the growth and health of children. This study aimed to estimate the current vitamin A status and the prevalence of vitamin A deficiency (VAD) among preschool children and explore the correlation between serum vitamin A concentration and changes in hematological parameters. The study included 697 children aged 1-6 years, presenting for routine checkups at the Department of Pediatrics, Peking University Shougang Hospital, Beijing, from April 2017 to December 2020. We obtained the complete laboratory test data of 630 children. The mean serum vitamin A concentration among preschool children was 0.29±0.08 mg/L, with a median of 0.29 mg/L. The proportion of children with VAD and marginal VAD (MVAD) was 9.84% and 43.49%, respectively. The highest prevalence of VAD and MVAD was in the 3- to 4-year age group. Compared with the normal vitamin A serum concentration group, other groups had lower mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and higher red blood cell distribution width. The mean serum vitamin A concentration among anemic children was significantly lower (0.27±0.07 mg/L) than among those children who were not anemic (p<0.05). VAD constitutes a public health problem in northern China. The prevalence of VAD is highest, and the serum vitamin A concentration was the lowest among preschool children aged 3-4 years. Vitamin A serum concentration was associated with red blood cell indices. We should attach more importance to those children aged 3-4 years.

English

Vitamin A deficiency (VAD) is a major global health issue, contributing to morbidity and mortality. East and Central Africa face VAD prevalence that exceeds the World Health Organization (WHO) threshold of 15%. In Burundi and the Democratic Republic of Congo (DRC), VAD prevalence is greater than 43% in rural communities. Promoting vitamin A-rich foods (including banana) is an effective and sustainable strategy to address VAD in poor rural communities. Supported principally by HarvestPlus over more than a decade, banana researchers have been evaluating the performance of high provitaminA banana cultivars to address this challenge. This study evaluated the agronomic performance of six provitamin A-rich banana cultivars originally from outside Burundi and Eastern DRC. Growth and yield parameters were collected for the first, second and third crop cycles. Results revealed that growth and yield parameters were significantly affected by the interaction between sites and cultivars (P&lt;0.05). Banana cultivar yield was also influenced by the combined effect of bunch weight and crop cycle duration. The most promising cultivars in terms of yield were &lsquo;Apantu-AAB&rsquo;, &lsquo;Lahi-AAB&rsquo;, &lsquo;Lai- AA&rsquo;, &lsquo;Bira-AAB&rsquo; and &lsquo;Pelipita-ABB&rsquo; across all sites and crop cycles. This indicates that although ecological factors could have influenced their performances over sites, genotype could be the most important influencing factor. These evaluations provide hard evidence of the high potential for adoption of the most promising cultivars by the local community members to boost (pro) vitamin A consumption and effectively eliminate VAD. Key words: Agronomic performance, vitamin A rich banana, crop cycle, Burundi, Democratic Republic of Congo.

Vitamin A Deficiency among Rural Primary School Children, A still Neglected Group for Vitamin A Supplementation Strategies

Background: Vitamin A deficiency (VAD) is still a public health problem across the globe and also in Burkina Faso, especially for under-five-years-old children. Since less information is available about the prevalence of VAD among the primary school children, this study aimed to study this area. Methods: A randomised double-blind placebo-controlled trial was conducted to assess the effect of high dose of vitamin A (VA) and daily zinc versus high dose of VA and daily zinc placebo (6 days per week) during four months among the primary school children. Of the total number of 200 school children, 100 were allocated to two random groups. Participants’ gender, age, weight, and height were measured, a blood smear was performed for malaria diagnosis, stool samples were collected for intestine parasites’ assessment, and blood samples were collected for haemoglobin and serum retinol measurement. Results: Baseline data of 183 school children were analysed and the findings showed that 20.6% of the school children were underweight (23.2% in girls vs. 16.5% in boys; P = 0.043). Anemia affected 36.2%, 39% had Plasmodium Falciparum, and 37.6% had intestine parasites. Furthermore, VAD prevalence was 46.1% (51.0% in boys vs. 41.2% in girls; P = 0,072). Conclusion: Among primary school children in the Western part of Burkina Faso, VAD is not only higher than other regions of the country, but also twice the critical level and defined as a severe public health problem by WHO. This result calls for action among the primary school children and recalls the importance of taking strategies against VAD among under-five-year-old children.

Inflammation Adjustments to Serum Retinol and Retinol-Binding Protein Improve Specificity but Reduce Sensitivity when Estimating Vitamin A Deficiency Compared with the Modified Relative Dose-Response Test in Ghanaian Children.

ABSTRACTBackgroundSerum retinol and retinol-binding protein (RBP) concentrations are commonly used biomarkers of vitamin A deficiency (VAD); however, evidence indicates that they are not always accurate, especially in populations with high exposure to inflammation.ObjectiveThe aim was to assess sensitivity and specificity of serum retinol and RBP concentrations to predict VAD, with and without adjustment for inflammation (using categorical and regression-adjusted approaches), using the modified relative dose-response (MRDR) as the reference standard for liver reserves.MethodsThis secondary analysis of diagnostic accuracy used inflammation and RBP data and analyzed serum retinol and MRDR from a subsample of women of reproductive age (n = 178) and preschool children (n = 166) in the cross-sectional 2017 Ghana Micronutrient Survey.ResultsInflammation (elevated C-reactive protein and/or α1-acid glycoprotein) was present in 41% of children and 16% of women. Among children, estimates of VAD prevalence were as follows: 7% (MRDR), 40% (serum retinol), 29% (categorical-adjusted serum retinol), 24% (RBP), 13% (categorical-adjusted RBP), and 7% (regression-adjusted RBP). Sensitivity (95% CI) ranged from 22.2% (2.81%, 60.0%; both adjusted RBPs) to 80.0% (44.4%, 97.5%; serum retinol), whereas specificity ranged from 63.3% (54.7%, 71.3%; serum retinol) to 93.5% (88.0%, 97.0%; regression-adjusted RBP). Among women, VAD prevalence ranged from 1% (RBP) to 4% (all others); sensitivity was 0% and specificity was >96% for all indicators.ConclusionsSerum retinol and RBP had varying accuracy in estimating VAD, especially in children; adjustment for inflammation increased accuracy by increasing specificity at the expense of sensitivity. Effects of inflammation adjustment in the context of high inflammation and VAD prevalence need to be further explored. Especially in populations with high inflammation, the MRDR test should accompany serum retinol or RBP measurements in a subsample of subjects in population-based surveys. This trial was registered with the Open Science Framework registry (doi: 10.17605/OSF.IO/J7BP9).

Prevalence of vitamin A deficiency and dietary inadequacy in Indian school-age children and adolescents.

There are no representative estimates of vitamin A deficiency (VAD) and risk of vitamin A (VA) dietary inadequacy in Indian children and adolescents. To evaluate, from national surveys, the prevalence of VAD measured by serum retinol concentrations (< 0.7µmol/L or < 20µg/dL), and the risk of VA dietary inadequacy and excess intake beyond the tolerable upper limit (TUL). National and state-level VAD prevalence adjusted for inflammation was estimated in school-age children (5-9years: 10,298) and adolescents (10-19years: 9824) from the Comprehensive National Nutrition Survey (CNNS 2016-18). The risk of dietary inadequacy against age-specific average VA requirements, and excess intake against the TUL, was assessed from the National Sample Survey Office (NSSO 2014) data. Serum retinol concentrations increased with age (5-19years) in both genders and were significantly lower in school-age children (1.02µmol/L, CI: 1.01-1.03) compared to adolescents (1.13µmol/L, CI 1.12-1.15). The inflammation-adjusted prevalence of VAD in school-age children and adolescents was 19.3% (CI 18.8-19.9) and 14.4% (CI 13.9-14.9) respectively, and this was > 20% in seven and four states for children and adolescents, respectively. The prevalence of VAD was significantly higher among children with lower socio-economic status. The risk of dietary VA inadequacy, from the NSSO survey, was 69 and 78% in children and adolescents, respectively. This risk reduced to 6 and 17% with VA fortified oil and milk intake, while the proportion of intakes exceeding the TUL became 6 and 0.5% in children and adolescents, respectively. The national prevalence of VAD in school-age children and adolescents in India was just less than 20%. The risk of dietary VA deficiency is likely to decline substantially with VA fortified food intake, but a risk of excessive intake also begins to appear; therefore, a careful assessment of the risk of hypervitaminosis A is required at these ages.

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.

Vitamin A deficiency and association between serum retinol and IGF-1 concentrations in Brazilian children with Down syndrome

ObjectiveTo determine the prevalence of vitamin A deficiency (VAD) and serum concentrations of retinol, correlating them with IGF-1 concentrations in preschoolers with DS. MethodsCross-sectional study was conducted on 47 children with DS aged 24 to 72 months, in Ribeirão Preto, Brazil. VAD was determined by the relative dose-response (RDR) test. Retinol serum concentration ≤ 0.70 µmol/L and IGF-1 serum concentration below the 3rd percentile for sex and age were considered to represent deficiency. C-reactive protein (CRP) was determined at the beginning of the study. Weight, height, and information about fever and/or diarrhea were obtained at the beginning of the study. ResultsVAD prevalence was 25.5% (12/47), and 74.5% (35/47) of the children had deficient retinol before the intervention. CRP was not associated with VAD. Mean IGF-1 were 103.5 ng/mL (SD = 913) for the group with VAD and 116.3 ng/mL (SD = 54.9) for the group with no VAD (p-value = 0.85); 8.5% (4/47) of the children showed deficient IGF-1, but without VAD. No association was observed between VAD and IGF-1 deficiency. A moderate positive correlation was observed between pre-intervention retinol and IGF-1 (ρ = 0.37; p-value = 0.01). Conclusiona high prevalence of VAD and deficient retinol was observed and there was a positive correlation between serum retinol and IGF-1.

Prevalence and determinants of Vitamin A deficiency among children in India: Findings from a national cross-sectional survey

BackgroundVitamin A deficiency is major concern especially for the children living in developing countries. According to UNICEF around one third of the children are not receiving the supplementation of Vitamin A they need. AimThe present study focuses on Vitamin A deficiency among the children aged 12–59 months in India by analysing the data from the latest nutritional survey. MethodsThe Comprehensive National Nutrition Survey (CNNS), conducted during 2016–18, dataset for 0–5 years age has been used in the study. The study has employed bi-variate analysis to assess the prevalence of Vitamin A deficiency (VAD) based on the CRP (C-reactive protein) values (CRP ≤5 mg/L), by the different socio-economic and demographic characteristics along with dietary diversity, stunting, anaemia and breastfeeding related variables. Log-binomial regression model has been used for the multivariable analysis and based on that predicted probabilities were computed. ResultsThe overall prevalence of VAD in India is 17.54%. Children who are exposed to longer duration of breastfeeding have lower prevalence of VAD. Children in poorer economic sections are more vitamin A deficient compared to children in richer economic sections. The prevalence of VAD among children having minimum diet diversity is 18.63%. ConclusionThe study suggests in focusing on the targeted groups of children who are at more risk in developing VAD and planning interventions for specific groups. The nutrition programs require a multisectoral approach for addressing the needs of macronutrient and micronutrient deficiencies simultaneously to enhance the current situation of nutrition among children in India.

Vitamin A deficiency among children younger than 5 y in India: an analysis of national data sets to reflect on the need for vitamin A supplementation

Biochemical vitamin A deficiency (VAD) is believed to be a serious public health problem (low serum retinol prevalence>20%) in Indian children, justifying universal high-dose vitamin A supplementation (VAS). To evaluate in Indian children younger than 5 y the risk of biochemical VAD from the Comprehensive National Nutrition Survey, as well as dietary vitamin A inadequacy and excess over the tolerable upper limit of intake (TUL) from national and subnational surveys, factoring in fortification and VAS. Child serum retinol data, corrected for inflammation, were examined to evaluate national- and state-level prevalence of VAD. Simultaneously, dietary intakes from the National Sample Survey Office and the National Nutrition Monitoring Bureau were examined for risk of dietary vitamin A deficiency against its average requirement (AR) derived for Indian children. Theoretical estimates of risk reduction with oil and milk vitamin A fortification were evaluated along with the risk of exceeding the TUL, as well as when combined with intake from VAS. The national prevalence of biochemical VAD measured in 9563 children was 15.7% (95% CI: 15.2%, 16.3%), and only 3 states had prevalence significantly >20%. The AR of vitamin A was 198 and 191 µg/d for boys and girls; the risk of dietary inadequacy was ∼70%, which reduced to 25% with oil and milk fortification. Then, the risk of exceeding the TUL was 2% and 1% in 1- to 3-y-old and 4- to 5-y-old children, respectively, but when the VAS dose was added to this intake in a cumulative 6-mo framework, the risk of exceeding the TUL rose to 30% and 8%, respectively. The national prevalence of VAD risk is below 20% in Indian children. Because there is risk of excess intake with food fortification and VAS, serious consideration should be given to a targeted approach in place of the universal VAS program in India.

Relation between Timing of High-Dose Vitamin A Supplementation and Modified-Relative-Dose–Response Values in Children 12–23 Months in Uganda

High-dose vitamin A (VA) supplements (VAS) can temporarily affect VA status. Hence, micronutrient surveys might need to be timed around VAS campaigns to accurately estimate VA deficiency (VAD) prevalence. Little is known about optimal timing of micronutrient surveys when the modified-relative-dose-response (MRDR) is used as a VA indicator. We evaluated the association between days since the end of a VAS campaign and MRDR values in children aged 12-23 mo in Uganda. We pooled data from 2 cross-sectional, population-based surveys in eastern Uganda conducted in 2015-2016 (n=118 children). We estimated the prevalence of VAD (MRDR≥0.060). Days since the end of a VAS campaign ("days since VAS") was calculated as the interview date minus the end date of the VAS campaign. The MRDR value was assessed using HPLC. We excluded children whose MRDR values were below the limit of detection (<0.007). We used linear regression to evaluate the association between days since VAS and log-transformed MRDR. In adjusted analyses, we controlled for potential confounders. Statistical analyses accounted for the surveys' complex design. The prevalence of VAD was 5.2% (95% CI: 1.1%, 9.3%). Mean days since VAS was 54.1 d (range 39-68 d). Days since VAS was not associated with log-transformed MRDR in unadjusted analyses ($\hat{\beta } = \ $0.0055; 95% CI:-0.009, 0.020; P=0.45) or adjusted analyses ($\hat{\beta } = $ -0.0073; 95% CI:-0.024, 0.010; P=0.39). MRDR measurement through a nutrition survey began as early as 1.3 mo after the end of a VAS campaign in eastern Uganda. Days since the end of a VAS campaign was not associated with MRDR in Ugandan children aged 12-23mo. Future studies should consider longitudinal designs and evaluate time since VAS and MRDR in children of different ages and in regions with higher VAD prevalence.

Re-Defining the Population-Specific Cut-Off Mark for Vitamin A Deficiency in Pre-School Children of Malawi.

Retinol Binding Protein (RBP) is responsible for the transport of serum retinol (SR) to target tissue in the body. Since RBP is relatively easy and cheap to measure, it is widely used in national Micronutrient Surveys (MNS) as a proxy for SR to determine vitamin A status. By regressing RBP concentration against SR concentration measured in a subset of the survey population, one can define a population-specific threshold concentration of RBP that indicates vitamin A deficiency (VAD). However, the relationship between RBP and SR concentrations is affected by various factors including inflammation. This study, therefore, aimed to re-define the population-specific cut-off for VAD by examining the influence of inflammation on RBP and SR, among pre-school children (PSC) from the 2015–16 Malawi MNS. The initial association between RBP and SR concentrations was poor, and this remained the case despite applying various methods to correct for inflammation. The World Health Organization (WHO) recommends the threshold of 0.7 µmol/L to define VAD for SR concentrations. Applying this threshold to the RBP concentrations gave a VAD prevalence of 24%, which reduced to 10% after inflammation adjustments following methods developed by the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA). Further research is required to identify why SR and RBP were poorly associated in this population. Future MNS will need to account for the effect of inflammation on RBP to measure the prevalence of VAD in Malawi.

Serum Vitamin A Nutritional Status of Children and Adolescents Aged 6-17 Years - China, 2016-2017.

Summary What is already known on this topic? Vitamin A deficiency (VAD) in children is still a global public health problem, which needs continuous monitoring and timely intervention. What is added by this report? Using surveillance data from China Nutrition and Health Surveillance of Children and Lactating Mothers in 2016−2017, the prevalence of VAD and marginal deficiency was 0.96% and 14.71%, respectively. The vitamin A nutritional status of children and adolescents from urban areas and those aged 12−17 years were better than those from rural areas and aged 6−11 years. What are the implications for public health practice? Marginal VAD was a major form of VAD in Chinese children. The monitoring of vitamin A status in key populations should be continuously strengthened, and the public should be encouraged to consume foods rich in vitamin A or vitamin A supplements.