Based on the Guatemalan program of vitamin A fortification of sugar, a longitudinal evaluation on serum retinol levels of preschool-aged children was performed. Five consecutive surveys executed every 6 months were examined, considering only children who were surveyed more than once. Thus, the changes in their serum retinol after the intervention were evaluated. Natural dietary vitamin A remained unchanged throughout. Addition of retinyl palmitate to sugar increased significantly the intake (p < 0.001). After 1 yr of fortification 76% of the children experienced an elevation of retinol. All those with initial values < 20 microgram/dl showed an increase. Mean values increased significantly, particularly for children below 20 microgram/dl whose levels changed from 16.2 +/- 2.9 to 30.2 +/- 9.7 (P < 0.00001). Those between 20 to 29 microgram/dl increased from 24.9 +/- 3.2 to 30.1 +/- 8.1 (p < 0.0003). Similar results were obtained after 2 yr. The results indicated the effectiveness of the program in raising serum retinol levels.
The effect of improvement in vitamin A nutriture on biochemical indicators of iron nutrition during national vitamin A fortification of sugar was investigated longitudinally. Four "paired-comparison-subgroups" of preschoolers were studied before fortification (survey I) and, respectively, at 6 months (survey I versus II), at 1 yr (survey I versus III), at 1 1/2 yr (survey I versus IV), and at 2 yr (survey I versus V) after fortification began. Comparing I versus II gave a positive correlation (p less than 0.001) between changes in serum retinol or retinol-binding protein and changes in iron, total iron binding capacity, and percentage transferrin saturation. In contrast, changes in serum ferritin correlated negatively (p less than 0.05). Comparing V with I, retinol, retinol-binding protein, iron, and percentage transferritin saturation increased, but ferritin also increased (p less than 0.05). Consequently, the distribution of serum iron and ferritin values of the children improved (p less than 0.05). Because dietary iron did not change through the study period, the results suggest that vitamin A fortification had a favorable effect on iron metabolism and nutritional status.
In order to investigate the role of vitamin A nutriture in the prevalence of anemia in Central America, a retrospective evaluation of the data of the six Institute of Nutrition of Central Americal and Panama/Office for International Research nutrition surveys of Central America and Panama has been made. Three groups of children; 1 to 4, 5 to 8, and 9 to 12 years old, living between 0 and 2,5000 feet above sea level were studeid. Several biochemical and dietary parameters related to anemia were corrleated with plasma levels of retinol. Children between the ages of 5 and 12 years showed a significant positive correlation between hemoglobin and plasma retinol. Children aged 1 to 4 years did not show a similar correlation. In children of all age groups there were positive correlations between plasma retinol and serum iron. Percent saturation of transferrin was also found to be lower when plasma retinol levels were low. Children with an adequate intake of iron, as classified by both dietary information and socioeconomic level, showed a significant positive correlation between plasma retinol levels and iron in their serum. In contrast, no correlation was found when dietary iron was low. In the light of these findings, a possible relationship between vitamin A deficiency and anemia is suggested.
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