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Objective: To characterize circulating carotenoid and tocopherol levels in Nepali women during pregnancy and post-partum and to determine the effects of b-carotene and vitamin A supplementation on their concentration in serum. Design: Randomized community supplementation trial. Setting: The study was carried out from 1994 to 1997 in the Southern, rural plains District of Sarlahi, Nepal. Subjects: A total of 1431 married women had an ascertained pregnancy, of whom 1186 (83%) provided an analyzable serum sample during pregnancy; 1098 (77%) provided an analyzable 3 ± 4 months post-partum serum sample. Interventions: Women received a weekly dose of vitamin A (7000 mg RE), b-carotene (42 mg) or placebo before, during and after pregnancy. Serum was analyzed for retinol, a-tocopherol, g-tocopherol, b-carotene, a-carotene, lycopene, lutein zeaxanthin, and b-cryptoxanthin concentrations during mid-pregnancy and at $3 months post-partum. Results: Compared to placebo, serum retinol, b-carotene, g-tocopherol, b-cryptoxanthin and lutein zeaxanthin concentrations were higher among b-carotene recipients during pregnancy and, except for b-cryptoxanthin, at postpartum. In the vitamin A group, serum retinol and b-cryptoxanthin were higher during pregnancy, and retinol and g-tocopherol higher at postpartum. Lutein zeaxanthin was the dominant carotenoid, regardless of treatment group, followed by serum b-carotene. Serum lycopene level was lowest, and very low compared to the US population. Serum retinol was higher, and carotenoid and a-tocopherol lower, at postpartum than during pregnancy in all groups. Conclusions: Pregnant and lactating Nepali women have lower serum carotenoid and tocopherol levels than wellnourished populations. b-carotene supplementation appeared to increase levels of tocopherol and other carotenoids in this population.

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Objective: To explore the in¯uence of night blindness during pregnancy on nighttime work activities of women. Design and Subjects: A community based case-control study was used to compare nighttime activities of night blind (cases) and non-night blind pregnant women (controls) using a 24 h recall method to measure work activities (n 116 pairs). Setting: Rural South-Eastern district in the plains of Nepal.Results: Approximately one third of the night blind women reported being`inactive' the previous night, not participating in any of the inquired work activities, as compared with only 15% of the control group P`0X031. The type of work that was signi®cantly affected was the outdoor kind such as fetching water and washing dishes. Logistic regression analysis showed that night blind women were half as likely (odds ratio 0.49, 95% con®dence interval 0.25 ± 0.98) to work at night than women without night blindness after controlling for the effects of confounding variables including gestational age, season, and protein energy malnutrition which were signi®cantly associated with nighttime work activity. Conclusions: Night blindness during pregnancy, an indicator of vitamin A de®ciency, reduces the number and type of work activities women perform at night, thus impairing women's ability to participate in normal subsistence activities by reducing their`work day'.

ObjectiveAssess influences of early life undernutrition on young adult hearing loss in Nepal.Design: Ear health was assessed in 2378 Nepalese young adults (14‐23 y) who as preschoolers participated in a 4‐monthly placebo‐controlled, randomized vitamin A (VA, 200,000 IU) supplement trial ('89‐'92). At baseline, children were measured for WT, HT and MUAC. Parents were queried about ear discharge at each visit. Sixteen years later, audiometry and tympanometry were performed, blinded to original supplement receipt. Hearing loss was defined as pure‐tone average>30dB (0.5,1,2,4kHz) and middle ear dysfunction (MED) as abnormal tympanometric peak height (<0.3‐>1.4mmho) or width (<50‐>110daPa). Children were classified as stunted (<‐2 HAZ) or wasted (<‐2 MUAC & <‐2 BMI‐for‐age Z).Results: Hearing loss and MED affected 5.9% and 16.6% of subjects, respectively. Wasting was associated with odds ratios of 1.8‐2.2 for hearing loss and 1.4‐1.8 for MED, and stunting with ORs of 2.2‐1.7 for hearing loss, irrespective of MED (all 95% lower CL>1). For subjects with preschool ear discharge, VA receipt was protective against hearing loss, OR=0.58 (95% CI 0.37‐0.92). Further, we posit human antenatal VA deficiency may cause MED‐independent hearing loss (S Emmett, Med Hypotheses 2014;82:6), as reported in animals, similar to that associated with stunting.ConclusionPreventable early childhood and possibly fetal undernutrition, including VA deficiency, may predispose children to permanent hearing loss. Hearing loss should be considered a nutrition‐related public health burden.Funded by Gates Foundation (OPP614)