Variation in the relationship between plasma retinol-binding protein (RBP) and retinol (ROH) has implications for vitamin A (VA) status assessment using RBP. Our objectives were to identify factors affecting the RBP:ROH relationship and to derive and evaluate population-specific RBP cutoffs for VA deficiency (VAD) in Cameroon. Plasma RBP, C-reactive protein (CRP), α1-acid-glycoprotein (AGP), and ROH concentrations were compared in a subsample of women 15-49 y (n = 121) and children 12-59 mo (n = 123) included in a national survey conducted in 2009. Plasma RBP and ROH were highly correlated (r = 0.94 for women; r = 0.96 for children; P < 0.001). Pregnancy and lactation altered the RBP:ROH relationship in women, but obesity, elevated CRP and AGP, age, and VA status did not. Among children, age altered the RBP:ROH relationship, but sex, stunting, VA status, and elevated CRP and AGP did not. Cutoffs for VAD derived using regression analysis were <1.17 μmol RBP/L for women (corresponding to <1.05 μmol ROH/L) and <0.83 μmol RBP/L for children (corresponding to <0.70 μmol ROH/L). The sensitivity and specificity of derived cutoffs were 81.8 and 93.0% for women and 94.7 and 88.9% for children, respectively. The infection-adjusted prevalence of low VA status (<1.17 μmol RBP/L) was 21.9% (95% CI = 18.7-25.0%) among women. Among children, the infection-adjusted prevalence of VAD (<0.83 μmol RBP/L) was 35.0% (95% CI = 31.1-39.0%). In conclusion, VAD remains a public health problem in Cameroon. The RBP:ROH relationship should be considered in surveys using RBP to assess VA status, and use of population-specific cutoffs may be advisable.

Background: Few data are available on the effectiveness of large-scale food fortification programs.Objective: We assessed the impact of mandatory wheat flour fortification on micronutrient status in Yaoundé and Douala, Cameroon.Methods: We conducted representative surveys 2 y before and 1 y after the introduction of fortified wheat flour. In each survey, 10 households were selected within each of the same 30 clusters (n = ∼300 households). Indicators of inflammation, malaria, anemia, and micronutrient status [plasma ferritin, soluble transferrin receptor (sTfR), zinc, folate, and vitamin B-12] were assessed among women aged 15–49 y and children 12–59 mo of age.Results: Wheat flour was consumed in the past 7 d by ≥90% of participants. Postfortification, mean total iron and zinc concentrations of flour samples were 46.2 and 73.6 mg/kg (target added amounts were 60 and 95 mg/kg, respectively). Maternal anemia prevalence was significantly lower postfortification (46.7% compared with 39.1%; adjusted P = 0.01), but mean hemoglobin concentrations and child anemia prevalence did not differ. For both women and children postfortification, mean plasma concentrations were greater for ferritin and lower for sTfR after adjustments for potential confounders. Mean plasma zinc concentrations were greater postfortification and the prevalence of low plasma zinc concentration in women after fortification (21%) was lower than before fortification (39%, P < 0.001); likewise in children, the prevalence postfortification (28%) was lower than prefortification (47%, P < 0.001). Mean plasma total folate concentrations were ∼250% greater postfortification among women (47 compared with 15 nmol/L) and children (56 compared with 20 nmol/L), and the prevalence of low plasma folate values was <1% after fortification in both population subgroups. In a nonrepresentative subset of plasma samples, folic acid was detected in 77% of women (73% of those fasting) and 93% of children. Mean plasma and breast-milk vitamin B-12 concentrations were >50% greater postfortification.Conclusion: Although the pre-post survey design limits causal inference, iron, zinc, folate, and vitamin B-12 status increased among women and children in urban Cameroon after mandatory wheat flour fortification.

Dietary exposure to pesticide residues was assessed in Yaoundé, Cameroon, using the total diet study (TDS) method. Sixty-three composite samples, representative of the foods as consumed in Yaoundé, were collected, prepared, and analysed for residues of pesticides including organochlorine, organophosphorous, and pyrethroids. A multi-residue method was used with a limit of detection (LOD) of 0.005 mg kg(-1). Additional analyses were performed for dithiocarbamates (LOD=0.050 mg kg(-1)), glyphosate (LOD=0.005 mg kg(-1)) and chlordecone (LOD=0.0008 mg kg(-1)) on certain composites samples. The overall contamination was low with 37 out of 46 pesticides below the LOD in all samples. The estimated upper bound (for values less than the LOD equal the LOD; and values less than the LOQ equal the LOQ) of the mean dietary exposures ranged from 0.24% (cypermethrin) to 3.03% (pirimiphos-methyl) of the acceptable daily intakes (ADIs) for pesticides for which at least one analysis was greater than the LOD. This study suggests a low dietary exposure to pesticide residues in Yaoundé.

Dietary exposure to 11 elements was assessed by the Total Diet Study (TDS) method. Sixty-four pooled samples representing 96.5% of the diet in Yaoundé, Cameroon, were prepared as consumed before analysis. Consumption data were sourced from a household budget survey. Dietary exposures were compared with nutritional or health-based guidance values (HBGV) and to worldwide TDS results. Elevated prevalence of inadequate intake was estimated for calcium (71.6%), iron (89.7%), magnesium (31.8%), zinc (46.9%) and selenium (87.3%). The percentage of the study population exceeding the tolerable upper intake levels was estimated as <3.2% for calcium, iron, magnesium, zinc and cobalt; 19.1% of the population exceeded the HBGV for sodium. No exceedance of the HBGV for inorganic mercury was predicted in the population. The margin of exposure ranged from 0.91 to 25.0 for inorganic arsenic depending on the reference point. The "Fish" food group was the highest contributor to intake for calcium (65%), cobalt (32%) and selenium (96%). This group was the highest contributor to the exposure to total arsenic (71%) and organic mercury (96%). The "Cereals and cereal products" highly contributed to iron (26%), zinc (26%) and chromium (25%) intakes. The "Tubers and starches" highly contributed to magnesium (39%) and potassium (52%) intakes. This study highlights the dietary deficiency of some essential elements and a low dietary exposure to toxic elements in Yaoundé.

Dietary exposure to trace elements (aluminium, antimony, barium, cadmium, lead, nickel, vanadium, copper, manganese, molybdenum, germanium, lithium, strontium and tellurium) was assessed by the total diet study (TDS) method. Sixty-four pooled samples representing 96.5% of the diet in Yaoundé, Cameroon, were prepared "as consumed" before analysis. Consumption data were sourced from a households' budget survey. Dietary exposures were compared with health-based guidance or nutritional values and to worldwide TDS results. The health-based guidance value was exceeded by ≤ 0.2% of the study population for aluminium, antimony, barium, cadmium, nickel and vanadium. For lead, the observed 95th percentile of exposure (3.05 µg kg(-1) body weight day(-1)) equals the critical value considered by JECFA for cardiovascular effects; therefore, risk to health cannot be excluded for certain consumer groups. The population at risk of excess intake for manganese, copper, molybdenum and nickel was considered to be low (≤ 0.3%). The prevalence of inadequate intake was estimated at 5.9% for copper and was nil for molybdenum. Due to the lack of toxicological and/or nutritional consistent data to perform a risk assessment, dietary exposures to germanium, lithium, strontium and tellurium were provided as supplementary data. The food groups highest contributors to exposure were "tubers and starches" for aluminium (27%), lead (39%) and copper (26%), "cereals and cereal products" for cadmium (54%) and manganese (35%), "fruits, vegetables and oilseeds" for barium (34%), molybdenum (49%) and nickel (31%), "beverages" for antimony (27%) and "fish" for vanadium (43% - lower bound). Measures should be recommended to maintain low levels of exposure before the problem could become an important health or trade issue.