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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Pathways through which agricultural production may influence markets, household food security, dietary patterns and nutritional status remain incompletely understood. While cross-sectional surveys are common, national, population-based, standardized data collection systems that annually monitor markets, local services, food security, dietary intake and nutritional status may be needed to understand time trends and relationships. We describe the design and methods of an annual nationally representative series of surveys of households with preschool aged children in 7 Village Development Committees (VDCs) sampled across each agroecological zone (mountains, hills and plains) in Nepal. Our sampling methodology yielded 21 VDCs, 63 wards (3 per VDC) and 40 markets in 2013, 2014 and 2016. Each year between ~ 4286-5097 consenting households were assessed for agricultural practices, socioeconomic conditions and food security; diet by 7-day food frequency and nutritional status by anthropometry (weight, height and arm circumference) of women (n=4509-5458) and children (n=5401-5468) using standardized procedures. Due to a major earthquake in April 2015, a truncated sample (wards n=27) was reached in 2015. Three VDCs, each representing a centroid of surveyed VDCs in each zone, served as year-round sentinel sites in which we conducted six surveys of seasonal conditions from 2013-2015. Representative, sameseason, same-site surveys offer a feasible national framework for assessing annual status and trends in agricultural, food security and nutritional conditions to identify opportunities for policy and program interventions and observe population responses along a continuum leading from agriculture to nutrition.

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