Daily consumption of pro-vitamin A biofortified (yellow) cassava improves serum retinol concentrations in preschool children in Nigeria: a randomized controlled trial

Abstract

Background Vitamin A deficiency is a public health problem in sub-Saharan Africa. Pro-vitamin A biofortified (yellow) cassava has the potential to contribute significantly to improve vitamin A status, especially in populations that are difficult to reach with other strategies. Objectives The study aimed at determining the efficacy of biofortified cassava to improve vitamin A status of Nigerian preschool children. Methods An open-label randomized controlled trial was conducted in southwestern Nigeria. In total, 176 preschool children (aged 3–5 y) were randomized into 2 parallel arms comprising an experimental group (n = 88), fed foods prepared from biofortified (yellow) cassava, and a control group (n = 88), fed foods prepared from white cassava, twice a day, 6 d a week for 93 d. Results A total of 159 children completed the trial (yellow cassava group, n = 80; white cassava group, n = 79). Children consumed 221 and 74 µg/d retinol activity equivalents from intervention foods in the yellow and white cassava groups, respectively. The treatment effect on serum retinol concentrations at the end of the feeding trial was 0.06 µmol/L (95% CI: 0.004, 0.124 µmol/L), after adjustment for baseline retinol concentrations, inflammation, and asymptomatic malaria status. No significant treatment effects were detected for serum β-carotene (adjusted effect: 3.9%; 95% CI: −0.6%, 8.6%) and gut permeability (adjusted effect: 0.002; 95% CI: −0.089, 0.092), but a significant effect was detected for hemoglobin concentrations (adjusted effect: 3.08 g/L; 95% CI: 0.38, 5.78 g/L). Conclusions Daily consumption of β-carotene from biofortified cassava improved serum retinol and hemoglobin concentrations modestly in Nigerian preschool children. This study was registered with clinicaltrials.gov as NCT02627222.

The global challenge of hidden hunger: perspectives from the field

“…The cluster randomised trial is currently underway and the outcome measures include biomarkers of zinc status, anthropometry, and incidence and duration of diarrhoea and upper respiratory tract infections in adolescent girls and infants. For successful scale-up, the views of all stakeholders must be considered; therefore, the study also includes a Orange sweet potato (31,32) Vitamin A Uganda; Zambia Beans (33)(34)(35) Iron Uganda; Zimbabwe; Rwanda Cassava (36,37) Vitamin A Nigeria; Democratic Republic of Congo; Kenya Maize (38) Vitamin A Nigeria; Democratic Republic of Congo; Zambia; Zimbabwe Pearl millet (33,39,40) Iron India…”

Evidence to Underpin Vitamin A Requirements and Upper Limits in Children Aged 0 to 48 Months: A Scoping Review

“…Studies assessing the relationship between vitamin A intake and a marker of vitamin A status (Excel sheet 2B Intake Status) and between status and health, growth, or development outcomes (Excel sheet 2C Status Outcome) may in combination support the data directly assessing intake and outcomes. For Intake Status studies, we included three systematic reviews published since early 2013 [ 24 , 25 , 26 ], which were data-extracted and assessed for risk of bias (plus two older systematic reviews), 31 recent trials, of which 12 appeared particularly recent and relevant [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ] (and 80 older trials). Alongside these we noted 12 recent cohort or case–control studies, 15 earlier studies, nine recent cross-sectional studies, 25 older studies, and nine non-systematic reviews.…”

“…The majority of the 31 recent trials assessing effects of vitamin A intake on vitamin A status measures (Excel sheet 2B intake status), focused on supplementation. Fifteen trials assessed effects of biofortified cassava [ 27 , 34 , 66 ], sweet potato [ 69 ] or maize [ 31 , 33 ], complimentary foods [ 70 ], peanut butter and kale [ 71 ], high-carotenoid juice [ 67 ], different infant formulae [ 35 , 37 ], fortified rice [ 36 ], cow peas and amaranth [ 72 ], and home fortification with multiple micronutrient powder [ 65 , 73 ].…”

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“…The efficacy of biofortified staple crops in reducing micronutrient deficiencies among vulnerable populations in LMICs, namely children under 5, school children, adolescent/young women, and women of reproductive age, is well-demonstrated for several biofortified crops, including iron biofortified beans (25,26), iron-biofortified pearl millet (27), vitamin A-biofortified cassava (28,29), vitamin A-biofortified maize (30)(31)(32), and vitamin A-biofortified sweet potato (33)(34)(35). Studies have also shown that consumption of biofortified crops resulted in significant improvements in functional, cognitive, and health outcomes such as improved memory and ability to pay attention (36,37) and improved reaction time (37).…”