Dietary practices and xerophthalmia among Indonesian children

Abstract

The stated frequency with which 30 Indonesian children with corneal xerophthalmia and age/sex/neighborhood matched controls ordinarily consumed vitamin- and provitamin A-rich foods was compared. Controls were more frequent consumers of eggs (p less than 0.05), fish (p less than 0.05), dark green leafy vegetables (p less than 0.05), carrots (p less than 0.01), and carotene-containing fruits (p less than 0.1). Similar data were collected on 358 children with Bitot's spots and on normal preschool age children in a countrywide survey. Breast-feeding was more common among normals than among cases (p less than 0.001). Normals were also more frequent consumers of mango and papaya during the 2nd and 3rd yr of life (p less than 0.05); and of dark green leafy vegetables and eggs during the 3rd through 6th yr of life (p less than 0.01). In two separate studies, differences in carotene consumption by normals and abnormals were confirmed by differences in their serum carotene levels. Approximately 80% of Indonesian families, with an without xerophthalmic children, consumed dark-green leafy vegetables at least once a day, and 99% at least once a week. Diet therefore appears to be an important factor in the genesis of xerophthalmia in Indonesia despite the availability of suitable provitamin A-rich foods.

The Epidemiology of Global Micronutrient Deficiencies

“…For example, in Guatemala, vitamin A is added to sugar [24] in addition to intermittent supplementation programs, together yielding a low rate of VAD determined by serum retinol [25]. Despite the Cochrane reviews limiting maternal, neonatal, and infant vitamin A supplementation in developing countries [26,27], continued emphasis should be placed on vitamin A supplementation programs in Southeast Asia given the clearly documented effects on ocular health and mortality [22,28,29]. …”

Infant feeding practices reflect antecedent risk of xerophthalmia in Nepali children

“…There is a large literature linking a low, current intake of vitamin A to xerophthalmia in preschool-aged children (Blankhart, 1967;Pepping et al, 1989Solon et al, 1978Sommer & West, 1996;Tarwotjo et al, 1982). The evidence to date is believed to re¯ect a pattern of chronically low vitamin A intakes.…”

“…The evidence to date is believed to re¯ect a pattern of chronically low vitamin A intakes. Yet, beyond a propensity to wean early Tarwotjo et al, 1982) little is known about complementary feeding patterns during early infancy of high-risk children prior to developing clinically evident vitamin A de®ciency (VAD). Secondly, given that younger siblings are at a greatly increased risk of developing xerophthalmia (Katz et al, 1993) and that risk factors tend to cluster within families (Sommer & West, 1996), it is of interest to understand early dietary patterns of prexerophthalmic siblings in order to identify inadequacies of intake and develop more comprehensive dietary counseling strategies for high-risk families and their children.…”

“…As Sommer & West (1996) observe,`For many children, a weaning diet de®cient in vitamin A predicts a vitamin A de®cient diet through the rest of early childhood, and possibly beyond. ' Although most studies examining dietary patterns of children with night blindness have found signi®cant differences in consumption of preformed vitamin A (Shankar et al, 1996;Tarwotjo et al, 1982) and provitamin A food sources (Pepping et al, 1989;Solon et al, 1978;Tarwotjo et al, 1982), little evidence exists of the linkage between infant dietary intake of vitamin A food sources and later childhood xerophthalmia. An exception is a study by Mele et al (1991), which looked at xerophthalmic Indonesian children from 0±5 y (96% b 2 years) and matched controls, which found signi®cantly reduced risk of xerophthalmia in children whose mothers reported feeding them vitamin Arich foods regularly during the ®rst year of weaning.…”

Determination of Serum Vitamin-A, β-carotene, Total Proteins and Fractions in Women Within 24 Hours of Delivery from Different Age and Socioeconomic Groups

“…The vitamin-A showed a low positive correlation with β-carotene (r = 0.135) and albumin (r = 0.065) but negative with total proteins (r = !0.187) and globulins (r = !0.220). Tarwotjo et al (1982) reported that plasma carotene not necessarily provide a good index of vitamin-A status.…”