Serum retinol in 1–6-year-old children from a low socio-economic South African community with a high intake of liver: implications for blanket vitamin A supplementation

Abstract

Objective: To assess serum retinol, liver intake patterns, breast-feeding history and anthropometric status in pre-school children of a low socio-economic community where liver is regularly consumed. Design: Cross-sectional study. Setting: Northern Cape Province, South Africa. Subjects: Children aged 1-6 years (n 243) who attended the local primary healthcare facility and had not received a vitamin A supplement in the 6 months preceding the study. Non-pregnant female caregivers (n 225), below 50 years of age, were also assessed. Results: Despite stunting, underweight and wasting being prevalent in 40?5 %, 23?1 % and 8?4 % of the children, only 5?8 % had serum retinol concentrations , 20 mg/dl, which is in sharp contrast to the national prevalence of 63?6 %. None of the caregivers were vitamin A deficient. Liver was eaten by 89?2 % of children, with 87 % of households eating liver at least once monthly and 30 % eating it at least once weekly; liver was introduced into the diet of the children at a median age of 18 months. Ninety-three per cent of the children were being breast-fed or had been breast-fed in the past; children were breast-fed to a median age of 18 months. A significant negative correlation was found between educational level of the caregiver and frequency of liver intake (r 5 20?143, P50?032). There was no correlation between serum retinol and indicators of anthropometric or socio-economic status. Conclusions: The blanket approach in applying the national vitamin A supplementation programme may not be appropriate for all areas in the country, even though the community may be poor and undernourished.

Liver intake in 24–59-month-old children from an impoverished South African community provides enough vitamin A to meet requirements

“…The high levels of stunting, underweight and wasting, which are double the national prevalence (6) , are similar to those previously found in this population (12) . Although poor anthropometric status is usually associated with vitamin A deficiency, it does not apply to this area and the poor growth in these children may be due to factors other than vitamin A deficiency.…”

“…Both weekdays (75?8 %) and weekend days (24?2 %) were represented in the assessments. Bread is the staple food in the area (12) , and a sample size of 150 would have been large enough to reflect the mean consumption. The national vitamin A supplementation programme contributed an additional 122 mg RE/d.…”

Vitamin A supply to mothers and children

“…Second, the strategy of large-scale VAS in populations at risk should be adapted with regard to area-specific dietary habits in each country. Indeed, VAD is less prevalent in regular consumers of liver, even if they are poor and undernourished [40]. The use of circulating retinol levels to assess vitamin A status could also induce a bias in these practices.…”

Overlapping vitamin A interventions in the United States, Guatemala, Zambia, and South Africa: case studies

“…A study in preschool children from the Hantam district showed that only 5.8% of the children (4.9% when children with elevated CRP are excluded) had serum retinol concentrations <0.7 μmol/L . This is in sharp contrast to the two most recent national surveys in 2005 and 2012, showing low serum retinol prevalence rates of 64.6% and 43.6%, respectively .…”

“…This is reflected in the eating habits of its population, and VA status thus also varies from province to province. For the purposes of our review, we will focus on a particular district within the Northern Cape province of South Africa (Hantam district) where sheep farming is a main agricultural activity and sheep liver is an available and affordable source of meat, and commonly consumed by the poor . Liver is an exceptionally rich source of preformed VA; thus, in addition to exposure to the two national programs, children in this area might be at risk of excessive VA intake.…”