Effects of food-based approaches on vitamin A status of women and children: A Systematic Review

Abstract Background Vitamin A deficiency (VAD) increases risk for morbidity and mortality. Food-based approaches offer one strategy to improve vitamin A status. Objective This systematic review assessed evidence of the effects of food-based approaches on the vitamin A status of women and children under five years. Methods VAD was defined as clinical ocular symptoms, such as loss of vision, and/or retinol plasma or serum concentration <0.70 μmol/L. Searches on food-based approaches to improve vitamin A status were conducted for the period 2011-2022 on PubMed, CINHAL, Web of Science, and Google Scholar using PRISMA guidelines. English language publications were included. Case studies, unpublished dissertations, and non-peer-reviewed studies were excluded. Results This review comprises 24 of 27,322 identified studies; 23 included studies focused on provitamin A carotenoids. There were 17, 214 participants across the 24 studies with sample sizes ranging from 8 to 3571 individuals. Intervention studies spanned from three weeks to two years. Fifteen (63%) studies were randomized control trials, seven were cross-sectional, and two were longitudinal studies. Most studies (N = 21) used biochemical measurements, e.g. serum retinol, to assess vitamin A status; other studies used clinical symptoms (e.g. xerophtalmia) or dietary intake. Thirteen (54%) studies reported a statistically significant effect of food-based interventions (N = 8) or an association of diet (N= 5) on vitamin A status. Conclusions This systematic review indicated that some food-based interventions improved vitamin A status, thus offering a safe and effective delivery mechanism for vitamin A. There appeared to be significant association between vitamin A status and consumption of foods with high concentrations of preformed vitamin A and provitamin A carotenoids. Differences across studies in regard to the period of evaluation, food approaches used, and statistical power may explain the lack of effectiveness of food-based approaches on vitamin A status in some studies

Predictors of vitamin A rich food consumption among women living in households growing orange-fleshed sweetpotatoes in selected regions in Uganda

Objective: Vitamin A deficiency (VAD) has serious public health consequences including morbidity and mortality for populations in low and middle-income countries (LMICs), especially for children under 5 years and pregnant women. LMICs are at greater risk of VAD, in part due to low levels of consumption of vitamin A-rich foods most of which are plant-based, such as orange-fleshed sweet potatoes (OFSP), with lower bioavailability than animal sources of the vitamin A. Food-based approaches such as biofortification of OFSP, including promoting the consumption of vitamin A-rich biofortified staple crops, has been shown to be potentially eective in improving the status of vitamin A and other micronutrients. This study examined vitamin A-rich food consumption and its predictors among women of reproductive age from OFSP-growing households in two regions of Uganda. Methods: A cross-sectional survey was conducted among 617 OFSP growing households, focusing on women in the reproductive age group from the northern and eastern regions of Uganda. Households were not receiving any VAD-related intervention at the time of the survey. Quantitative data included vitamin A-rich food consumption, knowledge on vitamin A, and rich food sources dietary intake, using a 7-day food frequency questionnaire. Vitamin A consumption and risk of deficiency were estimated using the Hellen Keller International guide. Results: The majority of women in this study were either pregnant (80%) or lactating (17%). More than 70% of the study population had a weighted vitamin A rich food consumption mean score of <6 days per week, indicating a high risk of VAD. Knowledge about vitamin A [b (SE) = −0.18 (0.50), p < 0.001] was significantly and inversely associated with vitamin A rich food consumption. Conclusion: Components of food insecurity such as availability, aordability, utilization, and changing food preferences may contribute to the unexpected inverse relationship between knowledge and consumption of vitamin A rich foods. Scaling up biofortified food initiatives, including OFSP, can improve consumption of vitamin A rich foods with eective strategies comprehensively address consumption barriers such as lack of nutrition education, cooking skills, and storage facilities, as well as low production levels and perceived contamination of biofortified foods