The bioavailability of (pro) vitamin A Carotenoids and maximizing the contribution of homestead food production to combating vitamin A deficiency

An estimated 100-140 million children worldwide suffer vitamin A deficiency disorders (VADD). Strategies for combating VADD are best used in combination because they serve particular target groups and none has full coverage. Homestead food production (HFP) can contribute to combating vitamin A deficiency directly, by increasing intake of vitamin A-rich foods, and indirectly through improving health and increasing income. By the late 1990s, conversion factors for estimating vitamin A obtained from plant foods were revised from 6:1 to 12:1 (¿g ß-carotene:retinol activity equivalent) by the U.S. Institute of Medicine, and by West and colleagues to 21:1 for a mixed diet (12:1 for fruits and 26:1 for vegetables). Thus, plant foods contribute less to vitamin A intake than do other sources. HFP¿s contribution can be maximized by increasing the amount of vitamin A-rich food consumed, including animal source foods, choosing foods with higher vitamin A content, and improving bioavailability by adding fat, destroying the matrix of vegetables, and deworming. Since the early 1990s, HFP programs have also included nutrition education and were then generally successful in increasing vitamin A intake. However, impact on vitamin A status was not often accessed. Two examples of evaluating impact using a plausibility approach are described. It is concluded that HFP can make a valuable contribution to combating VADD, especially where dietary diversity is low and when animal husbandry and nutrition education are included. Impact can be further maximized by using program infrastructure to introduce micronutrient-rich cultivars and improved breeds, and by adding other interventions, such as deworming and micronutrient supplementation

The bioavailability of (pro) vitamin A Carotenoids and maximizing the contribution of homestead food production to combating vitamin A deficiency

An estimated 100-140 million children worldwide suffer vitamin A deficiency disorders (VADD). Strategies for combating VADD are best used in combination because they serve particular target groups and none has full coverage. Homestead food production (HFP) can contribute to combating vitamin A deficiency directly, by increasing intake of vitamin A-rich foods, and indirectly through improving health and increasing income. By the late 1990s, conversion factors for estimating vitamin A obtained from plant foods were revised from 6:1 to 12:1 (¿g ß-carotene:retinol activity equivalent) by the U.S. Institute of Medicine, and by West and colleagues to 21:1 for a mixed diet (12:1 for fruits and 26:1 for vegetables). Thus, plant foods contribute less to vitamin A intake than do other sources. HFP¿s contribution can be maximized by increasing the amount of vitamin A-rich food consumed, including animal source foods, choosing foods with higher vitamin A content, and improving bioavailability by adding fat, destroying the matrix of vegetables, and deworming. Since the early 1990s, HFP programs have also included nutrition education and were then generally successful in increasing vitamin A intake. However, impact on vitamin A status was not often accessed. Two examples of evaluating impact using a plausibility approach are described. It is concluded that HFP can make a valuable contribution to combating VADD, especially where dietary diversity is low and when animal husbandry and nutrition education are included. Impact can be further maximized by using program infrastructure to introduce micronutrient-rich cultivars and improved breeds, and by adding other interventions, such as deworming and micronutrient supplementation

Risk of Disabling Response Fluctuations and Dyskinesias for Dopamine Agonists Versus Levodopa in Parkinson's Disease1

BACKGROUND: Response fluctuations and dyskinesias develop during the use of both levodopa (LD) and dopamine agonists (DA), but may not be equally disabling. OBJECTIVE: To compare the risk and time of onset of disabling response fluctuations and dyskinesias (DRFD) among patients with Parkinson's disease (PD) who were initially treated with either LD or DA. METHODS: Open cohort study of all consecutive de-novo PD patients in routine clinical practice, included over a period of 15 years (median follow-up: 8.1 years, range 1.1-17.7), since embarking on LD or DA. Older patients and patients with more severe PD were started on LD (n = 77), younger patients on a DA (n = 50). Therapy was adjusted according to generally accepted guidelines. The primary endpoints were: the onset of response fluctuations, dyskinesias, and the moment when these complications became disabling (DRFD). RESULTS: LD-starters developed response fluctuations 0.8 years earlier than DA-starters (p = 0.07), while dyskinesias appeared around 2.5 years earlier (p = 0.003). However, the risk and time of onset of DRFD did not differ statistically between the groups (LD-starters: 60% , median interval 7.3 years, DA-starters: 52% , 6.1 years, p = 0.63). DA-starters displayed a 0.19 points lower adjusted mean improvement in motor scores than LD-starters (p = 0.002). Adjustments for age and severity of PD at start of dopaminergic therapy did not change these results. CONCLUSIONS: In routine clinical practice, the risk and time of onset of DRFD is comparable for LD-starters versus DA-starters, but motor functioning is worse in DA-starters. These results support the use of LD as initial therapy for PD

Coverage of vitamin A capsule programme in Bangladesh and risk factors associated with non-receipt of vitamin A.

Vitamin A supplementation reduces child morbidity, mortality, and blindness. The coverage of the national vitamin A programme and risk factors for not receiving vitamin A were characterized using data from the Bangladesh Demographic and Health Survey 2004. Of 3,745 children aged 18–59 months, 3,237 (86.4%) received a vitamin A capsule each within the last six months. Children who missed vitamin A were more likely to be stunted (prevalence ratio [PR] 0.97, 95% confidence interval [CI] 0.95–1.00) and come from a family with a previous history of mortality of children aged less than five years (PR 0.95, 95% CI 0.91–0.99). Maternal education of ≥10 years (PR 1.09, 95% CI 1.04–1.13), 7–9 years (PR 1.08, 95% CI 1.04–1.12), and 1–6 years (PR 1.05, 95% CI 1.02–1.08) compared to no formal education was associated with the child not receiving vitamin A in a multivariate model, adjusting for potential confounders. Children missed by the vitamin A programme were more likely to come from families with lower maternal education. Special efforts are required to ensure that the coverage of the national vitamin A programme is increased further so that the most vulnerable children are also better protected against morbidity, mortality, and blindness

Socio-economic status and puberty are the main factors determining anaemia in adolescent girls and boys in East Java, Indonesia

Objective: To determine prevalence and contributing factors of anaemia in adolescents. Design: Cross-sectional study of anaemia prevalence, socio-economic status and puberty. Setting: Schools in East Java, Indonesia. Subjects: Male and female adolescent pupils (age 12-15 y; n = 6486). Results: Anaemia prevalence was 25.8% among girls (n = 3486), 24.5% among pre-pubertal boys (n = 821), and 12.1% among pubertal boys (n = 2179). Socio-economic status, indicated by type of school attended, was an important factor determining the risk of anaemia. Girls had a higher risk when they attended a poor school (OR poorest school, 1.00; other schools, 0.67-0.87), had reached puberty (OR, 1.25), had lower retinol intake (OR 1st-4th quartiles-1.00, 0.97, 0.89, 0.77) and higher vitamin A intake from plant sources (OR 1st-4th quartiles-1.00, 1.10, 1.31, 1.04). Boys had a higher risk of anaemia when they attended a poor school (OR poorest school 1.00, other schools 0.54-0.63), were younger (OR per year=0.79), had not yet reached puberty (OR not yet, 1.00; already, 0.78), were shorter (OR per cm 0.95), had smaller mid-upper-arm circumference (MUAC) (OR per mm 0.99) and lower retinol intake (OR 1st-4th quartile 1.00, 0.67, 0.74, 0.68). Conclusions: Anaemia in adolescents should be reported separately for pre-pubertal and pubertal subjects and for different ages, and the population's socio-economic status should be specified. The results of this survey call for treatment of anaemia in adolescents. Given Indonesia's current situation, micronutrient intake of adolescents should be increased using supplements for all girls and for pre-pubertal boys. Chemicals/CAS: Iron, 7439-89-6; Iron, Dietary; Vitamin A, 11103-57-