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ABSTRACT: To describe the household intakes of retinol and carotenoids and social economic factors determining their intakes.
Data on a total of 1001 households (771 in rural areas and 230 in urban areas) were used in the analyses. Interviewed person was household food preparer.
Mean (s.d.) intake of carotenoids was 4178 (3154) microg/capita/day in rural and 4208 (3408) microg/capita/day in urban areas and intake of retinol was 101 (275) microg/capita/day in rural and 201 (470) microg/capita/day in urban areas. Multivariate analyses show that the subjects in households with four or more members consume about 700 microg carotenoids less compared to households with less than three members. Households with a higher expenditure (fourth quartile) consumed about 100 microg retinol/day more than those with a lower expenditure (first quartile).
Carotenoids from plant food sources is the main source of vitamin A intake of the population and its main determinants are household expenditure and size of household. Food fortification and dietary diversification with special emphasis on promotion of consumption of animal foods should be key strategies for overcoming vitamin A deficiency in Vietnam.
European Journal of Clinical Nutrition 07/2008; 62(6):810-6. · 2.46 Impact Factor
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ABSTRACT: To evaluate the effect of combined iron-zinc supplementation on micronutrient status, growth and morbidity.
Randomized, double-masked, placebo-controlled supplementation trial.
Rural district of Que Vo, in the Red River Delta in Vietnam.
A total of 915 breast-fed infants aged 4-7 months were included and 784 completed the study.
The Fe-group received daily and for a 6-month period 10 mg of iron, the Zn-group 10 mg zinc, the Fe-Zn group 10 mg iron+10 mg zinc and the placebo group a placebo. Hemoglobin (Hb), serum ferritin (SF) and zinc (SZn), and anthropometry were measured before and at the end of the intervention. Morbidity was recorded daily.
Changes of Hb and SF were higher in both Fe and Fe+Zn groups (respectively 22.6 and 20.6 g/l for Hb; 36.0 and 24.8 microg/l for SF) compared to Zn and placebo groups (Hb: 6.4 and 9.8 g/l; SF: -18.2 and -16.9 microg/l, P<0.0001). SZn increased more in Zn group (10.3 micromol/l) than in Fe+Zn group (8.0 micromol/l, P=0.03) and more in these groups compared to Fe and placebo groups (1.6 and 1.2 micromol/l, P<0.0001). Weight gain was higher in the Zn group. No significant effects of supplementations on growth in length or morbidity.
Combined iron-zinc supplementation had a positive effect on iron and zinc status in infants. However, the positive effect of zinc alone on SZn and weight would indicate a negative interaction of iron when added to zinc supplements.
UNICEF New York.
European Journal of Clinical Nutrition 04/2006; 60(4):443-54. · 2.46 Impact Factor
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Asia Pacific Journal of Clinical Nutrition 16 (2007) 4.
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ABSTRACT: BACKGROUND: Anemia is a significant public health problem among schoolchildren in Vietnam. Food fortification is considered one of the most sustainable long-term strategies to control iron-deficiency anemia in Vietnam. The success of a food-fortification program depends on the choice of the food vehicle. OBJECTIVES: The aim of the present study was to identify an appropriate vehicle for iron fortification to be used in a school-feeding program aimed at improving the iron and anemia status of schoolchildren in rural Vietnam. METHODS: Children 6 to 8 years of age in two primary schools in Tam Nong District, Phu Tho Province, and their parents were included in this study. The study consisted of three substudies: a food-consumption study with 24-hour recalls of two nonconsecutive days; a food-beliefs study, with focus group discussions, a pile-sorting test, and a food attributes and differences exercise; and a food-acceptance study using noodles and biscuits fortified with sodium iron ethylenediaminetetraacetic acid (NaFeEDTA). RESULTS: The average number of meals consumed daily was 3.2 +/- 0.4, and the average intakes of energy and iron were 1,218 +/- 406 kcal and 7.5 +/- 4.0 mg, respectively. Compared with biscuits and instant rice soup, instant noodles were consumed more frequently and in larger portion sizes and are more acceptable as children's food in the culture of the local people. The iron level of the fortified product did not affect the mean consumption of noodles, but a higher level of iron was associated with a lower mean consumption of biscuits (p < .05). The production process did not affect the NaFeEDTA level in noodles; however, during preparation at least 70% of the iron is leaked into the soup. CONCLUSIONS: Instant noodles are a suitable vehicle for iron fortification for use in school-based intervention to improve iron-deficiency anemia among primary schoolchildren in rural Vietnam.
Food and Nutrition Bulletin 28 (2007) 3.
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ABSTRACT: Background: More information is needed on the efficacy of carotenoids from plant foods in improving vitamin A status. Objective: We aimed to quantify the efficacy of provitamin A¿rich vegetables and fruit in improving vitamin A status. Design: Breastfeeding women in 9 rural communes in Vietnam were randomly allocated to 1 of 4 groups: the vegetable group (n = 73), which ingested 5.6 mg ß-carotene/d from green leafy vegetables; the fruit group (n = 69), which ingested 4.8 mg ß-carotene/d from orange or yellow fruit; the retinol-rich group (n = 70), which ingested 610 µg retinol/d from animal foods and 0.6 mg ß-carotene/d; and the control group (n = 68), which ingested 0.4 mg ß-carotene/d. Meals of groups 1, 2, and 4 contained <30 µg retinol/d. Lunch and dinner were provided 6 d/wk for 10 wk. Results: Mean (95% CI) changes in serum retinol concentrations of the vegetable, fruit, retinol-rich, and control groups were 0.09 (0.03, 0.16), 0.13 (0.07, 0.19), 0.25 (0.17, 0.33), and 0.00 (¿0.06, 0.06) µmol/L, respectively. Mean (95% CI) changes in breast-milk retinol concentrations were 0.15 (0.04, 0.27), 0.15 (0.02, 0.28), 0.48 (0.32, 0.64), and ¿0.06 (¿0.21, 0.09) µmol/L, respectively. According to these findings, the equivalent of 1 µg retinol would be 12 µg ß-carotene (95% CI: 8, 22 µg) for fruit and 28 µg ß-carotene (17, 84 µg) for green leafy vegetables. Thus, apparent mean vitamin A activity of carotenoids in fruit and in leafy vegetables was 50% (95% CI: 27%, 75%) and 21% (7%, 35%), respectively, of that assumed. Conclusion: The bioavailability of carotenoids from vegetables and fruit is less than previously assumed.
American Journal of Clinical Nutrition 85 (2007) 4.
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ABSTRACT: Previous data from Vietnam show that anaemia is highly prevalent among schoolchildren, who are considered not to be iron deficient. Trichuris infection doubled the risk of anaemia. The present study aimed to evaluate the hypothesis that de-worming is more effective than iron fortification in an anaemic, infection-prone population. In a trial with a 2 × 2 factorial design, 425 anaemic children aged 6¿8 years were randomly assigned to receive either iron-fortified noodles or placebo, and mebendazole or placebo. Outcomes considered were change in haematological indicators of iron status (Hb, serum ferritin (SF), serum transferrin receptor (TfR) and haemoglobinopathies analysis); inflammations (C-reactive protein (CRP)); parasite infection status (hookworm, Trichuris and Ascaris infection); and IgE. ANOVA and logistic regression were used to assess the effects of iron fortification and de-worming on Hb, SF, TfR, body iron and anaemia. Hb improved in all groups after 6 months of intervention. Iron fortification significantly improved Hb, SF and body iron (2·6 g/l, 16·3 ¿g/l and 1 mg/kg, respectively). Prevalence of elevated IgE was very high at baseline (99 %) and significantly reduced to about 75 % in all groups after intervention. De-worming unexpectedly showed no effect on Hb, iron status and IgE level. It is concluded that iron fortification slightly improved anaemia and iron status in anaemic schoolchildren in rural Vietnam that were not considered iron deficient. Chronic infection or other unidentified factors may play an important role in the seasonal reduction of anaemia seen in all treatment groups.
British Journal of Nutrition 97 (2007) 5.
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N.C. Khan
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ABSTRACT: Elimination of vitamin A deficiency has been high on the agenda of subsequently the Micronutrient Deficiency Meeting held in Montreal Canada 1991 and the International Conference on Nutrition in Rome Italy, 1992. During the last decade, the direction of research and approaches towards controlling vitamin A deficiency have changed enormously and has been shaped and advanced largely by public health professionals, policy makers and different organizations. Although vitamin A deficiency and xerophthalmia is not a public health problem anymore in Vietnam, the prevalence of sub clinical vitamin A deficiency is still high. Main sources of vitamin A in the diet are green leafy vegetables and fruits and only the wealthier part of the population gets a substantial part of their vitamin A from animal sources. To increase the vitamin A intake in the population, several approaches are possible. For many developing countries a food-based approach using foods naturally rich in vitamin A and other micronutrients is preferable because fruits and vegetables provide 70-80% of the total vitamin A intake due to their high content of provitamin A carotenoids .Thus, an increased consumption of plant provitamin A-rich foods should be encouraged. The question is, however, how much can plant foods contribute to vitamin A supply. An intervention study in breastfeeding women was carried out, specially designed to provide information about the role of different plant food sources in improving the vitamin A status. The results show that consumption of dark-green leafy vegetable only result in a very small improvement of the vitamin A status, suggesting that the relative bioavailability of β-carotene in dark-green leafy vegetables is lower than previously assumed. Interestingly, the bioavailability of carotenoids differs across different kinds of plant food: β -carotene in yellow/orange fruits is better available than that in dark-green leafy vegetables. The reason of the low bioavailability of carotenoids could be the complex matrix of leaves in addition to absorption inhibitors such as fiber which entraps carotenoids. Parasitic infestation, genetic factors, and dietary factors might play a role as well. The study shows that approaches beyond the promotion of fruits and vegetables are required to eliminate (sub clinical) vitamin A deficiency. It might be necessary to apply combination strategies including public health measures, food fortification, " biofortification and other opportunities for targeted supplementation programs. Promotion of consumption of fruits and vegetables should, however, remain part of the holistic approach, not only because of their provitamin A content but also as protective factor in the prevention of chronic diseases.
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ABSTRACT: The objective of the study was to assess the prevalence of sub clinical vitamin A deficiency and anemia in Vietnamese children. For this, a cross-sectional survey was conducted in 40 villages (clus-ters) of four ecological regions in Vietnam during Apr-May 2001. In total 1657 children less than 5 years old were included by a cluster random sampling method. The prevalence of sub clinical vita-min A deficiency (serum retinol <0.70 ¿mol/L) was 12.0% and the prevalence of anemia (hemoglo-bin <110g/L) was 28.4 %. In the children under 6 months the prevalence of sub clinical vitamin A deficiency was 35.1 % whereas the prevalence of anemia in this group was as high as 61.7%. The prevalence of children with both sub clinical vitamin A deficiency and anemia was 6.1%. Sub clini-cal vitamin A deficiency and anemia prevalence differed significantly across the regions, with high-est prevalence in the Northern Mountainous areas for vitamin A deficiency and in the Northern Mountainous area and Mekong River Delta for anemia. It is concluded that sub clinical vitamin A deficiency and anemia are still important public health problems in Vietnam. Sustainable strategies for combating vitamin A deficiency and nutritional anemia are needed and should concentrate on target groups, especially infants and malnourished children in high risk regions.
Asia Pacific Journal of Clinical Nutrition 16 (2007) 1.
