J.G.A.J. Hautvast’s research while affiliated with Wageningen University & Research and other places

We sought to determine the effects of maternal zinc supplementation on skin infections among infants in poor urban areas of Dhaka, Bangladesh. A double-blind, placebo-controlled, randomized trial was conducted among 199 and 221 Bangladeshi infants whose mothers were administered 30 mg daily of zinc or placebo, respectively. The mothers received zinc supplementation from 12-16 weeks' gestation until delivery, and the infants were followed up until 6 months of age. Among the infants of mothers who received zinc supplementation during the antenatal period, 10.6% had at least 1 episode of impetigo compared with 19.6% of the infants of mothers in the placebo group (P = 0.01). Infants in the treatment group had a 54% reduction in incidence rate of episodes of impetigo when compared with infants in the placebo group (P = 0.01). The effect of zinc supplementation was more pronounced among male infants (64% reduction) and intrauterine growth restricted and low birth weight infants (73% reduction) and among infants of mothers with increased parity (60% reduction) or decreased socioeconomic status (71% reduction).

Dietary fat intake is extremely low in most communities with vitamin A deficiency. However, its role in vitamin A status of pregnant and lactating women is poorly understood. The aim of the study was to examine the effect of supplementing women with fat from mid-/late pregnancy until six months postpartum on their vitamin A status and that of their infants. Women recruited at 5-7 months of gestation were supplemented daily with 20 mL of soybean-oil (n=248) until six months postpartum or received no supplement (n=251). Dietary fat intake was assessed by 24-hour dietary recall at enrollment and at 1, 3 and 6 months postpartum. Concentrations of maternal plasma retinol, β-carotene, and lutein were measured at enrollment and at 1, 3 and 6 months postpartum, and those of infants at six months postpartum. Concentration of breastmilk retinol was measured at 1, 3 and 6 months postpartum. The change in concentration of plasma retinol at three months postpartum compared to pregnancy was significantly higher in the supplemented compared to the control women (+0.04 vs -0.07 μmol/L respectively; p<0.05). Concentrations of plasma β-carotene and lutein declined in both the groups during the postpartum period but the decline was significantly less in the supplemented than in the control women at one month (β-carotene -0.07 vs -0.13 μmol/L, p<0.05); lutein -0.26 vs -0.49 μmol/L, p<0.05) and three months (β-carotene -0.04 vs -0.08 μmol/L, p<0.05; lutein -0.31 vs -0.47 μmol/L, p<0.05). Concentration of breastmilk retinol was also significantly greater in the supplemented group at three months postpartum than in the controls (0.68±0.35 vs 0.55±0.34 μmol/L respectively, p<0.03). Concentrations of infants’ plasma retinol, β-carotene, and lutein, measured at six months of age, did not differ between the groups. Fat supplementation during pregnancy and lactation in women with a very low intake of dietary fat has beneficial effects on maternal postpartum vitamin A status.

Samenvatting ‘Vorig jaar waren er voor het eerst in de wereldgeschiedenis evenveel mensen met overgewicht als mensen met ondervoeding’. Eén zinnetje uit de omvangrijke Nota Overgewicht van de ministers Klink en Rouvoet en staatssecretaris Bussemaker .1 Eén zinnetje dat meteen de eerste oorzaak van het probleem onthult. Evolutionair is de mens succesvol geweest in een wereld waarin het nooit zeker was dat er ook morgen voldoende eten zou zijn. Als er eten was, at hij dus zoveel als hij maar kon. Nu leven wij in een wereld waarin er altijd en overal veel te veel te eten is, maar zonder het te weten vrezen we nog altijd de honger van de volgende dag.

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.

Schoolchildren in developing countries often have inadequate intakes of iron, due primarily to poor bioavailability. Increasing meat in the diet could improve both the amount of iron consumed and its availability. The effect of increases in intakes of meat and ascorbic acid on absorbed iron was investigated by theoretically modifying the habitual diet of rural Kenyan schoolchildren. The projected changes in the amount of absorbed iron and prevalence of inadequate iron intakes were calculated for 78 children (6-9 years of age). The prevalence of inadequate iron intakes decreased from 77% to 54% through the theoretical addition of 50 g beef or 100 mg ascorbic acid and to 23% through the addition of both to dinner each day. To reduce the prevalence of inadequate iron intake to 5%, the addition of 100 g meat plus 150 mg ascorbic acid would be necessary. The combined addition of meat and ascorbic acid to a meal has the potential to reduce the projected prevalence of inadequate iron intakes among these schoolchildren.

Schoolchildren in developing countries often have inadequate intakes of iron, due primarily to poor I bioavailability. Increasing meat in the diet could improve both the amount of iron consumed and its availability. The effect of increases in intakes of meat and ascorbic acid on absorbed iron was investigated by theoretically modifying the habitual diet of rural Kenyan schoolchildren. The projected changes in the amount of absorbed iron and prevalence of inadequate iron intakes were calculated for 78 children (6-9 years of age). The prevalence of inadequate iron intakes decreased from 77% to 54% through the theoretical addition of 50 g beef prevalence or 100 mg ascorbic acid and to 23% through the addition of both to dinner each day. To reduce the of inadequate iron intake to 5%, the addition of 100 g meat plus 150 mg ascorbic acid would be necessary. The combined addition of meat and ascorbic acid to a meal has the potential to reduce the,projected prevalence of inadequate iron intakes among these schoolchildren.

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 (clusters) 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 vitamin A deficiency (serum retinol <0.70 mumol/l) was 12.0% and the prevalence of anemia (hemoglobin <110g/l) was 28.4 %. 35.1%. 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 clinical vitamin A deficiency and anemia prevalence differed significantly across the regions, with highest 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.

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.

Observational studies have shown that children in developing countries consuming diets containing high amounts of bioavailable nutrients, such as those found in animal-source foods, grow better. The present study investigated which specific nutrients from the diet of Kenyan school children predicted their growth. The children (n 544, median age 7 years) participated in a 2-year long food supplementation study with animal-source foods. Height gain during the intervention period was positively predicted by average daily intakes of energy from animal-source foods, haem Fe, preformed vitamin A, Ca and vitamin B12. Weight gain was positively predicted by average daily intakes of energy from animal-source foods, haem Fe, preformed vitamin A, Ca and vitamin B12. Gain in mid-upper-arm muscle area was positively predicted by average daily intakes of energy from animal-source foods and vitamin B12. Gain in mid-upper-arm fat area was positively predicted by average daily intakes of energy from animal-source foods. Gain in subscapular skinfold thickness was not predicted by any of the nutrient intakes. Negative predictors of growth were total energy and nutrients that are contained in high amounts in plant foods. The study shows that growth was positively predicted by energy and nutrients that are provided in high amounts and in a bioavailable form in meat and milk, and their inclusion into the diets of children in developing countries should be part of all food-based programmes in order to improve micronutrient status and growth.

Maternal nutrition is important for fetal development, but its impact on the functional outcome of infants is still unclear. The present study investigated the effects of vitamin A and Fe supplementation during gestation on infant mental and psychomotor development. Mothers of infants from five villages in Indonesia were randomly assigned to supervised, double-blind supplementation once per week from approximately 18 weeks of pregnancy until delivery. Supplementation comprised 120 mg Fe+500 microg folic acid with (n 94) or without (n 94) 4800 microg retinol in the form of retinyl acetate. Mothers of infants who participated in the national Fe+folic acid supplementation programme, but whose intake of supplements was not supervised, were recruited from four other villages (n 88). The mental and psychomotor development of infants was assessed, either at 6 or 12 months of age, using the Bayley Scales of Infant Development (BSID). We found no impact of vitamin A supplementation on mental or psychomotor development of infants. In addition, infants whose mothers had received weekly Fe supplementation had similar mental and psychomotor indices as those whose mothers had participated in the governmental Fe supplementation programme. The study population was moderately Fe and vitamin A deficient. The size of the treatment groups was large enough to detect a mean difference of 10 points on the BSID, which is less than 1 sd (15 points) of the average performance of an infant on the BSID. In conclusion, the present study did not find an impact of weekly supplementation of 4800 RE vitamin A in addition to Fe during gestation on functional development of Indonesian infants. However, smaller improvements in development may be seen if studied in a larger and/or more deficient population.