Children with Sub-Clinical Vitamin-A Deficiency are at Risk for Significant Nutritional Iron and Zinc Deficiencies

Jump To References Section

Authors

  • The Institute of Science, Department of Biochemistry, 15, Madame Cama Road, Mumbai - 400 032 ,IN

Keywords:

Vitamin A, Retinol-Binding Protein, Iron, Zinc, Malnourished Children.

Abstract

Nutrient interaction and vitamin A deficiency were studied using several biochemical markers of nutritional deficiency in 100 socio-economically deprived children living in the slums of Mumbai, India. The purpose of the study was to examine whether children with sub-clinical vitamin A deficiency are at risk for nutritional iron and zinc deficiencies. Children were originally identified to suffer from sub-clinical vitamin A deficiency as manifested by the presence of abnormal conjunctival impression cytology for early epithelial changes with/without associated (1) night blindness (XN), (2) conjunctival xerosis (XIA) or (3) bitot's spots (XIB). Twenty five per cent of these children had adequate serum vitamin A levels (>0.698μmol/L) thereby suggesting that vitamin A levels were insensitive for determining likelihood of clinical disease. In contrast Retinol Binding Protein (RBP) measurements more accurately profiled the clinical disease status. All children with sub-clinical vitamin A deficiency had significantly lower RBP values compared to control children. In addition, these children had significant iron-deficiency anemia (hemoglobin 99.5 g/dL) and low serum iron along with low serum zinc compared to control children. These results suggest that malnourished children with sub-clinical evidence of vitamin A deficiency, despite normal vitamin A levels were at risk of inadequate iron and zinc nutriture. Children with sub-clinical vitamin A deficiency should receive vitamin A therapy that includes iron and zinc supplementation. Furthermore, this points to a significant under-reported health problem that impacts intellectual development of many of the world's children.

Downloads

Download data is not yet available.

Published

2015-12-01

How to Cite

Aspatwar, A. (2015). Children with Sub-Clinical Vitamin-A Deficiency are at Risk for Significant Nutritional Iron and Zinc Deficiencies. The Indian Journal of Nutrition and Dietetics, 52(4), 404–414. Retrieved from https://informaticsjournals.com/index.php/ijnd/article/view/2404

 

References

Akhtar, S., Ahmed, A., Randhawa, M.A., Atukorala, S., Arlappa, N., Ismail, T. and Ali, Z. Prevalence of vitamin A deficiency in South Asia: causes, outcomes, and possible remedies. J. Health Popul. Nutr., 2013, 31, 413-423.

Iannotti, L.L., Trehan, I. and Manary, M.J. Review of the safety and efficacy of vitamin A supplementation in the treatment of children with severe acute malnutrition. Nutr. J., 2013, 12, 12:125.

Munoz, E.C., Rosado, J.L., Lopez, et al. Iron and zinc supplementation improves indicators of vitamin A status of Mexican preschoolers. Am. J. Clin. Nutr., 2000, 71, 789-794.

Sommer, A., West, K.P., Jr. Vitamin A Deficiency: Health, Survival, and Vision, Oxford: Oxford University Press. 1996, 438.

Hodges, R.E., Sauberlich, H.E. and Canham, J.E. Hematopoietic studies in vitamin A deficiency. Am. J. Clin. Nutr., 1978, 31, 876-885.

Staab, D.B., Hodges, R.E. and Metcalf, W.K. Relationship between vitamin A and iron in the liver. J. Nutr. 1984, 114, 840-844.

Mejia, L.A. and Chew, W. Hematologic effect of supplementing anemic children with vitamin A alone or in combination with iron. Am. J. Clin. Nutr. 1986, 48, 595-600.

Solomons, N.W. and Russel, R.M. The interaction of Zinc and Vitamin A: Implication for human nutrition. Am. J. Clin. Nutr., 1980, 33, 2031-2040.

Christian, P. and West, K.P. Jr. Interactions between zinc and vitamin A: an update. Am. J. Clin. Nutr., 1998, 68, 435S-441S.

Aspatwar, A.P. and Bapat, M.M. Vitamin A status of socioeconomically backward children. Ind. J. Pediatr., 1995, 62, 427-432.

Bieri, J.G., Tolliver, T.J. and Catignani, G.L. Simultaneous determination of alphatocopherol and retinol in plasma or red cell by High Pressure Liquid Chromatography. Am. J. Clin. Nutr., 1978, 32, 2143-1249.

Melton, L.A., Tracy, M.L. and Moller, G. Screening trace elements and electrolytes in serum by inductively coupled plasma emission spectrometry. Clin. Chem., 1990, 36, 247250.

Mancini, G., Carbonara, A.O. and Heremans, J.F. Immunochemical quantitation of antigens by single radial immunodiffusion. Immunochemistry. 1965, 2, 235-254.

Doumas, B.T. Standards for total serum protein assays - a collaborative study. Clin. Chem., 1975, 21, 1159-1166.

Doumas, B.T., Watson, W.A. and Biggs, H.G. Albumin standards and measurement of serum albumin with Bromocresol green. Clin. Chim. Acta., 1971, 31, 87-96.

Amedee-Manesme, O., Anderson, D. and Olson, J.A. Relation of the relative dose response to liver concentrations of vitamin A in generally well-nourished surgical patients. Am. J. Clin. Nutr., 1984, 39, 898-902.

Pearson, W.N. Blood and urinary vitamin levels as potential indices of body store. Am. J. Clin. Nutr., 1967, 20, 514-527.

Pitt, G.A. Assessment of vitamin A status. Proc. Nutr. Soc., 1967, 40, 773-778.

Blaner, W.S. Retinol-binding protein: the serum transport protein for vitamin A. Endocr. Rev., 1989, 10, 308-316.

Jain, M.K., Mehta, N.J. and Fonseca, M. et al. Correlation of serum vitamin A and its transport protein (RBP) in malnourished and vitamin A deficient children. J. Postgrad. Med., 1990, 36, 119-123.

Fishman, S.M., Christian, P. and West, K.P. The role of vitamins in the prevention and control of anemia. Public Health Nutr., 2000, 3, 125-150.

Hodges, R.E., Sauberlich, H.E. and Canham, J.E. Iron deficiency anemia and hypovitaminosis A. Kyoto, Japan Xth International Congress of Nutrition. 1975, (abstr. 3307).

Oelofse, A., Faber, M. and Benade. The nutritional status of a rural community in Kwa Zulu-Natal, South Africa: the Ndunakazi project. Cent. Afr. J. Med., 1999, 45, 14-19.

Mwanri, L., Worsley, A. and Ryan, P. Supplemental vitamin A improves anemia and growth in anemic school children in Tanzania. J. Nutr., 2000, 130, 2691-2696.

Shingwekar, A.G., Mohanram, M. and Reddy, V. Effect of zinc supplementation on plasma levels of vitamin A and retinol binding protein in malnourished children. Clin. Chim. Acta., 1979, 2, 97-100.

Boron, B., Hupert, J. and Barch, D.H. Effect of zinc deficiency on hepatic enzymes regulating vitamin A status. J. Nutr., 1988, 118, 995-1001.