Interpretation of vitamin A status in apparently healthy Pakistani children by using markers of subclinical infection 1 3
|
|
- Ruby Johns
- 6 years ago
- Views:
Transcription
1 Interpretation of vitamin A status in apparently healthy Pakistani children by using markers of subclinical infection 1 3 Parvez I Paracha, Abdul Jamil, Christine A Northrop-Clewes, and David I Thurnham ABSTRACT Background: Plasma retinol concentrations are depressed by infection but are commonly used to assess vitamin A status. Objective: We measured 2 acute phase proteins, 1 -antichymotrypsin (ACT) and 1 -acid glycoprotein (AGP), to determine whether they could be used to assist in interpreting vitamin A status. Design: In 1997, a 2-stage cluster-sampling procedure was used to select 3074 apparently healthy, 6 60-mo-old children from rural and urban areas of North West Frontier Province, Pakistan. Plasma retinol, ACT, AGP, and ferritin measurements and anthropometric measurements were obtained for 2519 children. Results: Median plasma retinol, ACT, AGP, and ferritin concentrations were 0.86 mol/l, 0.39 g/l, 1.14 g/l, and 5.5 g/l, respectively. There were no significant (P > 0.05) differences in retinol, ACT, or AGP by sex or age. Some 797 children (32%) had retinol concentrations <0.7 mol/l and 87 (4%) had retinol concentrations <0.35 mol/l; 274 children (11%) had elevated ACT (>0.6 g/l) and 1141 (45%) had elevated AGP (>1.2 g/l). Retinol concentration correlated with ACT (r = 0.141), AGP (r = 0.138), and ferritin (r = 0.09) (all P < 0.001), but stepwise multiple regression indicated that these 3 variables made a minimal although quantifiable contribution to the variance of retinol (ACT, r 2 = 0.02; all 3 variables, r 2 = 0.03). Conclusions: The transient depression in plasma retinol produced by subclinical infection increased the number of atrisk children by 10% (76 of 797) and 56% (49 of 87) for plasma retinol concentrations <0.7 and <0.35 mol/l, respectively. In addition, dietary inadequacy may be responsible for retinol concentrations being 16% lower in Pakistani children than in children in the United Kingdom, where dietary vitamin A is adequate. Am J Clin Nutr 2000;72: KEY WORDS Acute phase proteins, 1 -antichymotrypsin, 1 -acid glycoprotein, ferritin, vitamin A status, plasma retinol, children, Pakistan, United Kingdom INTRODUCTION It is estimated that there are 254 million preschool children in the world who are at risk of vitamin A deficiency; 50% of these children are from Southeast Asia (1). In addition, vitamin A deficiency worldwide may be responsible for million deaths of young children annually and may cause blindness in > children (2, 3). These estimates of vitamin A status are based predominantly on dietary or biochemical data, particularly plasma retinol, but both are difficult to interpret because the bioavailability of provitamin A carotenoids is in doubt (4) and plasma retinol concentrations are depressed by concurrent disease (5, 6). The interpretation of other nutrient concentrations is also made more difficult by disease (7, 8), but it has been suggested that acute phase proteins might be used to correct biochemical markers of vitamin A (9) and iron status (10). The acute phase response is the body s immediate reaction to infection and inflammation, and changes in the synthesis of acute phase proteins are to maintain body homeostasis and avert tissue damage. C-reactive protein (CRP) is probably the most commonly used and sensitive acute phase protein for monitoring infection and inflammatory activity and is particularly useful in assessing bacterial and connective tissue diseases (11, 12). However, CRP concentration may not remain abnormal long enough to detect patients in early convalescence (12) and thus is unlikely to be useful in nutritional studies of apparently healthy subjects. Other acute phase proteins remain elevated for longer than does CRP and may therefore be more useful for detecting children in whom infection has subsided but whose retinol concentrations may still be reduced. 1 -Antichymotrypsin (ACT; 11) and 1 -acid glycoprotein (AGP; 11, 13) are 2 such proteins. The response time for ACT is similar to that for CRP (ie, 6 10 h), whereas the response time for AGP is 24 h. These proteins remain elevated for longer than CRP does because AGP may be needed postinfection for immunomodulatory effects and ACT for the synthesis of new tissue (11). Reports from Bangladesh (14), the Gambia (15), and central Africa (16) suggest that these proteins may be useful indicators of subclinical, chronic, or recent ill health. 1 From the Department of Nutrition, Agricultural University and Goverment Department of Health, Peshawar, North West Frontier Province, Pakistan, and the Northern Ireland Centre of Diet and Health, School of Biomedical Sciences, University of Ulster, Coleraine, United Kingdom. 2 Supported by UNICEF. PIP is the recipient of a Commonwealth Scholarship. 3 Address reprint requests to DI Thurnham, Northern Ireland Centre of Diet and Health, School of Biomedical Sciences, University of Ulster, Coleraine BT52 1SA, Northern Ireland, United Kingdom. di.thurnham@ ulst.ac.uk. Received November 4, Accepted for publication April 31, Am J Clin Nutr 2000;72: Printed in USA American Society for Clinical Nutrition
2 ACUTE PHASE PROTEINS AND VITAMIN A STATUS 1165 Because poor vitamin A status and infections coexist in children of less developed countries, it is difficult to establish whether low plasma retinol concentrations are due to nutritional or to pathologic causes. The differentiation is important for health professionals, policymakers, and program managers as they devise more cost-effective strategies to reduce vitamin A deficiency. In the study reported in this article, AGP and ACT measurements were used to assess subclinical infection in the population and the association between subclinical infection and plasma retinol. Plasma ferritin is also influenced by infection and the concentrations are included in the analysis of the vitamin A data. The relation of plasma ferritin to iron status will be reported separately. A short report on this study was presented at the XIX International Vitamin A Consultative Group Meeting (17). SUBJECTS AND METHODS A study was carried out to assess the vitamin A, iron, and zinc status of 6 60-mo-old children in North West Frontier Province (NWFP), Pakistan. Ethical approval for the study was obtained from the Health Department of NWFP. A 2-stage cluster-sampling procedure was followed to select 3074 apparently healthy children from 2193 households in both the urban and rural communities of NWFP. However, in this article only the relation between vitamin A status and acute phase proteins, for which 2519 children had complete biochemical and anthropometric data, is examined. The households in the selected clusters were visited by the nutrition officers and health workers of the survey teams to identify children aged 6 60 mo. Children were excluded if they were malnourished [<60% of weight-for-age according to the National Center for Health Statistics reference standards (18)]; if they had symptoms of disease, such as runny nose, fever, or diarrhea; or if they had acute or chronic infections such as pneumonia, typhoid, or malaria. Such symptoms and infections were assessed both by history from the caregiver and by observation during the clinical assessment and interview. Informed consent was obtained from each child s parents. Confirmation of a child s age was made with the mother with the help of a local-events calendar followed by discussion of the child s feeding practices and frequency of food consumption, and completion of demographic and socioeconomic questionnaires. Weight and height measurements of the children were taken according to the recommended procedures of the World Health Organization (WHO; 19) and were followed by an eye examination for clinical signs of vitamin A deficiency performed by ophthalmic technicians. The WHO (20) clinical classification of vitamin A deficiency was used to identify children with clinical signs of vitamin A deficiency and the results were recorded on the questionnaire. A 5-mL blood sample was collected from each child in 4 different disposable EDTA-containing evacuated tubes (Becton Dickinson, Franklin Lakes, NJ) with use of disposable single-use needles (Sherwood & Co, Sussex, United Kingdom). Hemoglobin concentration was determined spectrophotometrically by using a Hemocue device (21, 22) in the field; the accuracy of the equipment was checked at the beginning of the day and at intervals of every 20 samples. The remaining blood was centrifuged at 1500 g for 5 min at ambient temperature to separate plasma into 4 different polypropylene tubes for the subsequent vitamin A, iron, zinc, ACT, and AGP analyses. The plasma samples for vitamin A analysis were wrapped in aluminum foil and were immediately transported in a refrigerated van to the central storage room of Agricultural University, Peshawar, where samples were kept at 20 C until analyzed. Plasma retinol was determined by reversed-phase liquid chromatography (23) at the Institute of Nutrition at Mahidol University, Bangkok. The accuracy and precision of the analytic method were checked by analyzing a pooled plasma sample (n = 150) with each batch and by using a human serum standard reference material (SRM 968b) from the National Institute of Standards and Technology (Gaithersburg, MD). The mean (±SD) plasma retinol concentrations from 5 determinations of reference materials with low, medium, and high concentrations were 1.03 ± 0.04, 1.79 ± 0.05, and 3.12 ± 0.16 mol/l compared with certified concentrations of 1.04 ± 0.05, 1.80 ± 0.06, and 3.12 ± 0.31 mol/l, respectively. Plasma ferritin was determined with an Immulite Automated Analyser (24) by a chemiluminescent enzyme immunometric assay at Aga Khan University, Karachi. The accuracy and precision of the method were checked by analyzing pooled plasma samples and controls (low, medium, and high). ACT and AGP were measured on a Cobas Fara analyzer (Roche Products, Welwyn, United Kingdom) with use of immunoturbidimetric techniques (25) at the Northern Ireland Centre for Diet and Health, University of Ulster, Northern Ireland. The accuracy of the method was monitored in each batch by including control samples of low and high concentrations. Interbatch precision with use of these controls was <8%. The prevalences of micronutrient deficiencies (ie, vitamin A and iron) were assessed according to the recommendations of WHO and expert committee reports. Children with plasma retinol concentrations <0.35 mol/l (<10 g/dl) and <0.70 mol/l (<20 g/dl) were characterized as being vitamin A deficient or having low vitamin A status, respectively (26), and children with plasma ferritin concentrations <12 g/l were characterized as iron deficient (27). The EPI-INFO (28) and SAS software programs (29) were used to prepare descriptive statistics, clean the data, and check for skewness. Plasma retinol, ferritin, ACT, and AGP data were skewed; therefore, nonparametric statistics were used for comparative analyses at a 5% level of significance, and median and ranges were computed. Analysis of the differences in plasma retinol between the groups with different acute phase protein statuses was done by using analysis of variance (ANOVA) followed by a Scheffe test on both log-transformed and arithmetic data. Differences between the groups were identical by either method of analysis. Medians and ranges are reported for consistency. Stepwise multiple regression analysis was performed by using log-transformed data to determine the variance contributed by different variables to plasma retinol and to determine Pearson product-moment correlation coefficients (30). RESULTS The median plasma retinol concentration was 0.86 mol/l and there was no significant difference between boys and girls (Table 1). The prevalence of low vitamin A concentration (<0.7 mol/l) was 32% in both boys and girls. However, the girls had a significantly higher median plasma ferritin concentration (6.1 g/l) than did the boys (5.0 g/l) and the prevalence of iron deficiency (ferritin < 12 g/l) was 66% in girls and 71% in boys (NS). The median ACT and AGP concentrations were 0.39 and 1.14 g/l, respectively, and there were no significant differences between boys and girls. When elevated ACT
3 1166 PARACHA ET AL TABLE 1 Biochemical and anthropometric measurements in the 2519 children by sex Variable Both sexes (n = 2519) Boys (n = 1318) Girls (n = 1201) Age (mo) 30.5 (6 60.1) 1, (6 60.1) (6 60.0) Plasma retinol ( mol/l) 0.86 ( ) 0.86 ( ) 0.86 ( ) Plasma ferritin ( g/l) 5.5 ( ) 5.0 ( ) ( ) 1 -Antichymotrypsin (g/l) 0.39 ( ) 0.38 ( ) 0.39 ( ) 1 -Acid glycoprotein (g/l) 1.14 ( ) 1.13 ( ) 1.15 ( ) Weight-for-age z score 1.68 ( ) 1.79 ( ) ( ) Height-for-age z score 1.57 ( ) 1.61 ( ) ( ) Weight-for-height z score 0.89 ( ) 1.02 ( ) ( ) Subjects with plasma retinol < 0.7 mol/l 797 (31.6) (31.7) 379 (31.6) Subjects with plasma retinol < 0.35 mol/l 87 (3.5) 45 (3.4) 42 (3.5) Subjects with ferritin < 12 g/l 1731 (68.7) 934 (70.9) 797 (66.4) Subjects with 1 -antichymotrypsin > 0.6 g/l 274 (10.9) 130 (9.9) 144 (12.0) Subjects with 1 -acid glycoprotein > 1.2 g/l 1141 (45.3) 578 (43.9) 563 (46.9) 1 Median; range in parentheses. 2 Significantly different from girls, P < n; percentage in parentheses. (>0.6 g/l) and AGP (>1.2 g/l) concentrations were used as markers of infection, 11% and 45%, respectively, of the children were identified as having elevated concentrations. The median z scores for weight-for-age (WAZ), height-for-age (HAZ), and weight-for-height (WHZ) of the children were 1.68, 1.57, and 0.89, respectively. The boys had significantly lower (poorer) z scores than did the girls (Table 1). Median plasma retinol, ferritin, ACT, and AGP concentrations in children aged <24 mo and 24 mo were not significantly different. Similarly, there were no significant differences in the prevalence of children with low plasma retinol or markers of infection between these 2 age groups. However, both the WAZ and WHZ of the children aged <24 mo were significantly lower than those of the children aged 24 mo, but the HAZ of the younger group was significantly higher than that of the older group (Table 2). There were no significant differences in z scores between children with normal or elevated acute phase proteins (Table 3). Information about age, retinol, and ferritin in the children classified according to whether they had normal or elevated ACT or AGP concentrations is also shown in Table 3. Plasma retinol was significantly higher in children with normal ACT and AGP concentrations. Furthermore, ferritin was significantly lower in the children with normal ACT, but the difference was not significant in those with normal AGP. The relation between plasma retinol and elevated ACT and AGP concentrations is explored further in Table 4. Children with a current subclinical infection, ie, elevated ACT (with or without elevated AGP) had lower retinol concentrations than did children with elevated AGP only or no elevated acute phase proteins (P < 0.001; ANOVA). In addition, the prevalence of low retinol concentrations (<0.7 mol/l) was significantly higher in the children with elevated ACT (with or without elevated AGP) than in the children with elevated AGP only or without elevated concentrations. The strong association (r = 0.74) between ACT and AGP (Table 5) indicated that both are measuring the same thing, namely infection. Furthermore, correlation coefficients between logarithms of plasma retinol, ACT, and AGP showed that plasma retinol was significantly associated with both ACT and AGP. Stepwise multiple regression analysis showed that ACT explained most of the variance (r 2 = 0.02) in plasma retinol compared with AGP and ferritin; however, the total variance that could be accounted for by the 3 independent variables (ACT, AGP, and ferritin) was small (r 2 = 0.03) (Table 6). The correlation coefficients between logarithms of plasma ferritin, ACT, and AGP showed that plasma ferritin was slightly more strongly associated with ACT than with AGP. These weak associations indicated that the acute phase proteins have only minimal, but nevertheless quantifiable, effects on plasma retinol and that ferritin is probably more strongly associated with iron status than with infection. DISCUSSION Infection in children aged <5 y is common in Pakistan and it is estimated that diarrhea and acute respiratory infection cause deaths/y (31). Poor health and nutritional status of women and unhygienic living environments are the leading causes of early childhood morbidity and mortality (31). The children selected in this study were apparently healthy, yet 32% had low plasma retinol concentrations (<0.7 mol/l) and 4% were biochemically vitamin A deficient (<0.35 mol/l). The observed prevalence rates of vitamin A deficiency were similar to those found in previous surveys (32, 33) conducted in different areas of Pakistan, where 13 47% of the children had low plasma retinol (<0.7 mol/l) and 2% were vitamin A deficient (<0.35 mol/l). Low plasma retinol may be partly responsible for increased childhood morbidity due to impaired immune function. However, it is important to know whether low plasma retinol is due to infection, TABLE 2 Biochemical and anthropometric measurements in the 2519 children by age group 1 Aged < 24 mo Aged 24 mo Variable (n = 967) (n = 1552) Age (mo) 13.9 (6 23.9) 46.0 ( ) 2 Plasma retinol ( mol/l) 0.86 ( ) 0.84 ( ) Plasma ferritin ( g/l) 5.5 ( ) 5.0 ( ) Weight-for-age z score 1.74 ( 3.55 to 2.13) 1.66 ( 3.90 to 0.67) 2 Height-for-age z score 1.43 ( 3.87 to 3.6) 1.64 ( 3.84 to 1.67) 2 Weight-for-height z score 1.08 ( 3.22 to 3.65) 0.79 ( 3.09 to 2.26) 2 1 Median; range in parentheses. 2 Significantly different from children aged < 24 mo, P < 0.05.
4 ACUTE PHASE PROTEINS AND VITAMIN A STATUS 1167 TABLE 3 Biochemical and anthropometric measurements in the 2519 children by acute phase protein concentration 1 ACT 0.6 g/l ACT > 0.6 g/l AGP 1.2 g/l AGP > 1.2 g/l Variable (n = 2245) (n = 274) (n = 1378) (n = 1141) Age (mo) (6 60.0) ( ) (6 60.0) ( ) Plasma retinol ( mol/l) 0.87 ( ) 0.73 ( ) ( ) 0.80 ( ) 4 Plasma ferritin ( g/l) 5.3 ( ) 8.0 ( ) ( ) 5.9 ( ) ACT (g/l) 0.37 ( ) 0.70 ( ) ( ) 0.48 ( ) 4 AGP (g/l) 1.08 ( ) 2.17 ( ) ( ) 1.68 ( ) 4 Weight-for-age z score 1.69 ( 3.90 to 2.13) 1.65 ( 3.45 to 0.93) 1.69 ( 3.56 to 2.13) 1.66 ( 3.90 to 1.49) Height-for-age z score 1.57 ( 3.87 to 2.99) 1.56 ( 3.75 to 3.6) 1.56 ( 3.87 to 2.99) 1.58 ( 3.82 to 3.6) Weight-for-height z score 0.89 ( 3.22 to 3.65) 0.89 ( 2.87 to 1.99) 0.91 ( 3.22 to 3.65) 0.88 ( 3.09 to 3.16) Subjects with plasma retinol < 0.7 mol/l 669 (29.8) (46.7) 383 (27.8) 414 (36.3) Subjects with plasma retinol < 0.35 mol/l 68 (3.0) 19 (6.9) 26 (1.9) 61 (5.4) Subjects with plasma ferritin < 12 g/l 1568 (69.8) 163 (59.5) 972 (70.5) 759 (66.5) 1 ACT, 1 -antichymotrypsin; AGP, 1 -acid glycoprotein. 2 Median; range in parentheses. 3 Significantly different from children with ACT 0.6 g/l, P < Significantly different from children with AGP 1.2 g/l, P < n; percentage in parentheses. and thus is transient, or to dietary deficiency, and therefore is potentially more permanent. Elevated ACT and AGP are both used as markers of infection (11). In this study, elevated ACT identified 247 children (11%) and elevated AGP identified 1141 children (45%) who showed evidence of subclinical infection. After the onset of infection, ACT, CRP, AGP, and serum amyloid A (SAA) all behave similarly, with an initial rise at 6 h, but the rate of increase of ACT, CRP, and SAA is much faster than that of AGP, and they reach their peak within 24 h. In contrast, AGP reaches its maximum at 5 d and remains elevated for longer than do the others (11, 13). Thus, elevated ACT in children may provide biochemical evidence of subclinical infection or recent exposure to infection, whereas elevated AGP may indicate that the exposure at the onset of infection was less recent and that convalescence has already started. Filteau et al (9) reported something similar in asymptomatic Ghanaian children when they observed that 57% had elevated AGP and 20% had elevated SAA. SAA is described as behaving almost the same as CRP (34) and therefore, like elevated ACT, elevated SAA probably represents an earlier stage in the acute phase response. A possible interpretation of elevated ACT and AGP in relation to vitamin A status is presented in Table 4. The data are grouped according to the presence or absence of elevated acute phase protein concentrations and the corresponding results for plasma retinol are shown. There were 14 children (<1%) in whom ACT, but not AGP, was elevated. Such children may have been exposed to infection within the previous 24 h (11). Because the children were apparently healthy, it is not surprising that there were so few such as these in the group. Most of the children with elevated ACT also had elevated AGP (n = 260, 10%). Given that the children were healthy, it is probable that ACT in this group was now decreasing (but still >0.6 g/l), which, in combination with the elevated AGP values, indicates they were at an early stage of convalescence. Note that in these 2 groups the number of children with plasma retinol concentration <0.7 mol/l was 45%, and greater than that in the other 2 groups, the convalescent (those with elevated AGP only) and the healthy (no elevated acute phase proteins), in which there were fewer (30%) children with a low plasma retinol. The proportion with low retinol concentrations in the latter 2 groups did not differ from that in the whole group (Table 1). Louw et al (35) showed that there were rapid and significant decreases in plasma retinol associated with the acute phase response after surgery. That is, retinol rapidly decreases after trauma at a speed similar to that of the increase in CRP, SAA, and ACT. Neither ACT nor AGP were measured in these studies, so it is not possible to know which of the 2 acute phase proteins, AGP or ACT, correlates more closely with the changes in plasma retinol during the acute phase response. However, although there was no significant difference in the proportion of low plasma retinol concentrations between groups 3 and 4 (Table 4), plasma retinol concentrations were significantly lower in the group with TABLE 4 Relation between plasma retinol and elevated acute phase protein status in the 2519 children 1 Hypothetical disease state or time of exposure 2 Acute phase protein status Retinol Retinol < 0.7 mol/l 3 µmol/l n% Group 1: current and very recent infection (n = 14) Elevated ACT and normal AGP 0.81 a ( ) [0.73] 4 6 (43) Group 2: current or recent infection (n = 260) Elevated ACT and elevated AGP 0.73 a ( ) [0.70] 22 (47) Group 3: convalescence (n = 881) Elevated AGP and normal ACT 0.83 b ( ) [0.80] 292 (33) Group 4: healthy (n = 1364) Normal ACT and normal AGP 0.90 c ( ) [0.87] 377 (28) 1 ACT, 1 -antichymotrypsin; AGP, 1 -acid glycoprotein. 2 Hypothetical state of subclinical infection based on presence or absence of elevated ACT (> 0.6 g/l) and AGP (> 1.2 g/l). 3 Significant difference between groups, P < 0.01 (chi-square test). 4 Median; range in parentheses; geometric mean in brackets. Values within the column with different superscript letters are significantly different, P < 0.05 (ANOVA and Scheffe s test).
5 1168 PARACHA ET AL TABLE 5 Correlation coefficients (r) for plasma retinol, acute phase proteins, and ferritin in the 2519 children 1 Retinol ACT AGP Ferritin Retinol ACT AGP Log values were used for the correlation analysis. ACT, 1 -antichymotrypsin; AGP, 1 -acid glycoprotein. P < for all correlations. elevated AGP alone than in those with no elevated acute phase protein concentrations (P < 0.05). In addition, there was both a higher proportion of low retinol concentrations and lower median retinol concentrations in most of the children with elevated ACT (groups 1 and 2, Table 4), suggesting that elevated ACT is associated with that stage of the acute phase response when plasma retinol is more depressed than when only AGP is elevated. The information in Table 4 was used to calculate the effect of infection on plasma retinol in the Pakistani children. The difference in median retinol concentrations between groups 2 and 3, ie, those with elevated ACT and AGP (0.73) and those with elevated AGP only (0.83), was 0.10 mol/l, and there is a further difference of 0.07 mol/l between those in groups 3 and 4 (Table 4). Thus, by rounding off these differences to 0.2 and 0.1 mol/l, the current criteria used to assess threshold plasma retinol concentrations for low and deficient vitamin A status (ie, 0.7 and 0.35 mol/l) could be reset to 0.5 and 0.15 mol/l for children where both ACT and AGP concentrations were elevated and to the correspondingly higher thresholds of 0.6 and 0.25 mol/l in cases in which only AGP was elevated. If this is done, the proportion of children with a low retinol concentration (using <0.7, 0.6, or 0.5 mol/l, as appropriate) that can be attributed to a dietary deficiency of vitamin A is reduced from 797 to 721 (10%, or 76 of 797) and the proportion of those with deficient plasma retinol is reduced from 87 to 38 (56%, or 49 of 87). That is, although poor diet appears to be the main contributor to low plasma retinol (28%, or 721 of 2519), infection is responsible in more than one-half of children at high risk of vitamin A deficiency. However, it is important to realize that, irrespective of the cause of the depressed plasma retinol (ie, infection or poor diet), a low plasma retinol concentration plays a major role in determining functional vitamin A status. Plasma retinol is tightly controlled by homeostatic mechanisms. However, it may be possible to assess the influence of dietary vitamin A deficiency on plasma retinol in Pakistani children by comparing the data with results from the British Pre- School Survey, in which vitamin A deficiency was not likely to be present (36). Only the acute phase protein ACT was measured, but because the children were apparently healthy, most of them, like those in Pakistan, would probably also have had an elevated AGP concentration. Mean (±SD) plasma retinol concentrations in British children with normal (n = 624) and elevated (n = 129) ACT concentrations were 1.04 ± 0.28 and 0.91 ± 0.28 mol/l (P < 0.001), respectively. Thus, there were similar differences in plasma retinol between those with normal and those with abnormal ACT values in Pakistani (0.17 mol/l) and British (0.13 mol/l) children. Furthermore, plasma retinol in Pakistani children was lower than that in British children by 13% and 19% (x : 16%) in those with normal and elevated ACT, respectively, and this may represent the effects of dietary vitamin A insufficiency in Pakistan. However, the difference in dietary intake of vitamin A between children in the 2 countries may be far larger than 16% because plasma retinol is under homeostatic control. The adjustments to plasma retinol cutoff values suggested above are probably appropriate only for an apparently healthy group of children. In children who are clinically sick, the depression of serum retinol appears to be much greater. Hospitalized children with shigellosis were recently reported to have mean (± SD) serum retinol concentrations of 0.36 ± 0.22 mol/l on admission and 1.15 ± 0.5 mol/l on discharge (37). The children did not receive any vitamin A supplements during treatment but were, of course, fed, and the food eaten may have contributed to the discharge plasma retinol concentration. However, during the clinical phase of disease, children may lose a considerable amount of vitamin A in urine. Urinary losses of vitamin A are associated with fever and the severity of the infection (38). The depressed plasma retinol concentration on admission represents the depression due to disease plus the added drain of urinary losses. Children who are apparently healthy do not have an elevated temperature or loss of vitamin A in the urine. The transient decrease of plasma retinol in response to infection and its return to normal concentrations on recovery was reported by several researchers (6, 9, 35, 39). The decrease was ascribed mainly to the acute inflammatory response that results in decreased synthesis of retinol binding protein and transthyretin and increased excretion of urinary retinol, independent of the body s vitamin A stores (37). The results obtained for the Pakistani children show a relatively weak correlation between retinol and both ACT (r = 0.14) and AGP (r = 0.14), whereas those reported by others for Ghanaian children, for example (9) were stronger for both AGP (r = 0.35) and SAA (r = 0.20). Undoubtedly, differences in environmental factors, sickness, and measurement method will all contribute to these differences and will have to be properly standardized if acute phase proteins are to be used to correct plasma retinol and improve its usefulness at a marker of vitamin A status. The results of this study suggest that subclinical infection is widely prevalent in apparently healthy preschool-age Pakistani children. A large proportion of the children also showed evidence of low vitamin A status, but when the data were adjusted to take into account the depression in plasma retinol caused by the presence of subclinical infection or dietary deficiency, infection had its greatest effect on children with biochemically deficient retinol concentrations (<0.35 mol/l), whereas poor diet may have been responsible for a 16% (13 19%) deficit in overall plasma retinol concentrations. It is important to be able to correctly quantify the extent of vitamin A deficiency in less TABLE 6 Stepwise multiple regression to predict plasma retinol in the 2519 children 1 Variable + SE Partial r 2 P Intercept ACT AGP Ferritin Height-for-age z score 1 Log values were used for the analysis. The model included the following independent variables: age, weight-for-age z score, weight-for-height z score, height-for-age z score, ACT, AGP, and ferritin. ACT, 1 -antichymotrypsin; AGP, 1 -acid glycoprotein.
6 ACUTE PHASE PROTEINS AND VITAMIN A STATUS 1169 developed countries to correctly target intervention strategies. This study provides basic information to allied health professionals, planners, and policymakers and, we hope, will encourage them to find better ways of combating both infection and vitamin A deficiency, which go side by side in less developed countries such as Pakistan. We thank Ms Chureeporn, Institute of Nutrition, Mahidol University, Bangkok, for plasma retinol analysis; Ms Nasim and Mr Mujib, Aga Khan University, Karachi, for ferritin analysis; and Ms Roisin O Kane, Northern Ireland Centre for Diet and Health, United Kingdom, for assistance in the 1 -antichymotrypsin and 1 -acid glycoprotein analyses. REFERENCES 1. World Health Organization. Global prevalence of vitamin A deficiency. Geneva: World Health Organization, (WHO/NUT/95.3.) 2. Humphery JH, West KP, Sommer A. Vitamin A deficiency and attributable mortality among under-5-year-olds. Bull World Health Organ 1992;70: Sommer A, Tarwotjo I, Hussaini G, Susanto D. Increased mortality in children with mild vitamin A deficiency. Lancet 1983;2: de Pee S, West CE. Dietary carotenoids and their role in combating vitamin A deficiency: a review of the literature. Eur J Clin Nutr 1996;50:S Reddy V, Bhaskaram P, Raghuramulu N, et al. Relationship between measles, malnutrition, and blindness: a prospective study in Indian children. Am J Clin Nutr 1986;44: Thurnham DI, Singkamani R. The acute phase response and vitamin A status in malaria. Trans R Soc Trop Med Hyg 1991;85: Brown KH, Lanata CF, Yuen ML, Peerson JM, Butron B, Lonnerdal B. Potential magnitude of the misclassification of a population s trace element status due to infection: example from a survey of young Peruvian children. Am J Clin Nutr 1993;58: Beisel WR. Trace elements in infectious processes. Med Clin North Am 1976;60: Filteau SM, Morris SS, Abbott RA, et al. Influence of morbidity on serum retinol of children in a community-based study in northern Ghana. Am J Clin Nutr 1993;58: Witte DL. Can ferritin be effectively interpreted in the presence of the acute-phase response? Clin Chem 1991;37: Thompson D, Milford-Ward A, Whicher JT. The value of acute phase protein measurements in clinical practice. Ann Clin Biochem 1992;29: Young B, Gleeson M, Cripps AW. C-reactive protein: a critical review. Pathology 1991;23: Cruickshank AM, Hansell DT, Burns HJG, Shenkin A. Effect of nutritional status on acute phase protein response to elective surgery. Br J Surg 1989;76: Rousham EK, Northrop-Clewes CA, Lunn PG. Maternal reports of child illness and the biochemical status of the child: the use of morbidity interview in rural Bangladesh. Br J Nutr 1998;80: Northrop-Clewes CA, Lunn PG, Downes RM. Seasonal fluctuations in vitamin A status and health indicators in Gambian infants. Proc Nutr Soc 1994;53:144A (abstr). 16. Tonglet R, Mahangaiko Lembo E, Dramaix M, Hennart P. Weakness of biochemical markers of nutritional and inflammatory status as indices for growth retardation and morbidity of young children in central Africa. Eur J Clin Nutr 1997;51: Paracha PI, Jamil A, Belbase K, Northrop-Clewes CA, Thurnham DI. Discriminatory effects of 1-antichymotrypsin and 1-acid glycoprotein when monitoring plasma retinol and ferritin. Washington, DC: IVACG Secretariat, 1999 (abstr). 18. Fomon SJ, Haschke F, Ziegler EE, Nelson SE. Body composition of reference children from birth to age 10 years. Am J Clin Nutr 1982; 35: World Health Organization. Measuring change in nutritional status. Geneva: World Health Organization, Sommer A, ed. World Health Organization. Field guide to the detection and control of xerophthalmia. Geneva: World Health Organization, Bridges N, Parvin RM, van Assendelft OW. Evaluation of a new system of hemoglobin measurement. Am Clin Prod Rev 1987;April: von Schenck H, Falkensson M, Lundberg B. Evaluation of Hemocue: a new device for determining haemoglobin. Clin Chem 1986; 32: DeRuyter MGM, De Leenheer AP. Simultaneous determination of retinol and retinyl esters in serum or plasma by reversed-phase high-performance liquid chromatography. Clin Chem 1978;24: European Diagnostic Products Cooperation. Immulite: chemiluminescent enzyme immunoassay. Glyn Rhonwy Llanberies, Gwynedd, United Kingdom: European Diagnostic Products Cooperation, Svendsen PJ, Bli-rup Jensn SJ. Determination of human plasma proteins by turbidimetry and nepholometry. Basic principles and Dako s optimized system for quantitative protein determination on automated instruments. Copenhagen: Dako/AS, World Health Organization/United Nations Children s Fund. Indicators for assessing vitamin A deficiency and their application in monitoring and evaluating intervention programmes: report of a joint WHO/UNICEF consultation. Geneva: World Health Organization, World Health Organization. WHO/UNICEF/UNU consultation on indicators and strategies for iron deficiency and anaemia programmes. Geneva: World Health Organization, Dean AD, Dean JA, Burton AH. EPI INFO, version 5: a word processing, data base and statistics program for epidemiology on microcomputers. Stone Mountain, GA: USD Inc, SAS Institute Inc. SAS user s guide: statistics, version 5. Cary, NC: SAS Institute Inc, Tabachnick BG, Fidell LS. Using multivariate statistics. 2nd ed. New York: Harper and Row Publishers, United Nations Children s Fund. Children and women in Pakistan: a situation analysis. Karachi, Pakistan: UNICEF, Nutrition Cell, Planning and Development Division, Government of Pakistan. Micro-nutrient survey ( ) of Pakistan. Islamabad, Pakistan: Government of Pakistan, Molla A, Khurshid M, Molla AM, Badruddin SH, Hendricks K, Snyder JD. Is anaemia an accurate predictor of vitamin A status in Pakistani children? Am J Trop Med Hyg 1993;49: Fleck A, Myers MA. Diagnostic and prognostic significance of the acute phase proteins. In: Gordon AH, Koj A, eds. The acute-phase response to injury and infection. Amsterdam: Elsevier Science Publishers, 1985: Louw JA, Werbeck A, Louw MEJ, Kotze TJVW, Cooper R, Labadarios D. Blood vitamin concentration during the acute phase response. Crit Care Med 1992;20: Gregory JR, Collins DL, Davies PSW, Hughes JM, Clarke PC. National diet and nutrition survey: children aged 1.5 to 4.5 years. London: Her Majesty s Stationery Office, Mitra AK, Alvarez JO, Mahed MA, Fuchs GJ, Stephensen CB. Predictors of serum retinol in children with shigellosis. Am J Clin Nutr 1998;68: Mitra AK, Alvarez JO, Guay-Woodford L, Fuchs GJ, Wahed MA, Stephensen CB. Urinary retinol excretion and kidney function in children with shigellosis. Am J Clin Nutr 1998;68: Ramsden DB, Prince HP, Burr WA, et al. The inter-relationships of thyroid hormones, vitamin A and their binding protein following acute stress. Clin Endocrinol 1978;8:
Rainer Gross Award Ceremony. David I. Thurnham Howard Professor of Human Nutrition (Emeritus) University of Ulster
Rainer Gross Award Ceremony David I. Thurnham Howard Professor of Human Nutrition (Emeritus) University of Ulster Hildergard-Grunow Foundation Award Criteria 1. Researchers pursuing innovative ideas and
More informationPrevalence of Vitamin A Deficiency among 6 months to 5 years old Children
Prevalence of Vitamin A Deficiency among 6 months to 5 years old Children Htin Lin, May Khin Than, Khaing Mar Zaw, Theingi Thwin, Moh Moh Hlaing I. Introduction Myanmar, likewise other South-East Asian
More information2011 UGANDA DHS - ADDENDUM TO CHAPTER 11
2011 UGANDA DHS - ADDENDUM TO CHAPTER 11 11.9 VITAMIN A 11.9.1 Background and Methodology Vitamin A is an essential micronutrient for vision, for the maintenance of epithelial cells, and for regulation
More informationMeasures of Malnutrition
Measuring food insecurity and assessing the sustainability of global food systems NAS, Washington, DC 16 February 2011 Measures of Malnutrition Lynnette M. Neufeld, Chief Technical Advisor Presentation
More informationChege et al...j. Appl. Biosci Study on diet, morbidity and nutrition of HIV/AIDS infected/non-infected children
A comparative study on dietary practices, morbidity patterns and nutrition status of HIV/AIDS infected and non-infected pre-school children in Kibera slum, Kenya Chege P.*, Kuria E. and Kimiywe J. Journal
More informationEvaluation of Retinol Level Among Preschool Children, Pregnant and Lactating Women Attending Primary Health Care Centres in Baghdad
International Journal of Child Health and Nutrition, 2013, 2, 63-69 63 Evaluation of Retinol Level Among Preschool Children, Pregnant and Lactating Women Attending Primary Health Care Centres in Baghdad
More informationArchives of Clinical and Biomedical Research
Archives of Clinical and Biomedical Research Volume 1, Issue 4 Research Article ISSN: 2572-5017 Haemoglobin Profiles of University Students Participating in Routine Medical Examinations, 2009-2011 Fabian
More informationFinal published version: Accessed May 7, :19 PM EDT
Factors associated with inflammation in preschool children and women of reproductive age: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project Parminder Suchdev, Emory
More informationField Sites Sangam Vihar and Harsh Vihar, Delhi
Institutions Involved Institutions Involved Center for Micronutrient Research, Subharti Medical College, UP Center for Micronutrient Research, Subharti Medical College, UP Center for Public Health Kinetics,
More informationInt.J.Curr.Res.Aca.Rev.2016; 4(6): Impact of Mid Day Meal on Nutritional Status of School Going Children with Special Emphasis on Zinc
Impact of Mid Day Meal on Nutritional Status of School Going Children with Special Emphasis on Zinc Iram Khan* and Sangeeta Pandey Department of Nutrition and Dietetics, Mount Carmel College, No.58, Palace
More informationRedistribution of vitamin A after iron supplementation in Indonesian infants 1 3
Redistribution of vitamin A after iron supplementation in Indonesian infants 1 3 Frank T Wieringa, Marjoleine A Dijkhuizen, Clive E West, David I Thurnham, Muhilal, and Jos WM Van der Meer ABSTRACT Background:
More information(Black et a., 2013) How can livestock interventions affect nutrition outcomes?
Improving diets and nutrition through an integrated poultry value chain and nutrition intervention (SELEVER) in Burkina Faso: A cluster randomised control trial. Livestock, Sanitation, Hygiene, and Child
More informationHOMESTEAD GARDENING FOR COMBATING VITAMIN A DEFICIENCY:THE HELEN KELLER INTERNATIONAL, BANGLADESH, EXPERIENCE
9 HOMESTEAD GARDENING FOR COMBATING VITAMIN A DEFICIENCY:THE HELEN KELLER INTERNATIONAL, BANGLADESH, EXPERIENCE A.TAHER, A.TALUKDER, N.R. SARKAR,V.N. BUSHAMUKA, A. HALL, S. DE PEE, R. MOENCH-PFANNER, L.
More informationRISK APPROACH FOR REDUCING MALNUTRITION IN CHILDREN FROM A PRIVILEGED COMMUNITY
RISK APPROACH FOR REDUCING MALNUTRITION IN CHILDREN FROM A PRIVILEGED COMMUNITY Abstract Pages with reference to book, From 59 To 61 Inayat Hussain Thaver ( Department of Community Health Sciences, Aga
More informationMALNUTRITION. At the end of the lecture students should be able to:
MALNUTRITION 1 MALNUTRITION OBJECTIVES: At the end of the lecture students should be able to: Define and classify malnutrition Enumerate causes and effects of malnutrition Identify strategies for prevention
More informationVitamin A Deficiency: Counting the Cost in Women s Lives
TECHNICAL BRIEF Vitamin A Deficiency: Counting the Cost in Women s Lives Amy L. Rice, PhD INTRODUCTION Over half a million women around the world die each year from conditions related to pregnancy and
More informationMethodological issues in the use of anthropometry for evaluation of nutritional status
Methodological issues in the use of anthropometry for evaluation of nutritional status Monika Blössner WHO Department of Nutrition for Health and Development Methodological issues in the use of anthropometry?
More informationK. Srinivasa Rao 1, K. Kalyan Kumar 2, Usha L H 3
185 Print ISSN - Acta Biomedica Scientia e - ISSN - 2348-2168 Print ISSN - 2348-215X J o u r n a l h o m e p a g e : w w w. m c m e d. u s / j o u r n a l / a b s ASSESSMENT OF SERUM RETINOL LEVEL AND
More informationAgriculture and Nutrition Global Learning and Evidence Exchange (AgN-GLEE)
This presentation is part of the Agriculture and Nutrition Global Learning and Evidence Exchange (AgN-GLEE) held in Bangkok, Thailand from March 19-21, 2013. For additional presentations and related event
More informationTHE IMPACT OF PARENTAL EDUCATION AND SOCIOECONOMIC STATUS ON ROUTINE CHILDHOOD VACCINATION: AN OBSEVATIONAL STUDY
ORIGINAL ARTICLE THE IMPACT OF PARENTAL EDUCATION AND SOCIOECONOMIC STATUS ON ROUTINE CHILDHOOD VACCINATION: AN OBSEVATIONAL STUDY Samreen Ahmad 1, Shahzada Bakhtyar Zahid 2, Anwar Zeb Jan 3 ABSTRACT Objective:
More informationWomen by area: Urban F Women by area: Rural F
Vitamin and Mineral Nutrition Information System (VMNIS) WHO Global Database on Vitamin A Deficiency The Vitamin A Deficiency database includes data by country based on xerophthalmia and/or serum or plasma
More informationTHE PREVALENCE OF MALNUTRITION IN DEVELOPING COUNTRIES: A REVIEW ABSTRACT
THE PREVALENCE OF MALNUTRITION IN DEVELOPING COUNTRIES: A REVIEW Yasser Hussein Issa Mohammed, Noor Fathima Khanum, S. V. Mamatha, Mahima Jyothi, Zabiulla,Fares Hezam Al-Ostoot and Shaukath Ara Khanum
More informationJMSCR Vol 06 Issue 01 Page January 2018
www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 71.58 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v6i1.101 Prevalence of anemia and its association
More informationNutrition News for Africa 05/2017
Predictors and pathways of language and motor development in four prospective cohorts of young children in Ghana, Malawi, and Burkina Faso. Prado EL, Abbeddou S, Adu-Afarwuah S, et al. Journal of Child
More informationCURRICULUM VITAE. University Address: Department of Human Nutrition, Khyber Paktunkhwa Agricultural University, Peshawar, Pakistan
CURRICULUM VITAE Personal: Name: Parvez Iqbal Paracha Date of Birth: April 1, 1953 Place of Birth: Marital Status: Present Position: Field of Specialization: Field of Interest (Teaching): Field of Interest
More informationRoutine Immunization Status among Children under 5 Years of Age living in Rural District of Pakistan
International Journal of Health Research and Innovation, vol. 3, no. 2, 2015, 13-20 ISSN: 2051-5057 (print version), 2051-5065 (online) Scienpress Ltd, 2015 Routine Immunization Status among Children under
More informationDeterminants of Under Nutrition in Children under 2 years of age from Rural. Bangladesh
RESEARCH BRIEF Determinants of Under Nutrition in Children under 2 years of age from Rural Bangladesh AM SHAMSIR AHMED, TAHMEED AHMED, SK ROY, NURUL ALAM AND MD IQBAL HOSSAIN From the Centre for Nutrition
More informationNutrition in the Post-2015 Context. Lynnda Kiess Head, Nutrition and HIV Unit, WFP
Nutrition in the Post-2015 Context Lynnda Kiess Head, Nutrition and HIV Unit, WFP Presentation Different Dimensions of Malnutrition Consequences Food Security and Nutrition Looking forward Key Points Nutrition
More informationFig. 64 Framework describing causes and consequences of maternal and child undernutriton
9.0 PREVALENCE OF MALNUTRITION 118 This chapter presents the prevalence of the three types of malnutrition (wasting, stunting and underweight) by background characteristic and livelihood zones in children
More informationAdjusting ferritin concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project
Adjusting ferritin concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project Sorrel ML Namaste, Strengthening Partnerships, Results, and
More informationPublished by HSRC Press Private Bag X9182, Cape Town, 8000, South Africa First published 2013
Published by HSRC Press Private Bag X9182, Cape Town, 8000, South Africa www.hsrcpress.ac.za First published 2013 ISBN (soft cover) 978-0-7969-2446-9 ISBN (pdf) 978-0-7969-2447-6 ISBN (e-pub) 978-0-7969-2448-3
More informationCHILD MORBIDITY PATTERNS AND THE RISK TO ZINC DEFICIENCY: A CASE OF ELGEYO-MARAKWET COUNTY, KENYA
CHILD MORBIDITY PATTERNS AND THE RISK TO ZINC DEFICIENCY: A CASE OF ELGEYO-MARAKWET COUNTY, KENYA Caroline K.Gatobu Kisii University-Eldoret Campus School of Health Sciences, P.O. Box, 6434-30100, Eldoret,
More informationMALNUTRITION AND INFECTIOUS DISEASE MORBIDITY AMONG CHILDREN MISSED BY THE CHILDHOOD IMMUNIZATION PROGRAM IN INDONESIA
SOUTHEAST ASIAN J TROP MED PUBLIC HEALTH MALNUTRITION AND INFECTIOUS DISEASE MORBIDITY AMONG CHILDREN MISSED BY THE CHILDHOOD IMMUNIZATION PROGRAM IN INDONESIA Richard D Semba 1, Saskia de Pee 2, Sarah
More informationMaternal and Infant Nutrition Briefs
Maternal and Infant Nutrition Briefs November/December 2002 A research-based newsletter prepared by the University of California for professionals interested in maternal and infant nutrition Recent Trends
More informationPrevalence of vitamin A deficiency in primary school children of Taluka Maval, district Pune of India
ISSN: 2347-3215 Volume 2 Number 1 (January, 2014) pp. 25-29 www.ijcrar.com Prevalence of vitamin A deficiency in primary school children of Taluka Maval, district Pune of India Ranjeeta Chatterjee* Department
More informationNutritional Status in Pakistan
MIMAP TECHNICAL PAPER SERIES NO. 8 Nutritional Status in Pakistan SARFRAZ KHAN QURESHI Former Director HINA NAZLI Research Economist and GHULAM YASIN SOOMRO Senior Research Demographer January 2001 PAKISTAN
More informationIron deficiency anaemia in young children (6 to 23 months) in relation to complementary feeding practices in rural Telangana, India
International Journal of Contemporary Pediatrics Sailaja K et al. Int J Contemp Pediatr. 2017 Jul;4(4):1240-1244 http://www.ijpediatrics.com pissn 2349-3283 eissn 2349-3291 Original Research Article DOI:
More informationBiomarkers of inflammation for population research: Stability of C-reactive protein and alpha 1 -acid glycoprotein in dried blood spots.
Biomarkers of inflammation for population research: Stability of C-reactive protein and alpha -acid glycoprotein in dried blood spots. Running title: CRP and AGP in dried blood spots Authors and institutions:
More informationDeterminants of Food Acceptance and Micro-Nutrient Deficiency in Preschoolers: A Case Study of Households from Karachi, Pakistan
MPRA Munich Personal RePEc Archive Determinants of Food Acceptance and Micro-Nutrient Deficiency in Preschoolers: A Case Study of Households from Karachi, Pakistan Subzwari, Zammurud; Hasnain, Abid and
More informationPrevalence and Socio-Demographic Correlates of Anaemia among G.C.E (A/L) Students in Jaffna Zonal Schools
Proceedings of Jaffna University International Research Conference (JUICE-2012), pp. 122-128, published: March 2014, Sri Lanka Prevalence and Socio-Demographic Correlates of Anaemia among G.C.E (A/L) Students
More informationStop stunting: situation and way forward to improve maternal, child and adolescent nutrition in Afghanistan 1
Commentary DOI: 10.1111/mcn.12288 Stop stunting: situation and way forward to improve maternal, child and adolescent nutrition in Afghanistan 1 Ariel Higgins-Steele *, Piyali Mustaphi *, Sherin Varkey
More informationGAIN S GLOBAL STRATEGY ON FOOD FORTIFICATION TO IMPROVE PUBLIC HEALTH ASIA HIGHLIGHTS. Regina Moench-Pfanner, PhD Director, Singapore GAIN
GAIN S GLOBAL STRATEGY ON FOOD FORTIFICATION TO IMPROVE PUBLIC HEALTH ASIA HIGHLIGHTS Regina Moench-Pfanner, PhD Director, Singapore GAIN 1 GAIN - Introduction GAIN was founded at a UN global summit on
More informationA PATH ANALYSIS ON THE NOURISHMENT DIRECTED HAEMOGLOBIN STATUS AND RESULTING ENDURANCE CAPACITY OF ADOLESCENT INDIAN RURAL GIRLS
J. Dairying, Foods & H.S., 29 (1) : 47-51, 21 AGRICULTURAL RESEARCH COMMUNICATION CENTRE www.arccjournals.com / indianjournals.com A PATH ANALYSIS ON THE NOURISHMENT DIRECTED HAEMOGLOBIN STATUS AND RESULTING
More informationAppraisal of Iodine Status and Goiter Rate in Adolescent School Girls of City District Lahore
ORIGINAL ARTICLE Appraisal of Iodine Status and Goiter Rate in Adolescent School Girls of City District Lahore SEEMA IMDAD, RIZWANA MUZAFFAR, MALIK SHAHID SHOUKAT ABSTRACT Aim: To appraise the iodine status
More informationNUTRITION and. Child Growth & Development. Washington, DC May 2-3, Kay Dewey. UC-Davis and Alive & Thrive
Clean, Fed & Nurtured: Joining forces to promote child growth and development NUTRITION and Child Growth & Development Washington, DC May 2-3, 2013 Kay Dewey UC-Davis and Alive & Thrive Nutrition Basics
More informationPrevalence of Anaemia in Semi-Urban Areas of Peshawar, Pakistan: A Challenge for Health Professionals and Policy Makers
Abstract Prevalence of Anaemia in Semi-Urban Areas of Peshawar, Pakistan: A Challenge for Health Professionals and Policy Makers Pages with reference to book, From 49 To 53 Parvez I. Paracha ( Department
More informationCommunity and International Nutrition
Community and International Nutrition Effects of Iron and Zinc Supplementation in Indonesian Infants on Micronutrient Status and Growth 1 Marjoleine A. Dijkhuizen,* Frank T. Wieringa,* Clive E. West,*
More informationCHAPTER 9 GENERAL RECOMMENDATIONS FRAMEWORK FOR MAKING RECOMMENDATIONS
CHAPTER 9 GENERAL RECOMMENDATIONS FRAMEWORK FOR MAKING RECOMMENDATIONS Initially, the prime objective of this study was to assess the anthropometric, vitamin A and iron status in children 6-71 months old
More informationJosie Grace C. Castillo, M.D.
Josie Grace C. Castillo, M.D. 2 types of nutrients Macronutrients Carbohydrate Fats Protein Micronutrients Vitamins Minerals 1 Occur when the quantity or quality of food is not sufficient to meet a persons
More informationIMPROVING NUTRITION SECURITY IN ASIA An EU-UNICEF Joint Action
IMPROVING NUTRITION SECURITY IN ASIA An EU-UNICEF Joint Action One billion people in the world suffer from chronic hunger. Two thirds of them live in Asia. This is a crisis with devastating and farreaching
More informationIRON DEFICIENCY IN ADOLESCENTS
ABSTRACT IRON DEFICIENCY IN ADOLESCENTS Pages with reference to book, From 3 To 5 Farida Agha, Agha Sadaruddin ( PMRC Central Research Centre, Islamabad. ) R.A. Khan ( Energy Medical Centre, Jinnah Postgraduate
More informationVitamin A Facts. for health workers. The USAID Micronutrient Program
Vitamin A Facts for health workers The USAID Micronutrient Program What is vitamin A? Vitamin A Vitamin A is a nutrient required in small amounts for the body to function properly. It is called a micronutrient
More informationBiochemical parameters
Biochemical parameters Urea The liver produces urea if amino acids break down. Urea production is bigger after a protein rich meal and when endogenous catabolism is increased (infections, internal bleedings,
More informationNutrition News for Africa October
Nutrition News for Africa October 2013 Engle-Stone R, Nankap M, Ndjebayi AO, Erhardt J, Brown KH. Plasma ferritin, soluble transferrin receptor, and body iron stores identify similar risk factors for iron
More informationDevelopment of a complementary feeding manual for Bangladesh
TERMS OF REFERENCE #14 For the research proposal to be funded under NFPCSP Phase II Development of a complementary feeding manual for Bangladesh 1. Background and Rationale Inappropriate infant and young
More informationINDIAN JOURNAL OF MATERNAL AND CHILD HEALTH
Volume 13 (1), 2011 Prevalance of Clinical Vitamin A Deficiency (VAD) amongst Preschool going Children in Rural Areas of Kancheepuram District ( Tamil Nadu) Jha Ranjit K S Gopalakrishnan K Mohanraj K Ajitha
More informationLinking Rice Fortification Opportunities with Nutrition Objectives
RICE FORTIFICATION IN WEST AFRICA LINKING RICE FORTIFICATION OPPORTUNITIES WITH NUTRITION OBJECTIVES 87 Linking Rice Fortification Opportunities with Nutrition Objectives Christiane Rudert UNICEF East
More informationNutritional Status of Anganwadi Children under the Integrated Child Development Services Scheme in a Rural Area in Goa
Original Article DOI: 10.17354/ijss/015/480 Nutritional Status of Anganwadi Children under the Integrated Child Development Services Scheme in a Rural Area in Goa Vanita G Pinto Silva 1, Savita G Pinto
More informationCook Islands Food and Nutrition Security Profiles
Key Indicators Cook Islands Food and Nutrition Security Profiles Mortality in children has shown a constant reduction over the years, but unless further acceleration, Cook Islands will not achieve the
More informationThe Success of Fortification of Sugar. Héctor Cori Nutrition Science Director Latinoamérica London, November 30, 2016.
The Success of Fortification of Sugar Héctor Cori Nutrition Science Director Latinoamérica London, November 30, 2016. Vitamin A Functions Vitamin A is essential for Embryogenesis, growth and development
More informationDIETARY REFERENCE INTAKES (DRIS) FOR MONGOLIANS
DIETARY REFERENCE INTAKES (DRIS) FOR MONGOLIANS Tuyatsetseg Jambal, Ph.D School of Industrial Technology, Mongolian University of Science & Technology, Outline Background Mongolian DRIs Briefly report
More informationDIET INTERVENTION FOR REDUCING MALNUTRITION AMONG PRESCHOOL CHILDREN
Indo-Am. J. Agric. & Vet. Sci., 2014 Maharshi ISSN Deepa 2321 9602 and Suratani www.iajavs.com Sreedhar, 2014 Vol. 2, No. 3, September 2014 2014 Meghana Publications. All Rights Reserved Research Paper
More information390S. Keywords: anemia, inflammation, meta-analysis, nutritional assessment, retinol-binding protein, vitamin A deficiency INTRODUCTION
Adjusting retinol-binding protein concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project Leila M Larson, 1 Sorrel ML Namaste, 3,4 Anne
More informationMyanmar Food and Nutrition Security Profiles
Key Indicators Myanmar Food and Nutrition Security Profiles Myanmar has experienced growth in Dietary Energy Supply (DES). Dietary quality remains poor, low on protein and vitamins and with high carbohydrates.
More informationMarshall Islands Food and Nutrition Security Profiles
Key Indicators Marshall Islands Food and Nutrition Security Profiles Marshall Islands has made significant improvements in health and child survival; nevertheless, it will not achieve the Millennium Development
More informationFill the Nutrient Gap Pakistan: Rationale, key findings and recommendations. Fill the Nutrient Gap National Consultation Islamabad, 11 April 2017
Fill the Nutrient Gap Pakistan: Rationale, key findings and recommendations Fill the Nutrient Gap National Consultation Islamabad, 11 April 2017 Meeting nutrient requirements is a prerequisite for preventing
More informationEarly Nutrition and Adult Noncommunicable. that must be broken
Early Nutrition and Adult Noncommunicable diseases: A vital link that must be broken Commonwealth Health Ministers Meeting WHO, Geneva May 14, 2011 Anna Lartey (Associate Professor) Department of Nutrition
More informationTuvalu Food and Nutrition Security Profiles
Key Indicators Tuvalu Food and Nutrition Security Profiles Tuvalu has experienced a decreasing trend in infant mortality rates, but the country will not meet the Millennium Development Goal (MDG) target.
More informationDeficiency of Micronutrient Status in Pulmonary Tuberculosis Patients in North India
Biomedical Research 211, 22 (4): 449-454 Deficiency of Micronutrient Status in Pulmonary Tuberculosis s in North India Irfan Ahmad*, VK Srivastava*, R Prasad**, Mohd. Yusuf***, Safia***, M Saleem*, Wahid
More informationBREASTFEEDING TO PREVENT DOUBLE BURDEN OF MALNUTRITION
BREASTFEEDING TO PREVENT DOUBLE BURDEN OF MALNUTRITION Sirinuch Chomtho Department of Pediatrics, Chulalongkorn University, Bangkok, Thailand The double burden of malnutrition means under- and over-nutrition
More informationChildren s Health and Nutritional Status. Data from the 2011 Ethiopia Demographic and Health Survey
Children s Health and Nutritional Status Data from the 2011 Ethiopia Demographic and Health Survey This report summarises the child health and nutrition findings from the 2011 Ethiopia Demographic and
More informationOriginal Research: Nutrition education to improve dietary intake and micronutrient nutriture among children. Abstract.
Nutrition education to improve dietary intake and micronutrient nutriture among children in less-resourced areas: a randomised controlled intervention in Kabarole district, western Uganda Abstract Kabahenda
More informationUnder-five and infant mortality constitutes. Validation of IMNCI Algorithm for Young Infants (0-2 months) in India
R E S E A R C H P A P E R Validation of IMNCI Algorithm for Young Infants (0-2 months) in India SATNAM KAUR, V SINGH, AK DUTTA AND J CHANDRA From the Department of Pediatrics, Kalawati Saran Children s
More informationMyanmar - Food and Nutrition Security Profiles
Key Indicators Myanmar - Food and Nutrition Security Profiles Myanmar has experienced growth in Dietary Energy Supply (DES). Dietary quality remains poor, low on protein and vitamins and with high carbohydrates.
More informationMangement of severe acute malnutrition in Cambodian children 6-59 months
Mangement of severe acute malnutrition in Cambodian children 6-59 months 14 th LAO PEDIATRIC CONTINUING MEDICAL EDUCATION CONFERENCE March 1-2, 2018 Vientiane, Laos Ms. Sanne Sigh, Cand. scient. Human
More informationPrevalence of Zinc Deficiency in Elementary School Children of South Khorasan Province (East Iran)
Original Article Iran J Pediatr Sep 2009; Vol 19 (No 3), Pp:249-254 Prevalence of Zinc Deficiency in Elementary School Children of South Khorasan Province (East Iran) Azita Fesharakinia* 1, MD; Asghar
More informationShiree/EEP nutritional surveys in 2013 and 2015: adolescent girls
Dr Rie Goto and Professor Nick Mascie-Taylor University of Cambridge May 2015 Shiree/EEP nutritional surveys in 2013 and 2015: adolescent girls Key findings Regular iron and folate supplementation and
More informationIntegrated Community Case Management (iccm) and the role of pneumonia diagnostic tools
Integrated Community Case Management (iccm) and the role of pneumonia diagnostic tools Theresa Diaz MD MPH Senior Health Advisor Health Section UNICEF, NY (on behalf of Mark Young) Strong need for community-based
More informationNutritional Profile of Urban Preschool Children of Punjab
KamlaRaj 2003 Anthropologist, 5 (3): 149153 (2003) Nutritional Profile of Urban Preschool Children of Punjab Inderjit Singh and Kiran Grover Growth retardation and malnutrition are the major public health
More informationSUMMARY REPORT GENERAL NUTRITION SURVEY
SUMMARY REPORT GENERAL NUTRITION SURVEY 29-21 NATIONAL NUTRITION STRATEGY FOR 211 22, WITH A VISION TOWARD 23 NATIONAL INSTITUTE OF NUTRITION MINISTRY OF HEALTH UNITED NATIONS CHILDREN S FUND SUMMARY Assessment
More informationRisk Factors of Pneumonia in Children A Community Survey
TAJ December 2007; Volume 20 Number 2 ISSN 1019-8555 The Journal of Teachers Association RMC, Rajshahi Original Article Risk Factors of Pneumonia in Children A Community Survey M I Bari 1, A B Siddiqui
More informationNauru Food and Nutrition Security Profiles
Key Indicators Nauru Food and Nutrition Security Profiles Nauru has remained stationary in health and child survival outcomes and will not achieve the Millennium Development Goal (MDG) on child mortality.
More informationReducing Malnutrition in Zambia: Summary of Estimates to Support Nutrition Advocacy ZAMBIA NUTRITION PROFILES 2017
Reducing Malnutrition in Zambia: Summary of Estimates to Support Nutrition Advocacy ZAMBIA NUTRITION PROFILES 2017 This report is made possible by the generous support of the American people through the
More informationGlobal Update. Reducing Mortality From Major Childhood Killer Diseases. infant feeding, including exclusive breastfeeding.
INDIAN PEDIATRICS VOLUME 35-FEBRUARY 1998 Global Update Reducing Mortality From Major Childhood Killer Diseases Seven out of 10 childhood deaths in developing countries can be attributed to just five main
More informationDemographic and Health-related Risk Factors of Subclinical Vitamin A Deficiency in Ethiopia
J HEALTH POPUL NUTR 2009 Oct;27(5):666-673 ISSN 606-0997 $ 5.00+0.20 INTERNATIONAL CENTRE FOR DIARRHOEAL DISEASE RESEARCH, BANGLADESH Demographic and Health-related Risk Factors of Subclinical Vitamin
More informationInvesting in Essential Vitamins and Minerals: A Critical Public Health Strategy for Tajikistan
Investing in Essential Vitamins and Minerals: A Critical Public Health Strategy for Tajikistan Greg S. Garrett 27 January 2017 Contents 1. Magnitude of problem: hidden hunger 2. Effects of hidden hunger
More informationh e a l t h l i n e ISSN X Volume 3 Issue 1 January-June 2012
Original article A study of risk factors of acute respiratory tract infection (ARI) of under five age group in uban and rural communities of Ahmedabad district, Gujarat Bipin Prajapati 1, Niti Talsania
More informationMONGOLIA. The 1997 World Vision/Nutrition Research Center (WV/NRC) report showed that 5.8% of infants were born with a low birth weight (<2500 g).
MONGOLIA Population 1 2 442.540 Infant mortality rate 2 30.4 per 1000 live births Life expectancy at birth 1 65.3 years Fertility rate 1 2.2 Annual population growth 1 1.4% NUTRITION OVERVIEW Major achievements
More informationMalnutrition among Pre-school Children in Alexandria, Egypt
J HEALTH POPUL NUTR 2001 Dec;19(4):275-280 2001 ICDDR,B: Centre for Health and Population Research ISSN Malnutrition 1606-0997 among $ pre-school 5.00+0.20children 275 Malnutrition among Pre-school Children
More informationInsights into Child Nutritional Status and Programmes in Malaysia
Insights into Child Nutritional Status and Programmes in Malaysia Khor Geok Lin International Medical University, Malaysia Kuala Lumpur 6-7 Nov 2012 1 Child nutritional status in Malaysia including changing
More informationKey words: social marketing, iron-folic acid, socioeconomic INTRODUCTION
December 2005: (II)S134 S138 Positive Impact of a Weekly Iron-Folic Acid Supplement Delivered with Social Marketing to Cambodian Women: Compliance, Participation, and Hemoglobin Levels Increase with Higher
More informationImpact of Vitamin A Deficiency on Infant and Childhood Mortality
Vitamins and Minerals in Pregnancy and Lactation, edited by Heribert Berger. Nestte Nutrition Workshop Series, Vol. 16. Nestec Ltd., Vevey/Raven Press, Ltd., New York 1988. Impact of Vitamin A Deficiency
More informationThe Lancet Series on Maternal and Child Nutrition Launch Symposium 6 June, 2013
The Lancet Series on Maternal and Child Nutrition Launch Symposium 6 June, 2013 Imperial College St Mary s Campus Rothschild Lecture Hall, School of Medicine Norfolk Place, London Maternal and Child Undernutrition
More informationSoutheast Asia: Nutrition in transition and its challenges for maternal and child nutrition
Southeast Asia: Nutrition in transition and its challenges for maternal and child nutrition Pattanee Winichagoon, PhD Institute of Nutrition, Mahidol University (INMU), Thailand Presented at the Regional
More informationUpdate on the nutrition situation in the Asia Pacific region
Update on the nutrition situation in the Asia Pacific region Mike Toole 13 th National Rural Health Conference, Darwin, 24-27 May 2015 Source: DFAT, Port Moresby, Papua New Guinea Conceptual framework
More informationAcute Malnutrition in Bangladeshi Children: levels and determinants
1 Acute Malnutrition in Bangladeshi Children: levels and determinants by A Rahman (MSc, UC; MPhil, USQ) *,, S Chowdhury (MA, ANU; PhD, DU) ** and D Hossain (MSc, BAU; PhD, MSU) * * Centre for Rural and
More informationEradicating Malnutrition Income Growth or Nutrition Programs?
Eradicating Malnutrition Income Growth or Nutrition Programs? By: Lawrence James Haddad Harold Alderman From IFPRI 1999-2000 Industrial Food Policy Research Institute 2033 K. Street NW Washington, DC 20006-1002
More informationNutrition News for Africa June
Nutrition News for Africa June 2015 Olney DK, Pedehombga A, Ruel MT, Dillon A. A 2-year integrated agriculture and nutrition and health behavior change communication program targeted to women in Burkina
More informationSolomon Islands Food and Nutrition Security Profiles
Key Indicators Solomon Islands Food and Nutrition Security Profiles Solomon Islands has experienced stagnation in percapita GDP and undernourishment in recent years. Dietary Energy Supply (DES) has continued
More informationCHILD HEALTH. There is a list of references at the end where you can find more information. FACT SHEETS
SOME 18,000 CHILDREN STILL DIE EVERY DAY FROM DISEASES THAT ARE MOSTLY PREVENTABLE. This fact sheet outlines some of the basic information related to the health and wellbeing of children under five years
More information