Gantira Natadisastra

Impact of vitamin a supplementation on hematological indicators of iron metabolism and protein status in children

Abstract A randomized, double-masked, placebo-controlled, clinical trial of 236 preschool children, age 3–6, in West Java, Indonesia, was carried out to assess the impact of vitamin A supplementation on hematological indicators of iron metabolism and nutritional status. Clinically normal children (n=118) were matched by age and sex with xerophthalmic children (n=118) and randomized to receive oral vitamin A, 60,000 μg retinol equivalent, or placebo, creating a total of four study groups. Vitamin A supplementation was associated with a large increase (14.9±15.6 μg/L) in plasma ferritin (p

Response of Bitot's Spots in Preschool Children to Vitamin A Treatment

In a double-masked, placebo-controlled, clinical trial in Indonesia, 88 preschool children between the ages of 36 and 72 months with Bitots spots were randomly assigned to 200,000 IU of oral vitamin A or placebo and followed up for five weeks. Baseline and follow-up serum vitamin A levels were obtained. Of the 45 children receiving vitamin A, 33 (73.3%) showed complete cure and disappearance of Bitots spots, six (13.3%) had disappearance of some but not all Bitots spots, and six (13.3%) were unresponsive to treatment. The nonresponsive children were older, all male, and had higher initial mean serum vitamin A levels, 23.0 micrograms/dl, compared to 15.9 micrograms/dl in the cured group (P = .017). These data suggest that normal vitamin A status may be found in approximately 13% of children with Bitots spots before vitamin A intervention and that one fourth of those who had Bitots spots originally will not be cured of all Bitots spots after intervention. These are important factors to consider when using Bitots spots in prevalence surveys as a clinical sign of vitamin A deficiency.

24-Hour History is More Closely Associated with Vitamin a Status and Provides a Better Estimate of Dietary Vitamin a Intake of Deficient Indonesian Preschool Children Than a Food Frequency Method

OBJECTIVES To determine if the Simplified Dietary Assessment to Identify Groups at Risk of Inadequate Intake of Vitamin A developed by the International Vitamin A Consultative Group (IVACG) correctly classified a group of vitamin A-deficient children as being at risk, and to see if a food frequency questionnaire (FFQ) or 24-hour history (24HH) yielded estimated dietary vitamin A intakes most closely associated with vitamin A status. DESIGN Forty-seven foods were identified as contributing most of the vitamin A to the diet of the study population. For each food, usual portion sizes were determined during a pilot study. Intake was calculated from data collected by FFQ and 24HH. Four modifications of the 24HH analysis were made to determine if this method of analysis could be simplified. SUBJECTS/SETTING Subjects were 265 Indonesian children with or at high risk of developing xerophthalmia. RESULTS Mean and median intakes of vitamin A based on the 24HH analysis were 50% and 27% of the US Recommended Dietary Allowance, respectively, which accurately identified the study sample as being at risk. Dietary intake based on the 24HH was significantly associated with serum retinol concentration (P = .01, trend test). Eliciting portion sizes during the 24HH was not necessary once the usual portion sizes consumed by the population were estimated in the pilot study. Mean and median intakes of vitamin A based on the FFQ were 150% and 118% of the Recommended Dietary Allowance, respectively, which suggests that the FFQ overestimated intake. Intake based on the FFQ was not correlated with serum retinol concentration. CONCLUSIONS Our findings do not support the IVACG recommendation that the FFQ be regarded as more reliable than the 24HH when the 2 methods produce different conclusions, nor the recommendation of some users of the method that the 24HH be dropped from the assessment method.

Response of Bitot's spots to a single oral 100,000- or 200,000-IU dose of vitamin A.

PURPOSE A randomized, controlled clinical trial was conducted in Indonesia to study the response of Bitots spots to a 100,000-IU dose of vitamin A, which is known to be associated with fewer acute side effects than the currently recommended 200,000-IU dose. METHODS A total of 114 children (ages 13 to 59 months) with Bitots spots were given an ocular examination; serum retinol concentration was measured, and the relative dose response test carried out. After administering one 100,000- or 200,000-IU oral dose of vitamin A, ocular examinations were repeated weekly for seven weeks and then biweekly for 20 more weeks, or until lesions were healed on two consecutive examinations. RESULTS Either dose of vitamin A was similarly effective in healing Bitots spots. The most important factor in predicting responsiveness to treatment was baseline serum retinol concentration: children with lower pretreatment concentrations were more likely to have responsive lesions. No child had a relapse within the first three months after treatment. However, by six months, children who had received the higher dose were 82% less likely to have a relapse compared with children who had received the lower dose. CONCLUSIONS Although either a 100,000- or 200,000-IU dose of vitamin A is similarly effective in healing Bitots spots, a 200,000-IU dose provides longer protection. This benefit justifies the higher rates of transient mild side effects associated with the 200,000-IU dose. The current 200,000-IU dose of vitamin A recommended by the World Health Organization for prophylactic dosing should not be reduced.

Reproducibility of Determining Vitamin A Status by Impression Cytology

Impression cytology is a simple technique for detecting vitamin A deficiency. Methods of specimen collection, fixation, and staining are amenable to use in developing countries. Routine use of the technique requires good interobserver agreement. We compared the impression cytology results of 206 patient examinations analyzed by an experienced observer with those obtained by a newly trained observer. Percent agreement measured 96% (197/206) with a kappa of 0.90, indicating excellent agreement. Further improvement in interobserver agreement may be obtainable by simplification of the staining process to highlight the presence or absence of goblet cells, and by simplification of the staging criteria.