Rejane Andréa Ramalho

Hipovitaminose A no Brasil: um problema de saúde pública

Vitamin A deficiency is considered one of the most important of the easily preventable public health problems in a number of countries, including Brazil. The objective of this study was to review the scientific literature in the MEDLINE and LILACS databases that was published between 1970 and 2000 concerning vitamin A deficiency, and to assess the occurrence of hypovitaminosis A in Latin America, especially Brazil. Our research showed that until around 1980 the public health concerns focused mainly on the importance of vitamin A in ensuring good vision. In the second half of the 1980s, epidemiological studies suggested that, on a population level, subclinical vitamin A deficiency could also have a negative effect on metabolic functions, with a great impact on childhood morbidity and mortality. Marginal vitamin A deficiency has been reported in all the regions of Brazil for which there are data available, with high prevalences in various age groups. This situation is inexcusable, given the health care technology and resources that are now available. There must be a commitment to reducing vitamin A deficiency in order to ensure the adequate development of future generations.

Hipovitaminose A em recém-nascidos em duas maternidades públicas no Rio de Janeiro, Brasil

O estado nutricional de vitamina A foi avaliado, atraves dos niveis de retinol no sangue do cordao umbilical, em 253 recem-nascidos assistidos em duas maternidades publicas do Municipio do Rio de Janeiro. Independentemente da idade gestacional e do peso ao nascer, a prevalencia de valores baixos de retinol (< 1,05 µmol/l) foi elevada (55,7%). Em criancas com baixo peso, essa prevalencia chegou a 68,7%. Confirmando uma serie de observacoes de outros autores, nao se observou qualquer associacao entre estado nutricional, avaliado antropometricamente, e niveis de retinol. Os resultados mostram que, na amostra investigada, a prevalencia de hipovitaminose A nos recem-nascidos e comparavel as cifras que se encontram nas regioes mais pobres do mundo, e sugerem a necessidade de se prestar especial atencao a esse grupo populacional por ser, entre os grupos de risco, o mais vulneravel aos efeitos deleterios da carencia marginal de vitamina A, em razao do rapido crescimento nos primeiros meses de vida.Vitamin A status (umbilical cord retinol levels) of 253 newborns in two public hospitals of Rio de Janeiro showed a high prevalence (55. 7%) of deficiency (retinol levels below 1.05 micromol/L). This rate of vitamin A deficiency (VAD) was independent of other nutritional and anthropometric parameters, such as low birth weight or small for gestational age. These data suggest that newborns can be as vulnerable to VAD as other population groups considered at high risk. They also suggest that special attention should be paid to this group, actually the most vulnerable to the harmful effects of VAD. Hypovitaminosis A should be among the first diagnostic hypotheses when an infant presents with an abnormality

Valores séricos de vitamina A e teste terapêutico em pré-escolares atendidos em uma Unidade de Saúde do Rio de Janeiro, Brasil

The impact of a massive dose of vitamin A on preschool children attended in a health unit from Rio de Janeiro was evaluated. Initially, serum retinol levels and anthropometric measurements were determined in 175 preschool children attended in the Childrens Service of the Universidade Federal do Rio de Janeiro, after which a massive (200.000 IU) dose of vitamin A was provided. The children were requested to return to the unit after 30 days. Serum retinol levels were measured in the children who returned (n=99). The prevalence of low (below 1.05 µmol/L) levels of circulating retinol was of 34.3% in all children evaluated in the first attendance. After 30 days the prevalence was reduced from 42.4 to 3.0%. The lower the initial retinol levels the better the benefit from the massive dose. The proportion of children with protein-energy malnutrition was of 4.6%, but no clear association was found between vitamin A deficiency and protein-energy malnutrition. Vitamin A deficiency was independent of the household income and educational level of the parents. The response of children with vitamin A deficiency to the massive dose indicates that a low vitamin A intake may play an important role in the etiology of the problem. The prevalence figures also demonstrate that this problem is not exclusive of the traditionally poor areas of the country.

Níveis séricos de retinol em escolares de 7 a 17 anos no município do Rio de Janeiro

Encontrou-se um total de 10,30% de escolares com baixos niveis de retinol serico. Ao considerar a faixaetaria, observou-se uma tendencia a maiores percentuais de niveis inadequados de retinol serico entre escolaresmais jovens (11,98% na faixa etaria de 7 a 10 anos e 7,92% na faixa etaria de 10 a 17 anos).

Impact of Vitamin A Megadose Supplementation on the Anthropometry of Children and Adolescents with Non-Hormonal Statural Deficit: a Double-blind and Randomized Clinical Study

OBJECTIVE To evaluate the intake of retinol and carotenoids, and their serum levels, as well as the impact of vitamin A supplementation on the anthropometry and body composition of children and adolescents with non-hormonal-related statural deficit. METHOD Double-blind, randomized trial of 46 pre-pubertal patients, between 4 and 14 years of age, with normal growth rates. The subjects were divided into two groups, each with 23 individuals (Group I: Placebo; Group II: Vitamin A in a single megadose), and were evaluated at moments A and B with a six month interval. RESULTS There were no statistically significant differences in serum retinol levels, anthropometry, growth velocity, or body composition, between moments A and B, in Group II. Carotenoids were significantly lower in Group I at moment B. The semi-quantitative food intake questionnaire showed that approximately 60.9% of the children and adolescents ingested less than half of the amounts of retinol and carotenoids recommended by the Food Guide Pyramid. Inadequate intake was more prevalent regarding vegetable and fruit carotenoid sources, with 75 and 70% of inadequacy, respectively. CONCLUSION If one considers the inadequate food intake observed in the dietary evaluation in this study, it is possible that multiple micronutrient deficiencies could be involved in statural deficits. This could explain why vitamin A supplementation does not seem to influence growth in children and adolescents with statural deficit, as indicated by the present study. Thus in populations such as the one studied here, the supplementation with vitamin A should be integrated into comprehensive nutritional interventions, so as to possibly promote greater positive impact on linear growth.

Ultrassonografia e ressonância magnética: estudo comparativo no diagnóstico da esteatose em obesos grau III

OBJECTIVES: To evaluate the concordance between abdominal ultrasound and an MRI (Magnetic Resonance Imaging) in the diagnosis of non-alcoholic fatty liver disease (NAFLD), and concordance of these two methods with the histopathological exam. METHODS: The population studied was comprised of 145 patients with morbid obesity (BMI > 40 Kg/m2), of both genders. NAFLD diagnosis was performed by MRI and Ultrasound. Liver biopsy was performed in a sub-sample (n=40). To evaluate the concordance of these two methods, the kappa coefficient was used. RESULTS: Concordance between both methods (MRI and Ultrasound) was poor and not significant (Kappa adjusted= 0.27; CI 95%= 0.07-0.39.) Nevertheless a slight concordance was found between diagnosis of NAFLD by ultrasound and the hepatic biopsy, with 83.,3% of concordant results and Kappa adjusted= 0.67.Results of an MRI and the histopathological exam were compared and results showed 53.6% of concordant results and kappa adjusted= 0.07. CONCLUSION: The concordance found in the diagnosis performed using the ultrasound method and the hepatic biopsy, shows a need to implement and perform more research on the use of ultrasound to validate and reconsider these methods. This would minimize the need to perform biopsies to detect and diagnose such disease.

Vitamina A: nível sérico e ingestão dietética em crianças e adolecentes com déficit estatural de causa não hormonal

OBJETIVOS: Determinar a ingestao dietetica de vitamina A e os niveis sericos de carotenoides e retinol em criancas e adolescentes com deficit estatural sem causa hormonal, atendidos no Ambulatorio de Endocrinopediatria do Nucleo de Nutricao (NUNADI) da Secretaria de Estado da Saude de Sao Paulo. METODOS: Foram avaliados de maneira prospectiva 47 pacientes pre-puberes, entre 4 e 14 anos, com relacao a: antropometria, idade ossea, inquerito alimentar, bioimpedanciometria e nivel serico de retinol e carotenoides. RESULTADOS: A media do escore Z da estatura foi de -2,4; 20% dos pacientes eram desnutridos, 25,5% tinham inadequacao da massa gorda e maior atraso da idade ossea. Os niveis sericos de retinol e carotenoides foram inadequados em 21% dos pacientes, sendo que foi maior o percentual de inadequacao dos carotenoides nos pacientes que apresentavam deficit estatural mais acentuado. Nao houve relacao dos niveis sericos de retinol e carotenoides com a velocidade de crescimento. Em 82,9% dos inqueritos alimentares realizados, houve ingestao de vitamina A inferior a 50% do estabelecido na Pirâmide de Alimentos. CONCLUSAO: Baseados nestes resultados, concluimos que ha uma elevada prevalencia de desnutricao, comprometimento da idade ossea, inadequacao no nivel serico de carotenoides e ingestao de vitamina A em criancas com comprometimento estatural.

Vitamin A metabolic aspects and alcoholic liver disease

The liver is a strategic organ in the metabolism of macro and micronutrients; when its functioning is compromised, it may cause some change in the nutritional status of vitamin A. The purpose of this article is to review scientific evidence in literature on the liver metabolism of vitamin A, the role of ethanol and retinol interactions on hepatic morphology, besides the alterations in the metabolism of this vitamin in alcoholic liver disease. Data were collected from Medline database. The liver is the main organ responsible for the storage, metabolism and distribution of vitamin A to peripheral tissues. This organ uses retinol for its normal functioning such as cell proliferation and differentiation. This way, vitamin A deficiency seems to alter liver morphology. Patients with alcoholic liver disease have been found to have low hepatic levels of retinol in all stages of their disease. In alcoholic liver disease, vitamin A deficiency may result from decreased ingestion or absorption, reduction in retinoic acid synthesis or increased degradation. Long-term alcohol intake results in reduced levels of retinoic acid, which may promote the development of liver tumor. So, in chronic alcoholic subjects, vitamin A status needs to be closely monitored to avoid its deficiency and clinical effects, however its supplementation must be done with caution since the usual dose may be toxic for those who consume ethanol.

Intraplacental retinol distribution

With the objective of evaluating intraplacental vitamin A distribution, 234 placental samples were collected, corresponding to six samples from each of the placentas analyzed: two from the lateral maternal portion, one from the central maternal portion, two from the lateral fetal portion, and one from the central fetal portion. Samples were obtained from 39 adult puerperal mothers with low-risk pregnancies, without vitamin A deficiency or night blindness. Retinol content determination was achieved through spectrophotometry. Retinol values obtained for each region were correlated with the most probable value for each placenta (P < 0.001). Despite differences in retinol content between samples, statistical data analysis showed that intra-tissue variation had no influence on the conversion of data into information. Consequently, any portion of the placenta may be used for retinol level determination purposes, due to the correlation between all portions and the most probable value. The findings of the present study represent an advance for surveys intending to incorporate the collection and dosage of placental vitamin A levels into their analyses, thus increasing the arsenal of pre-pathological or subclinical vitamin A deficiency markers, which can allow for earlier intervention on the maternal–infant group.

Hepatic retinol levels in individuals deceased from several causes

Purpose – The aim of the present work is to evaluate the hepatic retinol levels in individuals deceased from several causes in the municipal district of Rio de Janeiro.Design/methodology/approach – This study was conducted at Instituto Medico Legal (IML/RJ) by researching 236 necropsied individuals from several causes, at the age between 1 and 89, whose samples of the liver were obtained through necropsies up to 48 hours post morten. The determination of the hepatic levels of retinol was performed through the spectrofotometrical dosage. As a cut‐off point for vitamin A deficiency (VAD) was considered 20 μg g−1 of the hepatic tissue.Findings – The mean retinol hepatic reserve evaluated according to the causa mortis was 281.55 μg per gram in subjects died from violent death, significantly higher than in other causa mortis (165.67 μg per gram in coronary heart disease, 226.89 μg per gram in infectious disease, 121.27 μg per gram in other chronic diseases and 214.87 μg per gram in other diseases, p<0.05). A p...