Taciana Fernanda dos Santos Fernandes

Hipovitaminose A em pré-escolares de creches públicas do Recife: indicadores bioquímico e dietético

OBJECTIVE: To evaluate the extent of vitamin A deficiency among preschool children attending public day care centres in Recife, State of Pernambuco, Brazil. METHODS: A cross-sectional survey involving 311 under 5-year-old children of both sexes, randomly selected, and assessed by biochemical (serum retinol), dietetic (vitamin A rich-food consumption) and anthropometric indicators (weight-for-height, weight-for-age and height-for-age). RESULTS: The prevalence of hyporetinolemia (serum retinol 0.05). Vitamin A rich-food intake showed low sensitivity (43.0%) and a very low positive predictive value (6.8%) as a screening diagnostic test for vitamin A deficiency. CONCLUSION: The identification of vulnerable population groups, and the selection of reliable indicators for the assessment of vitamin A status, are both essential for the diagnosis and planning aimed at preventing and controlling vitamin A deficiency.

Effect on Infant Illness of Maternal Supplementation With 400 000 IU Vs 200 000 IU of Vitamin A

BACKGROUND AND OBJECTIVE: Postpartum vitamin A supplementation is a strategy used to combat vitamin A deficiency and seems to reduce maternal/infant morbidity and mortality. However, studies have shown that a dose of 200 000 IU (World Health Organization [WHO] protocol) does not seem to provide adequate retinol levels in maternal breast milk, infant serum, and infant tissue. The objective of this study was to compare the effect of postpartum maternal supplementation with 400 000 IU (International Vitamin A Consultative Group protocol) compared with 200 000 IU of vitamin A on infant morbidity. METHODS: This was a randomized controlled, triple-blinded clinical trial conducted at 2 public maternity hospitals in Recife in northeastern Brazil. There were 276 mother–child pairs that were allocated to 2 treatment groups: 400 000 IU or 200 000 IU of vitamin A. They were followed up for >6 months to evaluate infant morbidity. RESULTS: Fever (rate ratio [RR]: 0.92 [95% confidence interval (CI): 0.75–1.14]), diarrhea (RR: 0.96 [95% CI: 0.72–1.28]), otitis (RR: 0.94 [95% CI: 0.48–1.85]), acute respiratory infection (RR: 1.03 [95% CI: 0.88–1.21]), the need for intravenous rehydration (RR: 2.08 [95% CI: 0.64–2.07]), and the use of antibiotic treatment (RR: 0.80 [95% CI: 0.43–1.47]) did not differ significantly between the 2 treatment groups. CONCLUSIONS: Our findings suggest that postpartum maternal supplementation with 400 000 IU of vitamin A does not provide any additional benefits in the reduction of illness in children aged <6 months; therefore, we do not support the proposal to increase the standard vitamin A dose in the existing WHO protocol.

Suplementação com vitamina A no puerpério: revisão sistemática

Se realizo revision sistematica de estudios evaluativos de la aplicacion de megadosis de vitamina A en las concentraciones de retinol en la sangre y en la leche maternos como medida de corto plazo para la prevencion de hipovitaminosis A. Con base en la estrategia del Centro Cochrane de Brasil para ensayos clinicos aleatorios fueron identificadas 115 publicaciones en el PubMed, entre las cuales, por un conjunto de criterios de inclusion/exclusion, fueron seleccionados 14 articulos publicados entre 1993 a 2007. El efecto de las intervenciones con tres esquemas posologicos (200.000. 300.000 y 400.000 UI) de vitamina A fueron analizados. De los 11 experimentos realizados en leche materna, nueve presentaron elevacion de los niveles de retinol en comparacion con el grupo control; de los nueve que evaluaron sangre materna, cuatro mostraron elevacion posterior a tiempos variados de aplicacion de megadosis de vitamina A. Se concluye que la administracion de vitamina A en elevadas dosis fue positiva en 82% de los ensayos con leche materna, pero menos notables en comparacion a la sangre materna. No fueron observadas diferencias significativas con relacion a la posologia aplicada.A systematic review on studies evaluating the effect of applying megadoses of vitamin A on the retinol concentrations in maternal milk and blood, as a short-term measure for preventing hypovitaminosis A, was conducted. Based on the strategy of the Brazilian Cochrane Center for randomized trials, 115 published papers were identified in PubMed. From these, through a set of inclusion/exclusion criteria, 14 articles published between 1993 and 2007 were selected. The effects of interventions with three posological regimens (200,000, 300,000 and 400,000 IU) of vitamin A were analyzed. Out of 11 experiments conducted on maternal milk, nine presented elevation of the retinol levels in comparison with the control group; out of nine that evaluated maternal blood, four showed elevation at varying times after applying megadoses of vitamin A. It was concluded that the results from administration of vitamin A at high doses were positive in 82% of the trials on maternal milk, but less notable in relation to maternal blood. No significant differences regarding the posological regimens applied were observed.

The Effect of a Maternal Double Megadose of Vitamin A Supplement on Serum Levels of Retinol in Children Aged under Six Months

Objective. To measure concentrations of serum retinol in children after the use of maternal vitamin A double megadose supplements. Design. Randomized controlled clinical trial. Setting. The study was conducted at two maternity hospitals in the city of Recife, in the northeast region of Brazil between August 2007 and June 2009. Subjects and Methods. 276 children/mothers were recruited after birth and the women received a 200,000 IU capsule of vitamin A. After ten days they were randomly assigned to two treatment groups. One group received a second 200.000 IU capsule, while the other received a placebo. The concentrations of retinol in the serum of the children from each group were measured at 2, 4, and 6 months. Results. 173 children completed the study. There was no difference between the two treatment groups (P = 0.514). The mean base retinol level was lower than that at four and six months (P < 0.001). Conclusions. The maternal double megadose supplement had no additional effect on the serum retinol levels of the children, although concentrations of retinol in the children rose in the first six months of life. This trial is registered with NCT00742937.

Vitamin A supplementation during puerperium: systematic review

Se realizo revision sistematica de estudios evaluativos de la aplicacion de megadosis de vitamina A en las concentraciones de retinol en la sangre y en la leche maternos como medida de corto plazo para la prevencion de hipovitaminosis A. Con base en la estrategia del Centro Cochrane de Brasil para ensayos clinicos aleatorios fueron identificadas 115 publicaciones en el PubMed, entre las cuales, por un conjunto de criterios de inclusion/exclusion, fueron seleccionados 14 articulos publicados entre 1993 a 2007. El efecto de las intervenciones con tres esquemas posologicos (200.000. 300.000 y 400.000 UI) de vitamina A fueron analizados. De los 11 experimentos realizados en leche materna, nueve presentaron elevacion de los niveles de retinol en comparacion con el grupo control; de los nueve que evaluaron sangre materna, cuatro mostraron elevacion posterior a tiempos variados de aplicacion de megadosis de vitamina A. Se concluye que la administracion de vitamina A en elevadas dosis fue positiva en 82% de los ensayos con leche materna, pero menos notables en comparacion a la sangre materna. No fueron observadas diferencias significativas con relacion a la posologia aplicada.A systematic review on studies evaluating the effect of applying megadoses of vitamin A on the retinol concentrations in maternal milk and blood, as a short-term measure for preventing hypovitaminosis A, was conducted. Based on the strategy of the Brazilian Cochrane Center for randomized trials, 115 published papers were identified in PubMed. From these, through a set of inclusion/exclusion criteria, 14 articles published between 1993 and 2007 were selected. The effects of interventions with three posological regimens (200,000, 300,000 and 400,000 IU) of vitamin A were analyzed. Out of 11 experiments conducted on maternal milk, nine presented elevation of the retinol levels in comparison with the control group; out of nine that evaluated maternal blood, four showed elevation at varying times after applying megadoses of vitamin A. It was concluded that the results from administration of vitamin A at high doses were positive in 82% of the trials on maternal milk, but less notable in relation to maternal blood. No significant differences regarding the posological regimens applied were observed.

Suplementación con vitamina A en el puerperio: revisión sistemática

Se realizo revision sistematica de estudios evaluativos de la aplicacion de megadosis de vitamina A en las concentraciones de retinol en la sangre y en la leche maternos como medida de corto plazo para la prevencion de hipovitaminosis A. Con base en la estrategia del Centro Cochrane de Brasil para ensayos clinicos aleatorios fueron identificadas 115 publicaciones en el PubMed, entre las cuales, por un conjunto de criterios de inclusion/exclusion, fueron seleccionados 14 articulos publicados entre 1993 a 2007. El efecto de las intervenciones con tres esquemas posologicos (200.000. 300.000 y 400.000 UI) de vitamina A fueron analizados. De los 11 experimentos realizados en leche materna, nueve presentaron elevacion de los niveles de retinol en comparacion con el grupo control; de los nueve que evaluaron sangre materna, cuatro mostraron elevacion posterior a tiempos variados de aplicacion de megadosis de vitamina A. Se concluye que la administracion de vitamina A en elevadas dosis fue positiva en 82% de los ensayos con leche materna, pero menos notables en comparacion a la sangre materna. No fueron observadas diferencias significativas con relacion a la posologia aplicada.A systematic review on studies evaluating the effect of applying megadoses of vitamin A on the retinol concentrations in maternal milk and blood, as a short-term measure for preventing hypovitaminosis A, was conducted. Based on the strategy of the Brazilian Cochrane Center for randomized trials, 115 published papers were identified in PubMed. From these, through a set of inclusion/exclusion criteria, 14 articles published between 1993 and 2007 were selected. The effects of interventions with three posological regimens (200,000, 300,000 and 400,000 IU) of vitamin A were analyzed. Out of 11 experiments conducted on maternal milk, nine presented elevation of the retinol levels in comparison with the control group; out of nine that evaluated maternal blood, four showed elevation at varying times after applying megadoses of vitamin A. It was concluded that the results from administration of vitamin A at high doses were positive in 82% of the trials on maternal milk, but less notable in relation to maternal blood. No significant differences regarding the posological regimens applied were observed.