Newsletter 02 2006.pdf - Sight and Life

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SIGHT AND LIFE 42 NEWSLETTER 2/2006 Partners Pharmacy Dept, 1-65 21 st St., Indianapolis, IN 46202-1367, USA. Email: hjackson@clarianorg) This literature search from 1966 to March 2005, using vitamin A consumption and fracture risk fails to provide definitive evidence for a causal association. “Vitamin supplementation of HIV-infected women improves postnatal child growth” by Villamor E, Saathoff E, Bosch RJ et al. Am J Clin Nutr 2005; 81: 880–888 (Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA. Email: evillamo@hsph.harvard.edu) Multivitamins (thiamin, riboflavin, vitamin B6, niacin, vitamin B12, vitamin C, vitamin E and folic acid) were tested against vitamin A or β-carotene. Multivitamins gave significant improvement in attained weight, weight for age, and weight for length. Vitamin A or β-carotene had no such effect, indeed vitamins and β-carotene mix seemed to reduce benefits on these outcomes. “Vitamin A, mastitis, and motherto-child transmission of HIV- 1 through breast-feeding” by Dorosko SM. Nutr Rev 2005; 63: 332–346 Mastitis is an increased mammary permeability and is frequently accompanied by bacterial infection. Supplementation with vitamin A reduces the prevalence of bacterial mastitis and the inflammatory response. However, studies of mother-to-child transmission in HIV-positive women have shown no reduction with vitamin A supplementation. One study in Tanzania reported an increase. Possible mechanisms for this unexpected result are being investigated. One way may be the paracellular entry of leukocytes affected by retinoic acid into breast milk. “Diarrhoea and malnutrition in children” by Baqui AH, Ahmed T. Brit Med J 2006; 332: 378 (Dept Int Hlth, Johns Hopkins University, Bloomberg School of Public Health, Baltimore MD 21205, USA. Email: abaqui@jhsph.edu) This review follows an international meeting in Bangladesh on this subject. Oral rehydration has been successfully pursued for more than three decades and now WHO and UNICEF have introduced a new reduced osmolarity formulation (WHO/UNICEF Joint Statement. Clinical management of acute diarrhoea. 2004). In addition they recommend the therapeutic use of zinc for 10–14 days at a dose of 10 mg daily in infants under 6 months and 20 mg daily in older children. There is no mention of vitamin A. Before the beneficial effect of zinc supplementation in acute diarrhea was discovered there were many reports of the efficacy of vitamin A. A recent reappraisal (see two abstracts below) reported even greater benefit of vitamin A than when analysis was made previously. Furthermore, there is growing acceptance of the concept that diarrhea is often an integral part of vitamin A deficiency and the need for vitamin A replacement is evident. Other recent documents, especially in connection with achievement of some of the Millennium Goals have always bracketed together vitamin A and zinc in this context. This issue requires urgent attention; data supporting vitamin A supplementation for treatment and prevention of diarrheal diseases are available. “Maternal vitamin A supplementation and immunity to malaria in pregnancy in Ghanaian primigravids” by Cox SE, Staalsoe T, Arthur P et al. Trop Med Int Hlth 2005;10:1286–1297 (Dept Epidemiology and Population Health, London Sch Hyg & Trop Med, London, UK. Email:Sharon.Cox@lshtm. ac.uk) The pathological effects of malaria in pregnancy are believed to be due to the sequestration of parasites in the placenta, mediated by binding of variant surface antigens (VSA) expressed on the surface of P. falciparum-infected red blood cells to placental chondroitin sulfate A (CSA). Vitamin A supplementation was accompanied by reduced levels of anti-VSACSA antibodies and may reflect reduced placental parasitemia. “Random-effects models in investigating the effect of vitamin A in childhood diarrhea” by Andreozzi VL, Bailey TC, Nobre FF et al. Ann Epidemiol 2006;16: 241–247 (VL Andreozzi, Avenida Humberto Delgado 33, Alhos Vedros, 2860-021, Portugal. Email: valeska@fiocruz.br) Enhanced statistical analysis methods were applied to previous studies on vitamin A and diarrhea in childhood. Levels of significant beneficial effects were reached that were not attained previously – see also comments on WHO/UNICEF recommendations that include zinc but exclude vitamin A two abstracts above. “The concentration of free holoretinol-binding protein is higher in vitamin A-sufficient than in deficient Nepalese women in late pregnancy” by Sankanarayanan S, Suarez M, Taren D et al. J Nutr 2005;135: 2817–2822 (Penn State Univ, Huck Inst Life Sci, University Park, PA 16802, USA. Email: fxr5@psu.edu) The RBP/TTR index (< 0.36 or serum retinol < 1.05 µmol/l indicative of vitamin A deficiency), introduced by FJ Rosales of this group, was shown to be a useful proxy for free holo-RBP concentration and that vitamin A status affects its distribution. “Serum carotenoids, vitamins A and E, and 8-year lung function decline in a general population” by Guenegou A, Leynaert B, Pin I et al. Thorax 2006; 61: 320–326 (Dept Epidemiology, INSERM Unit 700, University of Medicine Bichat, 16 rue Henry Huchard, 75018 Paris, France. Email: guenegou@bichat. inserm.fr) 1194 French subjects aged 20–44 years were examined in 1992 and followed up in 2000. Serum β-carotene underwent a steady increase in that period and along with this there was a similar slower decline in FEV1 (forced expiratory volume in 1 second) – an indicator of lung function. In heavy smokers both β-carotene and vitamin E were protective. “Dietary β-cryptoxanthin and inflammatory polyarthritis: re-
NEWSLETTER 2/2006 43 SIGHT AND LIFE sults from a population-based prospective study” by Pattison DJ, Symmons DPM, Lunt M et al. Am J Clin Nutr 2005; 82: 451–455 (Arthritis Research Campaign, Epidemiology Unit, University of Manchester, UK) A modest increase in β-cryptoxanthin intake, equivalent to one glass of freshly squeezed orange juice per day, is associated with a reduced risk of developing inflammatory disorders such as rheumatoid arthritis. “Serum retinol and total carotene concentrations in obese preschool children” by Saccardo-Sarni RO, De Souza FIS, Ramalho RA et al. Med Sci Monit 2005; 11: 510–514 (RO Saccardo-Sarni, R Zamlutti 94, Sao Paulo, CEP: 04116-260, Brazil. Email: rssarn@uol.com.br) It was found that there was an association between obesity and hyperlipidemia and low serum level of carotenoids; possibly affording some antioxidant protection. (It is doubtful if total carotenoid levels are meaningful; fractionation would appear essential.) “Momordica cochinchinensis, Rosa roxburghii, wolfberry, and sea buckthorn – highly nutritional fruits supported by tradition and science” by Burke DS, Smidt CR, Vuong LT. Curr Top Nutraceut Res 2005; 3: 259–266 (Pharmanex Research Institute, LLC, 75 West Center Street, Provo, UT 84601, USA. Email:dburke@pharmanex. com) Fruits such as these originate from Southeast Asia where their value as healthy fruits has been recognized for many years. Analysis has shown that they are rich in antioxidant vitamins, especially lycopene and β-carotene. “Modification of lymphocyte DNA damage by carotenoid supplementation in postmenopausal women” by Zhao X, Aldini G, Johnson EJ et al. Am J Clin Nutr 2006;83:163–169 (KJ Yeum, Mayer- USDA-Human Nutrition Research Center on Aging, Tufts University, Boston, MA 02111, USA. Email: kyungjin.yeum@tufts.edu) All carotenoid-supplemented groups showed a significant decline in endogenous DNA damage. 4 mg each of lutein, β-carotene and lycopene daily, an effective amount, can be readily taken orally. “Improving the nutritional value of Golden Rice through increased pro-vitamin A content” by Paine JA, Shipton CA, Chaggar S et al. Nature Biotech 2005; 23: 482–487 (Syngenta, Jealott’s Hill Int Res Cent, Bracknell, Berkshire, RG42 6EY, UK) It was discovered that the daffodil gene that encoded phytoene synthase (psy), one of the two genes used to develop Golden Rice, was the limiting step in β-carotene accumulation. A psy from maize was substituted. Total carotenoids increased up to 23-fold maximum with a preferential accumulation of β-carotene. Multimicronutrient research “Micronutrients in childhood and the influence of subclinical inflammation” by Thurnham DI, Mburu ASW, De Wagt A. Proc Nutr Soc 2005; 64: 502–509 (Univ Ulster, Ctr Food & Hlth, Sch Biomed Sci, 47 Knocknougher Rd, Coleraine BT51 4LA, Londonderry, Northern Ireland. Email:di.thurnham@ulster.ac.uk) Attention is drawn in this review to the neglected importance of the acute phase response (APR) in the assessment of nutritional status of a number of micronutrients. Vitamin A, iron and zinc have been most extensively studied in this regard but other vitamins and elements are likely to be implicated. The phenomenon is widespread, especially in childhood, as even subclinical infection and inflammation are capable of reducing the concentration of the nutrient in the serum and the effect is evident within as little as 24 hours. The overall effect is to give the impression that deficiency levels are more widespread than they really are. Attempts are being made to devise and introduce correction values for routine application. “Prevalence of iron deficiency and its association with vitamin A deficiency in preschool children” by Ferraz IS, Daneluzzi JC, Vannucchi H et al. J Pediatr 2005; 81: 169–174 (IS Ferraz, ER Preto/Bonfirm Paulista, km 308, CEP 14110- 000 Ribeiro Preto, SP, Brazil. Email: isferraz@uol.com.br) 179 children aged 24–72 months without diarrhea or fever at the time of the study were examined for vitamin A (30-day dose response test) and iron (HB, serum iron, and unsaturated iron-binding capacity assays) status. 135 had vitamin A deficiency and 64 had iron deficiency but there was no association between the two. “Anemia, iron status and vitamin A deficiency among adolescent refugees in Kenya and Nepal” by Woodruff BA, Blanck HM, Slutsker L et al. Publ Hlth Nutr 2006; 9: 26–34 (Ctr Dis Control & Prevent, Ntl Ctr Chron Dis Prevent & Hlth Promot, Maternal & Child Nutr Branch, 4770 Buford Highway NE, Mailstop K-25, Atlanta, GA 30341, USA. Email: BWoodruff@cdc.gov) Anemia (hemoglobin 8.3 µg/ml) and vitamin A deficiency (serum retinol < 0.7 µmol/l) had the following levels of prevalence: anemia 46% in Kenya, 24% in Nepal; 43% iron deficiency in each country; vitamin A deficiency 15% in Kenya and 30% in Nepal. Adolescents tend to be a neglected group in refugee situations and merit greater care. “Only a small proportion of anemia in northeast Thai schoolchildren is associated with iron deficiency” by Thurlow RA, Winichagoon P, Green T et al. Am J Clin Nutr 2005; 82: 380–387 (Institute of Nutrition, Mahidol University, Salaya, Thailand) 567 children aged 6–12.9 years were tested for anemia, hemoglobin type, iron and vitamin A status. The prevalence of anemia overall was 31%, only 16% of these were iron deficient. Hemoglobinopathy and vitamin A deficiency played larger parts. (The data were not presented in a way that showed a relationship between iron deficiency and vitamin A deficiency. However, the study suggests that there is still
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