FNRI

FOOD AND NUTRITION RESEARCH INSTITUTE DEPARTMENT OF SCIENCE AND TECHNOLOGY LUZON

VISAYAS

MINDANAO

ETIOLOGY
Vitamin A

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FOOD AND NUTRITION RESEARCH INSTITUTE DEPARTMENT OF SCIENCE AND TECHNOLOGY

-is an essential nutrient needed for:

normal functioning of the visual system maintenance of cell function for growth epithelial integrity red blood cell production immunity reproduction

Causes of deficiency
chronically insufficient vitamin A intake infection

FNRI h To re-assess the prevalence and

FOOD AND NUTRITION RESEARCH INSTITUTE DEPARTMENT OF SCIENCE AND TECHNOLOGY

severity of vitamin A deficiency among all Filipino population groups from 6 mos-old children to elderly and among all physiologic groups

h To compare results with previous surveys

FNRI
FOOD AND NUTRITION RESEARCH INSTITUTE DEPARTMENT OF SCIENCE AND TECHNOLOGY

PARTICIPANTS:
- 6 mos-old children elderly - Pregnant - Lactating

METHOD of COLLECTION :
- Finger-Prick Method (6 mos 5 yrs children) - Venipuncture Method (6 yrs - elderly)

FNRI
FOOD AND NUTRITION RESEARCH INSTITUTE DEPARTMENT OF SCIENCE AND TECHNOLOGY

ANALYTICAL METHOD:
Serum retinol determination by HPLC method (Furr et al, 1992)

SAMPLE for ANALYSIS:

Serum ( 0.1 mL )

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FOOD AND NUTRITION RESEARCH INSTITUTE DEPARTMENT OF SCIENCE AND TECHNOLOGY

QUALITY ASSURANCE :
- Standard Reference Materials (SRM) - Pooled control serum sample - Participates in the Vitamin A Laboratory External Quality Assurance (VITAL-EQA) Program*

* CDC

ASSESSMENT CRITERIA
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FOOD AND NUTRITION RESEARCH INSTITUTE DEPARTMENT OF SCIENCE AND TECHNOLOGY

Guidelines Used for the Interpretation of Vitamin A Biochemical Data

Level Plasma Retinol (mol/L) (g/dL) < 10 10 - 19 20 - 49 50 < 0.35 0.35 - 0.69 0.70 - 1.74 1.75

Deficient Low Acceptable High

(WHO/UNICEF/HKI/IVACG,1972)

ASSESSMENT CRITERIA
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FOOD AND NUTRITION RESEARCH INSTITUTE DEPARTMENT OF SCIENCE AND TECHNOLOGY

Criteria for Assessing the Public Health Significance of VAD in the Community based on Plasma Retinol Levels of Children, < 6 yrs
Criterion Minimum Prevalence (%) 5 15

Plasma Retinol (Vit A ) less than 10 g/dL / 0.35 mol/L (Deficient) Plasma Retinol (Vit A ) less than 20 g/dL / 0.70 mol/L (Deficient to Low)
WHO,UNICEF,HKI,IVACG, 1982

ASSESSMENT CRITERIA
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FOOD AND NUTRITION RESEARCH INSTITUTE DEPARTMENT OF SCIENCE AND TECHNOLOGY
1 WHO,

Prevalence cut-offs to define vitamin A deficiency in a population and its level of public health significance1
Public health importance (degree of severity) Serum or plasma retinol < 20 g/dL / 0.70 mol/L in preschool-age children and pregnant women a (%)

Mild Moderate Severe

2009
a Adopted b The

2 - <10 10 - < 20 b 20

the WHO, 1996 cut-off for children, 6 71 mos as there is no WHO cut-off for pregnant women

moderate range includes the minimum prevalence of 15% currently recommended by the Micronutrient Forum/ IVACG as the cut-off at or above which VAD should be considered of public health significance among PS children and pregnant women

FNRI
FOOD AND NUTRITION RESEARCH INSTITUTE DEPARTMENT OF SCIENCE AND TECHNOLOGY

Prevalence of VAD by age and physiologic state, 2008 Age/Sex/ Physiologic State Philippines FNRI
FOOD AND NUTRITION RESEARCH INSTITUTE

No. of Participants (n) 16917 2408 3802 2244 5894 1226 483 860
0

Prevalence (%)
5.9 15.2 11.1 4.6 3.4 3.6 9.5 6.4
10 20 30 40

6 mos 5 yrs 6 12 y 13 19 y 20 59 y 60 y Pregnant Lactating

DEPARTMENT OF SCIENCE AND TECHNOLOGY

Serum retinol level and percent distribution by age and physiologic state: Philippines, 2008

FNRI
FOOD AND NUTRITION 6 mos RESEARCH INSTITUTE

Age/ Physiologic State

Serum retinol level (g/dL)

x SD

% Distribution Def & low Acceptable 5.9 15.2 11.1 4.6 3.4 3.6 9.5 6.4 60.0 77.0 81.1 70.8 47.7 48.5 72.5 65.8 High 34.1 7.9 7.8 24.6 48.9 47.9 18.0 27.8

Philippines 5 yrs

16917 2408 3802 2244 5894 1226 483 860

41.1 17.4 31.1 12.0 32.1 11.6 40.4 14.2 50.0 18.3 49.0 18.3 37.33 14.2 41.53 15.4

DEPARTMENT OF 13 AND SCIENCE 19 y TECHNOLOGY

6 12 y

20 59 y 60 yr

Pregnant women Lactating women

Prevalence of VAD and number of vitamin A deficient children FNRI

FOOD AND NUTRITION RESEARCH INSTITUTE DEPARTMENT OF SCIENCE AND TECHNOLOGY

Age Group

Prevalence %

Estimated number with VAD (in million)

6 mos - < 5 yr

15.2

1.91

Trends in the prevalence of vitamin A deficiency (VAD) among children, 6 mos 5 yrs Philippines: 1993, 1998, 2003 and 2008
50

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40 FOOD AND NUTRITION RESEARCH INSTITUTE
DEPARTMENT OF % SCIENCE AND TECHNOLOGY 20

38.0 35.3

40.1

30

15.2

10

0 1993 1998 2003 2008

Trends in the prevalence of VAD among pregnant and lactating women, Philippines: 1993, 1998, 2003 and 2008
50

FNRI 40
FOOD AND NUTRITION RESEARCH 30 INSTITUTE DEPARTMENT % OF SCIENCE AND 20 TECHNOLOGY

Pregnant Lactating

22.2 16.4 16.4 16.5

20.1 17.5 9.5 6.4

10

0 1993 1998 2003 2008

30 30

Distribution of serum retinol levels among preschool children, Philippines: 1993, 1998, 2003 & 2008
NNS 2008 NNS 2003 NNS 1998

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FOOD AND

20 NUTRITION

% DEPARTMENT

RESEARCH INSTITUTE

NNS, 1993

OF SCIENCE AND 10 TECHNOLOGY

0
05 61 11 0 -1 5 16 -2 0 21 -2 5 26 -3 0 31 -3 5 36 -4 0 41 -4 5 46 -5 0 51 -5 5 56 -6 0 61 -6 66 5 -7 71 0 -7 5 76 -8 0 81 -8 5 86 -9 91 0 -9 96 5 -1 00 >1 00

Serum retinol, g/dL

Comparison of prevalence of VAD: Philippines, 1998 2008

FNRI Age/
FOOD AND NUTRITION RESEARCH INSTITUTE DEPARTMENT OF SCIENCE AND TECHNOLOGY

No. of Participants 1998 2008 2408 483 860

VAD (%) 1998 38.0 22.2 16.5 2008 15.2 9.5 6.4

Decrease 1998 vs 2008 22.8** 18.7** 11.1 **

Physiologic State

Children, 6 mos- 5y 14,291 Pregnant Lactating 2,963 3,165

** Significant at 0.01

Comparison of prevalence of VAD among preschool children and pregnant women globally and by WHO region (1995 2005)

FOOD AND NUTRITION RESEARCH INSTITUTE

WHO FNRI Region

Philippines Western Pacific* Global*

VAD (%) Preschool children Pregnant women

DEPARTMENT OF SCIENCE AND TECHNOLOGY

15.2 12.9** 33.3**

9.5 21.5 15.3

* WHO, 2009 * * Preschool children < 5 yrs

Contribution of food groups to vitamin A intake by population groups

POPULATION GROUP VIT. A INTAKE (mcg RE) PERCENT CONTRIBUTION

Children, 6 mos - 5y

FNRI - 12y Children, 6

Adults

303.8 288.5 405.2 499.6 379.9 493.3 455.4

6.3 8.2 5.9 3.3 3.4 4.4 4.9

0%

32.2 51.0 64.6 71.3 62.3 58.2 61.1

20% 40%

34.0

4.6 15.7 11.7 13.3 12.7 6.3 13.9 2.7 18.9 4.0 15.1 9.1 17.2 6.4

FOOD AND NUTRITION Adolescents RESEARCH INSTITUTE DEPARTMENT OF SCIENCE AND Elderly TECHNOLOGY

Pregnant women Lactating women

60%

80%

100%

Cereals & Products Fish, Meat & Poultry Milk & Products Vegetables Others Beverages & Others

Eggs

Prevalence of VAD among children by Garantisadong Pambata (GP) participation

40

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% Prev
FOOD AND NUTRITION RESEARCH INSTITUTE DEPARTMENT OF SCIENCE AND TECHNOLOGY

30

20

14.4

17.7

10

GP Participant

Non-GP Participant

Prevalence of VAD by use of supplements

FNRI
% Prev
FOOD AND NUTRITION RESEARCH INSTITUTE DEPARTMENT OF SCIENCE AND TECHNOLOGY

40

30

20

13.5
10

16.1

Supplement user

Non-supplement user

Prevalence of VAD by episodes of infection

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% Prev
FOOD AND NUTRITION RESEARCH INSTITUTE DEPARTMENT OF SCIENCE AND TECHNOLOGY

40

30

20

14.0

16.0

10

No infection

With infection

Prevalence of VAD by episodes of infection

Absence/presence/ type of infection

% VAD
14.0 16.0 39.5 18.3 14.9 15.8 21.9 17.6 27.4
0 10 20 30 40 50

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FOOD AND NUTRITION RESEARCH INSTITUTE DEPARTMENT OF SCIENCE AND TECHNOLOGY

No infection With infection

Measles Chicken pox URTI TB/PC Diarrhea Fever Others

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FOOD AND NUTRITION RESEARCH INSTITUTE DEPARTMENT OF SCIENCE AND TECHNOLOGY

i Over-all, the 2008 NNS showed a

decreasing trend in VAD prevalence among preschool children, pregnant and lactating women

i VAD is still a problem of public health

significance, but has decreased from severe in 2003 to moderate in 2008 among preschool children, and to mild among pregnant and lactating women

FNRI
FOOD AND NUTRITION RESEARCH INSTITUTE DEPARTMENT OF SCIENCE AND TECHNOLOGY