Tanumihardjo S A, Gannon B M, Kaliwile C, Chileshe J
Department of Nutritional Sciences, Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA.
Research and Planning Unit, National Food and Nutrition Commission of Zambia, Lusaka, Zambia.
Eur J Clin Nutr. 2015 Dec;69(12):1346-9. doi: 10.1038/ejcn.2015.143. Epub 2015 Sep 2.
Vitamin A (VA) deficiency is a public health problem in many countries. The World Health Organization recommends high-dose VA supplements to children aged 6-59 months based on unequivocal evidence that supplements decreased mortality risk. VA supplements were meant as a temporary intervention until more sustainable approaches could be implemented. Fortification of processed foods with preformed VA is a means to improve VA status. The most recent addition of retinyl palmitate to cooking oil in countries that may also fortify margarine and milk will undoubtedly have a positive impact on VA status. However, quantitative measures have not been used to assess the underlying VA status of the groups who have adopted widespread fortification. The addition of preformed VA to otherwise adequate diets in VA may cause excessive total body stores. Monitoring population status will require accurate VA assessment to ensure that hypervitaminosis does not prevail. This perspective describes a cohort of rural Zambian children who have adequate diets in VA, mostly as provitamin A carotenoids; who were given high-dose VA supplements till the age of 5 years; who have access to VA-fortified sugar; and whose mothers had access to VA-fortified sugar throughout pregnancy and lactation. Many of these children turned orange during mango season, and this phenomenon occurred at estimated liver reserve concentrations >1 μmol retinol equivalents/g liver. It will be necessary to continue to monitor VA status, including all sectors of the population that have access to successful interventions, to optimize health with the intent to lower retinol content of fortified foods or better target VA supplementation to areas of most need.
维生素A（VA）缺乏是许多国家的一个公共卫生问题。世界卫生组织基于补充剂可降低死亡风险的确凿证据，建议对6至59个月大的儿童补充高剂量VA。VA补充剂原本是一种临时干预措施，直到能够实施更可持续的方法。用预形成的VA强化加工食品是改善VA状况的一种手段。在那些可能还会强化人造黄油和牛奶的国家，最近在食用油中添加棕榈酸视黄酯无疑将对VA状况产生积极影响。然而，尚未采用定量措施来评估已广泛实施强化措施的群体的潜在VA状况。在原本VA充足的饮食中添加预形成的VA可能会导致体内VA储备过量。监测人群状况需要准确的VA评估，以确保不会普遍出现维生素A过多症。这篇观点文章描述了一群赞比亚农村儿童，他们的饮食中VA充足，主要是视黄醇原类胡萝卜素；他们在5岁之前一直服用高剂量VA补充剂；他们能够获得VA强化糖；并且他们的母亲在整个孕期和哺乳期都能获得VA强化糖。在芒果季节，这些孩子中有许多人的皮肤变成了橙色，这种现象发生时肝脏储备浓度估计>1微摩尔视黄醇当量/克肝脏。有必要继续监测VA状况，包括所有能够获得成功干预措施的人群，以便通过降低强化食品中的视黄醇含量或更好地将VA补充剂靶向最需要的地区来优化健康状况。
