Suri Shivali, Kumar Dinesh, Das Ranjan
Department of Community Medicine, Lady Hardinge Medical College and associated hospitals, New Delhi, 110001, India.
Department of Community Medicine, Government Medical College and associated hospitals, Jammu, Jammu and Kashmir, India.
Natl Med J India. 2017 Mar-Apr;30(2):61-64.
Overt vitamin A deficiency has been controlled in most parts of India, but prevalence of subclinical deficiency may still be high, which may enhance susceptibility to infections, reduce growth potential and also lead to higher mortality. We aimed to: (i) assess the consumption pattern of vitamin A-rich foods in children 1-5 years of age in rural Jammu; and (ii) estimate the dietary deficiency of vitamin A leading to risk of subclinical vitamin A deficiency in cluster- villages of the study area.
In 2011, we conducted a survey of 750 children by selecting 50 from each of the 1 5 clusters. The Helen Keller International's Food-Frequency Questionnaire (HKI-FFQ) modified to the local context was used to assess past week's intake for 28 food-items, including vitamin A-rich foods.
The study revealed that plant sources such as amaranth, carrots, etc. and animal sources such as eggs and butter were the major sources of vitamin A in the study population. Consumption of amaranth (2.7 days/week) and carrots (1.7 days/week) was moderate but that of animal foods rich in vitamin A was low to negligible (1.1 day/week for eggs and 0.2 day/week for liver and fish combined). The majority (80%) of the cluster-villages manifested inadequate intake of vitamin A-rich foods, thereby making subclinical vitamin A deficiency a public health problem for the whole area. Faulty diets, improper breastfeeding practices, low coverage of vitamin A supplementation and high prevalence of undernutrition could be related to the observed subclinical deficiency.
Dietary diversification by including both plant and animal sources of vitamin A in adequate amounts along with improved breastfeeding, better implementation of mega-dose vitamin A supplementation and minimizing undernutrition may help in lowering subclinical vitamin A deficiency. The HKI-FFQ may be used as a proxy indicator of vitamin A intake/status for identifying pockets at risk of subclinical vitamin A deficiency in resource-constrained settings.
印度大部分地区已控制了明显的维生素A缺乏症，但亚临床缺乏症的患病率可能仍然很高，这可能会增加感染易感性、降低生长潜力并导致更高的死亡率。我们的目标是：（i）评估查谟农村地区1至5岁儿童富含维生素A食物的消费模式；（ii）估计研究区域内集群村庄中导致亚临床维生素A缺乏风险的维生素A膳食缺乏情况。
2011年，我们通过从15个集群中每个集群选取50名儿童，对750名儿童进行了调查。采用根据当地情况修改的海伦·凯勒国际组织的食物频率问卷（HKI-FFQ）来评估过去一周28种食物的摄入量，包括富含维生素A的食物。
研究表明，苋菜、胡萝卜等植物性来源以及鸡蛋和黄油等动物性来源是研究人群中维生素A的主要来源。苋菜（每周2.7天）和胡萝卜（每周1.7天）的消费量适中，但富含维生素A的动物性食物消费量低至可忽略不计（鸡蛋每周1.1天，肝脏和鱼类合计每周0.2天）。大多数（80%）集群村庄表现出富含维生素A食物的摄入量不足，从而使亚临床维生素A缺乏成为整个地区的公共卫生问题。不良饮食、不当的母乳喂养方式、维生素A补充剂覆盖率低以及营养不良的高患病率可能与观察到的亚临床缺乏有关。
通过适量纳入植物性和动物性维生素A来源实现饮食多样化，同时改善母乳喂养、更好地实施大剂量维生素A补充以及尽量减少营养不良，可能有助于降低亚临床维生素A缺乏症。在资源有限的环境中，HKI-FFQ可作为维生素A摄入量/状况的替代指标，用于识别有亚临床维生素A缺乏风险的地区。
