title: Lack of improvement in vitamin A status with increased consumption of dark-green leafy vegetables.
abstract: There is little evidence to support the general assumption that dietary carotenoids can improve vitamin A status. We investigated in Bogor District, West Java, Indonesia, the effect of an additional daily portion of dark-green leafy vegetables on vitamin A and iron status in women with low haemoglobin concentrations (< 130 g/L) who were breastfeeding a child of 3-17 months. Every day for 12 weeks one group (n = 57) received stir-fried vegetables, a second (n = 62) received a wafer enriched with beta-carotene, iron, vitamin C, and folic acid, and a third (n = 56) received a non-enriched wafer to control for additional energy intake. The vegetable supplement and the enriched wafer contained 3.5 mg beta-carotene, 5.2 mg and 4.8 mg iron, and 7.8 g and 4.4 g fat, respectively. Assignment to vegetable or wafer groups was by village. Wafers were distributed double-masked. In the enriched-wafer group there were increases in serum retinol (mean increase 0.32 [95% CI 0.23-0.40] mumol/L), breastmilk retinol (0.59 [0.35-0.84] mumol/L), and serum beta-carotene (0.73 [0.59-0.88] mumol/L). These changes differed significantly from those in the other two groups, in which the only significant changes were small increases in breastmilk retinol in the control-wafer group (0.16 [0.02-0.30] mumol/L) and in serum beta-carotene in the vegetable group (0.03 [0-0.06] mumol/L). Changes in iron status were similar in all three groups. An additional daily portion of dark-green leafy vegetables did not improve vitamin A status, whereas a similar amount of beta-carotene from a simpler matrix produced a strong improvement. These results suggest that the approach to combating vitamin A deficiency by increases in the consumption of provitamin A carotenoids from vegetables should be re-examined.
authors.affiliation: Department of Human Nutrition, Wageningen Agricultural University, Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: de Pee
authors.forename: C E
authors.initials: CE
authors.lastname: West
authors.lastname: Muhilal
authors.forename: D
authors.initials: D
authors.lastname: Karyadi
authors.forename: J G
authors.initials: JG
authors.lastname: Hautvast
mesh_terms: D000740:Anemia / Q000097:blood; D001205:Ascorbic Acid / Q000008:administration & dosage; D001942:Breast Feeding; D002338:Carotenoids / Q000008:administration & dosage / Q000097:blood; D004032:Diet; D004311:Double-Blind Method; D002149:Energy Intake; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage; D005500:Follow-Up Studies; D005527:Food, Fortified; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007214:Indonesia; D007223:Infant; D007501:Iron / Q000008:administration & dosage / Q000097:blood; D008895:Milk, Human / Q000737:chemistry; D009752:Nutritional Status; D014675:Vegetables; D014801:Vitamin A / Q000032:analysis / Q000097:blood*; D019207:beta Carotene
chemical_list: D006454:Hemoglobins; D019207:beta Carotene; D014801:Vitamin A; D002338:Carotenoids; D005492:Folic Acid; D007501:Iron; D001205:Ascorbic Acid