title: The potential double-burden of vitamin A malnutrition: under- and overconsumption of fortified table sugar in the Guatemalan highlands.
abstract: In Guatemala, population-wide vitamin A fortification of table sugar has been operating for two decades. The objective of this study was to estimate the adequacy of vitamin A intakes in pregnant and lactating women from low-income, urban and rural communities.
  
  
  
  One or two previous-day dietary recalls were collected in a convenience sample of 234 pregnant and lactating women in the Western Highlands of Guatemala. Estimated daily intakes and main sources of total vitamin A, provitamin A and preformed vitamin A were calculated. Total intakes, adjusted for day-to-day variation, were examined in relation to estimated average requirements (EAR).
  
  
  
  Median estimated 1-day total vitamin A intake was 1177 μg retinol activity equivalents (RAE) (interquartile range (IQR) 832-1782) in the urban site and 567 μg RAE (IQR 441-737) in the rural site. Women not meeting their status-specific vitamin A requirement were 3.5 times more common in the rural communities (31%) than in the urban confines (9%). In the urban area, 26 women (21%) had preformed vitamin A intakes above 1500 μg on the day of data collection. Preformed vitamin A accounted for a median of 83.9% and 60.9% of the daily total vitamin A intake in the urban and rural sites, respectively. Sugar was the principal source of vitamin A, contributing 512 μg RAE (IQR 343-749) in the urban site and 256 μg RAE (IQR 189-363 μg) in the rural area.
  
  
  
  The vitamin A contribution from fortified sugar can be a determinant of reaching adequacy; nevertheless, a significant proportion of pregnant and lactating women do not meet the EAR, especially in the rural setting.
authors.affiliation: Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala City, Guatemala.|Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
authors.forename: I
authors.initials: I
authors.lastname: Bielderman
authors.affiliation: Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala City, Guatemala.
authors.forename: M
authors.initials: M
authors.lastname: Vossenaar
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Melse-Boonstra
authors.affiliation: Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala City, Guatemala.
authors.forename: N W
authors.initials: NW
authors.lastname: Solomons
mesh_terms: D000293:Adolescent; D000328:Adult; D015930:Diet Records; D019422:Dietary Sucrose / Q000032:analysis* / Q000737:chemistry; D004435:Eating; D005260:Female; D005527:Food, Fortified / Q000032:analysis / Q000706:statistics & numerical data*; D006166:Guatemala / Q000453:epidemiology; D006801:Humans; D007774:Lactation; D011247:Pregnancy; D012424:Rural Population / Q000706:statistics & numerical data; D014505:Urban Population / Q000706:statistics & numerical data; D014801:Vitamin A / Q000032:analysis*; D014802:Vitamin A Deficiency / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult
chemical_list: D019422:Dietary Sucrose; D014801:Vitamin A