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GDA may revise or withdraw the Contents, in whole or in part, at any time without notice. Most dietary surveys were conducted more than 10 years ago and do not indicate current consumption. In addition, there are well-known problems associated with estimation of preformed vitamin A from vegetable sources as well as problems related to data gathering.
Simplified dietary surveys may provide useful information on the risk of VAD in population groups, as has been the case with the rapid dietary assessment methods developed by Helen Keller International 41 and the International Vitamin A Consultative Group 42 , but they do not provide quantitative information on vitamin A intake by the population.
The data available from dietary surveys in population groups indicate that intake of vitamin A is usually inadequate, although in most cases there is poor correlation with biochemical data. Clinical signs of VAD Except for data reported from hospitalized children in the Dominican Republic in , the information available dates from the s and cannot be taken as an indication of the present situation.
Some studies in Bolivia and one in Brazil reported night blindness ranging from 0.
Bitot's spots WHO cutoff, 0. Subnational evidence strongly suggests that VAD is also a significant national problem in Brazil, Mexico, and Peru; it appears to be confined to indigenous groups in Panama.
On the other hand, ocular signs attributable to clinical VAD were extremely rare in the s and they have not been assessed more recently. MDIS is a significant effort to keep track of the situation by country; it compiles mostly published data.
The present review updates WHO information and includes unpublished but reliable and up-to-date data. National prevalence estimates were taken from national surveys in 11 countries and from subnational studies average weighted by sample size in five countries. The magnitude of VAD in the 16 countries with national estimates is severe in five, moderate in six, and mild in five Table 4.
The estimated regional prevalence is influenced by the contribution of large countries such as Brazil, Mexico, and Peru, whose prevalence was estimated from subnational rather than national surveys Table 3. Options to control vitamin A deficiency Epidemiological studies have identified two major types of immediate causative factors for VAD: a deficient consumption of food sources of vitamin A, either preformed or as precursors of the vitamin b-carotenes , coupled with low consumption of fats that facilitate their absorption; and b increased vitamin A requirements and poor utilization of the absorbed vitamin A because of infections, which are known to increase metabolic use and urinary excretion as well as to decrease absorption 45, The relative contribution of each group of factors to the etiology of VAD differs by country and region.
Current health and nutrition policies and programs address mainly the dietary causes-that is, those leading to deficient intake of the vitamin-and infectious morbidity is usually left to nonnutritional sectors environmental sanitation, diarrheal disease control, immunizations, etc.
An effective approach for controlling VAD should integrate short-term measures and medium and long-term actions. Short-term measures are universal or targeted supplementation aimed at young children and postpartum women, whereas medium to long-term actions include food-based approaches for increasing consumption of vitamin A from natural or fortified sources. In addition, other public health measures, such as those directed to reduce infections, have to be considered The relatively high coverage of primary health care services currently achieved in most Latin American and Caribbean countries compared with those of other regions allows for high coverage rates of vitamin A supplementation programs; however, only countries adopting a campaign approach-e.
Nongovernmental organizations NGOs significantly contribute to expanding government coverage in the rural areas where public health sector coverage is spotty. Actual supplementation coverage varies among countries, frequently with fluctuations in each country as government commitment changes and supplies mostly from UNICEF donations are not permanent.
Vitamin A supplementation is seen as a short-term measure, hardly sustainable in the long term, which may be implemented until other more sustainable interventions are in place or targeted to specific population groups at high risk of VAD that are not covered by other measures. The importance of dietary diversification as a long-term strategy for improved consumption of food sources of vitamin A can never be overemphasized.
The goal should be to increase vitamin A consumption to secure an adequate level with a safety margin to overcome seasonal variations.
Ideally, individual intakes should be increased well above the minimum requirements conventionally established, so as to attain "nutritional insurance" levels to sustain an adequate store at all times. However, ensuring consumption of natural sources of the vitamin may prove difficult, given variations in supply, availability, and cost as well as cultural resistance to changing deeply rooted dietary habits.
Single or multiple fortification of staple foods must be considered whenever possible. Fortification of processed food items has greatly contributed to eliminating micronutrient deficiencies in industrialized countries. The efficacy of sugar fortification in improving vitamin A nutrition was proved two decades ago in Central America. The cost to the government is usually limited to supervision and monitoring. In addition, for food fortification to be effective, there is usually no need to change dietary habits.
For infants, who are usually at lower risk of VAD than preschoolers, breast-feeding provides an adequate supply of vitamin A for the first 6 months of life and beyond. Its promotion should be among other strategies with marginal benefits to control VAD, as should disease prevention, helminth control, and other public health measures. In summary, proven cost-effective interventions are readily available, which, if properly implemented on a sustainable basis and supported by strong political commitment, will contribute to virtually eliminating VAD in the Region.
Current programs for controlling vitamin A deficiency in the Region A number of countries have formulated and are implementing plans to address several micronutrient deficiencies, including VAD when pertinent. Most of them have carried out, with variable degrees of population coverage, supplementation activities which have proved difficult to maintain and have tended to decline over time. The successful Guatemalan experience encouraged other countries with significant VAD to foster fortification of sugar or other food staples as a key intervention.
Other countries have initiated fortification or are in the process of doing so. In , Venezuela began fortifying corn flour with vitamin A and other micronutrients.
The same year El Salvador passed legislation on sugar fortification and began implementation in The governments of Bolivia, Colombia, the Dominican Republic, Ecuador, and Nicaragua are firmly committed to sugar fortification.
A pilot program is being implemented in Bolivia, and pertinent legislation and negotiations with sugar producers are under way in Bolivia, Colombia, the Dominican Republic, Ecuador, and Nicaragua. Through a consensusseeking negotiation process an effective public-private sector partnership is being built to contribute to prevention and control of VAD in these countries through sugar fortification. Other potential vehicles may be considered, such as margarine, vegetable oil, and wheat and corn flour.
In the International Sugar Council worldwide association of sugar producers issued the Sao Paulo Declaration, formally recognizing the need to foster fortification of sugar with vitamin A in countries with a significant VAD problem. Processed foods for infants as well as foods for wider consumption cereals, powdered milk, dairy products, margarine, etc.
Unfortunately, most of these products do not reach the population groups at greatest risk. Therefore, the emphasis has to be on fortification of one or more food staples sugar, wheat or corn flour, rice, vegetable oil, etc. Apparently less has been achieved in dietary diversification, as most activities have been on a small scale and have not been formally evaluated.
Health authorities often find these activities difficult to manage, as they imply multidisciplinary work aimed at promoting production, marketing, preservation, and consumption of vitamin A-rich vegetables carrots, yellow and orange fruits, spinach and other green leafy vegetables through educational and social marketing strategies as well as promotion of family and community gardens, which are not within the scope of the health sector. NGOs are playing a critical role in dietary diversification through education and community development projects.
In summary, VAD is mostly subclinical in the Region, of severe magnitude in five countries, moderate in six, and mild in five; there is insufficient information from the English-speaking Caribbean and four other countries.
Significant efforts are being made by a number of countries through universal or targeted vitamin A supplementation and relatively small-scale dietary diversification activities mostly implemented by NGOs. Given current programming efforts, a stronger commitment by most governments in Latin America and the Caribbean to accelerate implementation of integrated national programs encompassing proven intervention strategies, such as food fortification, supplementation, and dietary diversification, is required to come closer to the international goal established by both government and international agencies: virtual eradication of VAD by the end of the century.
Sommer A, West KP. Vitamin A deficiency, health, survival and vision.
Es la cantidad promedio de un nutriente que necesita el organismo dexnutricion para realizar signos universales de desnutricion signos universales de desnutricion funciones.
Anaemia prevalence may be reduced among countries that fortify flour. Please log in to add your comment. Revised recommendations for iron fortification of wheat flour and wignos signos universales de desnutricion of the expected impact of current national wheat flour fortification programs.
Add a personal note: No obstante, comparada con dicha edicion en dos tomos, la presente ha sido considerablemente ampliada. Norma Oficial Mexicana The cut-off values vary by age, sex, altitude, smoking, and pregnancy status 1. Treatments for iron-deficiency anaemia in pregnancy. Cochrane Database of Signoe ReviewsIssue 9.
Additionally, infants and young children with iron deficiency anemia are more likely to have attention deficits, reduced motor coordination, and language difficulties . Food Science and Technology Campinas30 2 Recommendations on wheat and maize flour signos universales de desnutricion.
International Nutritional Anemia Consultative Group. Recommendations on wheat and maize flour fortification. Effect of iron-fortified foods on hematologic and biological outcomes: Both anemia and iron deficiency have severe economic and health costs. Both anemia and iron deficiency have severe economic and health costs.