Reina Engle-Stone1, Jody C Miller1, Maria Fatima Dolly Reario2, Charles D Arnold1, Ame Stormer2, Eleanore Lafuente2, Anthony Oxley3, Mario V Capanzana4, Carl Vincent D Cabanilla4, Jennifer Lynn Ford5, Adam Clark3, Thirumalaisamy P Velavan6,7, Kenneth H Brown1, Georg Lietz3, Marjorie J Haskell1. 1. Institute for Global Nutrition, Department of Nutrition, University of California, Davis, Davis, CA, USA. 2. Helen Keller International, Malate, Manila, Philippines. 3. Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom. 4. Food and Nutrition Research Institute, Department of Science and Technology, Bicutan, Taguig City, Philippines. 5. Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA. 6. Institute of Tropical Medicine, Universitätsklinikum Tübingen, Tubingen, Germany. 7. Vietnamese German Center for Medical Research (VG-CARE), Hanoi, Vietnam.
Abstract
Background: Young children exposed to high-dose vitamin A supplements (VAS) and vitamin A (VA)-fortified foods may be at risk of high VA intake and high VA total body stores (TBS). Objectives: TBS and estimated liver VA concentration were compared among children with adequate or high VA intake and different timing of exposure to VAS, and associations between estimated liver VA concentrations and biomarkers of VA toxicity were examined. Methods: Children 12-18 mo of age (n = 123) were selected for 3 groups: 1) retinol intake >600 µg/d and VAS within the past mo, 2) retinol intake >600 µg/d and VAS in the past 3-6 mo, and 3) VA intake 200-500 µg retinol activity equivalents (RAE)/d and VAS in the past 3-6 mo. Dietary intake data were collected to measure VA intakes from complementary foods, breast milk, and low-dose, over-the-counter supplements. TBS were assessed by retinol isotope dilution, and VA toxicity biomarkers were measured. Main outcomes were compared by group. Results: Mean (95% CI) VA intakes excluding VAS were 1184 (942, 1426), 980 (772, 1187), and 627 (530, 724) µg RAE/d, in groups 1-3, respectively; mean VA intake was higher in groups 1 and 2 compared with group 3 (P < 0.05). Geometric mean (GM) (95% CI) TBS were 589 (525, 661), 493 (435, 559), and 466 (411, 528) µmol, respectively. GM TBS and GM liver VA concentrations were higher in group 1 compared with group 3 (liver VA concentration: 1.62 vs. 1.33 µmol/g; P < 0.05). Plasma retinyl ester and 4-oxo-retinoic acid concentrations and serum markers of bone turnover and liver damage did not indicate VA toxicity. Conclusions: In this sample, most children had retinol intakes above the Tolerable Upper Intake Level (UL) and liver VA concentrations above the proposed cutoff for "hypervitaminosis A" (>1 µmol/g liver). There was no evidence of chronic VA toxicity, suggesting that the liver VA cutoff value should be re-evaluated. This trial was registered at www.clinicaltrials.gov as NCT03030339.
Background: Young children exposed to high-dose vitamin A supplements (VAS) and vitamin A (VA)-fortified foods may be at risk of high VA intake and high VA total body stores (TBS). Objectives: TBS and estimated liver VA concentration were compared among children with adequate or high VA intake and different timing of exposure to VAS, and associations between estimated liver VA concentrations and biomarkers of VA toxicity were examined. Methods: Children 12-18 mo of age (n = 123) were selected for 3 groups: 1) retinol intake >600 µg/d and VAS within the past mo, 2) retinol intake >600 µg/d and VAS in the past 3-6 mo, and 3) VA intake 200-500 µg retinol activity equivalents (RAE)/d and VAS in the past 3-6 mo. Dietary intake data were collected to measure VA intakes from complementary foods, breast milk, and low-dose, over-the-counter supplements. TBS were assessed by retinol isotope dilution, and VA toxicity biomarkers were measured. Main outcomes were compared by group. Results: Mean (95% CI) VA intakes excluding VAS were 1184 (942, 1426), 980 (772, 1187), and 627 (530, 724) µg RAE/d, in groups 1-3, respectively; mean VA intake was higher in groups 1 and 2 compared with group 3 (P < 0.05). Geometric mean (GM) (95% CI) TBS were 589 (525, 661), 493 (435, 559), and 466 (411, 528) µmol, respectively. GM TBS and GM liver VA concentrations were higher in group 1 compared with group 3 (liver VA concentration: 1.62 vs. 1.33 µmol/g; P < 0.05). Plasma retinyl ester and 4-oxo-retinoic acid concentrations and serum markers of bone turnover and liver damage did not indicate VA toxicity. Conclusions: In this sample, most children had retinol intakes above the Tolerable Upper Intake Level (UL) and liver VA concentrations above the proposed cutoff for "hypervitaminosis A" (>1 µmol/g liver). There was no evidence of chronic VA toxicity, suggesting that the liver VA cutoff value should be re-evaluated. This trial was registered at www.clinicaltrials.gov as NCT03030339.
Authors: Gretchen A Stevens; James E Bennett; Quentin Hennocq; Yuan Lu; Luz Maria De-Regil; Lisa Rogers; Goodarz Danaei; Guangquan Li; Richard A White; Seth R Flaxman; Sean-Patrick Oehrle; Mariel M Finucane; Ramiro Guerrero; Zulfiqar A Bhutta; Amarilis Then-Paulino; Wafaie Fawzi; Robert E Black; Majid Ezzati Journal: Lancet Glob Health Date: 2015-09 Impact factor: 26.763
Authors: Dominique Turck; Torsten Bohn; Jacqueline Castenmiller; Stefaan De Henauw; Karen Ildico Hirsch-Ernst; Helle Katrine Knutsen; Alexandre Maciuk; Inge Mangelsdorf; Harry J McArdle; Carmen Peláez; Kristina Pentieva; Alfonso Siani; Frank Thies; Sophia Tsabouri; Marco Vinceti; Peter Aggett; Marta Crous Bou; Francesco Cubadda; Agnès de Sesmaisons Lecarré; Laura Martino; Androniki Naska Journal: EFSA J Date: 2022-01-24