Vitamin A Intake and Factors Influencing it Amongst Children and Caretakers in Kosrae, Micronesia

Abstract

A cross-sectional study was undertaken in Kosrae, Federated States of Micronesia to assess preschool children and caretaker dietary intake of vitamin A (VA) (including provitamin A carotenoids) and other nutrients contributing to VA status and to investigate relationships between VA intake and factors affecting dietary intake. Ethnography, food sample analysis, two dietary assessment methods (7-day food frequency questionnaire and quantitative 24-hour recall for three nonconsecutive days) administered by trained interviewers to a random sample group, and cultivar difference specification (yellow-fleshed versus white-fleshed bananas) contributed to the richness of the study. Vitamin A intake was low, approximately half of the estimated requirements for children (n = 65) and caretakers (n = 65), whereas protein intake was high. There were no clear significant relationships associated with gender, caretaker education, caretaker occupation, and socio-economic status with VA intake, indicating that a broad-based intervention over all population segments is needed to change dietary behavior. The ethnographic approach was critical for survey instrument development and data analysis.

Acknowledgement is made to The University of Queensland for provision of the International Postgraduate Research Scholarship for the primary author, who collected the data as part of her PhD research project. The Task Force Sight and Life, Thrasher Research Fund, and the Centers for Disease Control and Prevention provided funding support. All those providing assistance in the ethnographic study and dietary assessment are warmly thanked, including Dr. Eliuel Pretrick, Dr. Hiroshi Ismail, Mayble Sigrah, Jocelyn Charley, Cathy Wakuk, Isabel George, Matchuko Talley, Dr. Vita Skilling, and Procula Jackson.

KeyWords:

• dietary assessment
• vitamin A
• provitamin A carotenoids
• preschool children
• women
• ethnography
• food frequency questionnaire
• 24-hour recall
• Micronesia

Notes

Acknowledgement is made to The University of Queensland for provision of the International Postgraduate Research Scholarship for the primary author, who collected the data as part of her PhD research project. The Task Force Sight and Life, Thrasher Research Fund, and the Centers for Disease Control and Prevention provided funding support. All those providing assistance in the ethnographic study and dietary assessment are warmly thanked, including Dr. Eliuel Pretrick, Dr. Hiroshi Ismail, Mayble Sigrah, Jocelyn Charley, Cathy Wakuk, Isabel George, Matchuko Talley, Dr. Vita Skilling, and Procula Jackson.

¹An individual HKI FFQ animal score reflects the number of days eating animal sources of VA. An individual total score equals the animal score plus the number of days eating plant sources of VA divided by 6 (reflecting conversion of provitamin A carotenoids to VA). Community animal and total scores are calculated by averaging the individual animal and total scores.

²RE is a unit quantifying VA activity in foods, referring to 1 µg all-trans-retinol (VA). The RE is defined as equivalent to 6 µg of dietary all-trans-β-carotene.

³The Retinol Activity Equivalent unit was recently recommended for quantifying VA activity in foods and is equivalent to 12 µg of dietary all-trans-β-carotene. However, the RE is still used in food composition tables.

⁴Types of dark green leafy vegetables, seafood egg/crab ovary, fish/seafood, tinned fish, tinned meat, non-yellow-fleshed and yellow-fleshed banana cultivars were listed as sub-items within the FFQ food item categories. Giant swamp taro and breadfruit cultivars were not listed as the ethnographic study showed them difficult to identify.

⁵Since this study was done, a VA supplementation program has been initiated for preschool children through the Kosrae Department of Health, as supported by the FSM national government and the United Nations Children's Fund.

⁶The WHO/FAO Recommended Safe Intake of VA for children 1–3 years of age is 400 µg RE/day. For children 4–6 years of age, it is 450 µg RE/day.

⁷The FAO/WHO requirement is 16 g for a 3–5 year old child on a diet rich in complete proteins.

⁸The WHO/FAO Recommended Safe Intake of VA for non-pregnant, non-lactating women 19–65 years of age is 500 µg RE/day.

⁹Caretaker outliers had a high VA intake due to consumption of fish liver, whereas the child outliers had high VA intake due to consuming various foods.

Gonzaga, P. C. (2000). Results of vitamin A, anemia, and blood lead survey among 2–4 year old children and reproductive-aged women in Yap proper and Kosrae state, Federated States of Micronesia (January and February 2000). Centers for Disease Control and Prevention, Atlanta, GA.

Institute of Medicine (2001). Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. A report of the Panel on Micronutrients, Subcommittees on Upper Reference Levels of Nutrients and of Interpretation and Use of Dietary Reference Intakes, and the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Washington, DC: Food and Nutrition Board, National Academy Press