Vitamin A deficiency in children aged 6 to 24 months in Sao Paulo State, Brazil

Vitamin A deficiency (VAD), mainly the subclinical form, is endemic in seve ral areas of the Brazilian Northeast. However, studies concerning its preva lence and etiology (risk factors) in urban areas of Sao Paulo State are lac king. The objective of the present study was to identify VAD and the risk f actors among children attending a Child Care outpatient clinic in Ribeirao Preto city, Sb Paulo State, Brazil. A total of 103 children aged 6 to 24 mo nths without any diarrhea or fever illness were selected from a pediatric o utpatient clinic. A careful clinical history and physical examination provi ded information about breast-feeding, parental education, family income, fa mily size, birth weight and anthropometric data. The children also underwen t ophthalmologic examination to check for signs of xerophthalmia and were s ubmitted to blood tests in order to determine hemoglobin and serum iron, zi nc and retinol levels. Serum retinol levels pound 0.70 mu mol/l are conside red to be deficient by the World Health Organization. Retinol levels, deter mined by high performance liquid chromatography (HPLC), were pound? 0.70 mu ?mol/l in 22 children (21.4%). No child had xerophthalmia. The overall mean serum zinc level was 108.9 mu g% (2SD +/- 43.1 mu g%) and the values for c hildren with and without VAD were 105.1 mu g% (2SD +/- 44.1 mu g%) and 110. 0 mu g% (2SD r 43.2 mu g%) respectively, with no child presenting serum zin c levels below the normal range. None of them showed a <? -2 Z score for he ight/age or weight/height compared to reference values. No Significant diff erences were observed between children with or without VAD concerning paren tal education, family income, family size and hemoglobin, or serum iron and zinc levels, but low birth weight (<? 2,500 g) was more frequent among chi ldren with VAD. Moreover, children without VAD were breast-fed for a signif icantly longer time than children with VAD (p<0.05). Children with VAD pres ented a history of low birth weight more frequently than children without V AD and breast-feeding was protective against VAD. This study showed that VA D is an important problem in children attending a Child Care outpatient cli nic and that studies are needed in order to identify it and plan actions to combat it, mainly by encouraging breast-feeding practices. (C) 2000 Elsevi er Science.