Food-based approaches for controlling vitamin A deficiency : studies in breastfeeding women in Indonesia

S. de Pee

Research output: Thesisinternal PhD, WU


<br/>Micronutrient deficiencies seriously hinder mental and physical development and are still an important cause of death in developing countries. Therefore, goals have been set worldwide for the year 2000: to eliminate deficiencies of vitamin A and iodine and to reduce prevalence of iron deficiency anemia in women by onethird of 1990 levels. Food-based approaches for the control of micronutrient deficiencies, using foods naturally rich in micronutrients and/or fortified foods, are preferable, because a pharmaceutical approach can only reach a selective group and is less sustainable. This thesis describes research on the role of foods for improving vitamin A status of breastfeeding women in Indonesia.<p>In developing countries, people derive 80-85% of vitamin A from plant sources in the form of provitamin A carotenoids, which the body converts to vitamin A. Preformed vitamin A, retinol, exists only in animal foods and accounts for 15-20% of vitamin A intake. Our questionnaire confirmed that dark-green leafy vegetables are the most important source of vitamin A. However, feeding a portion of dark-green leafy vegetables daily for 12 weeks did not improve vitamin A status, while it improved after feeding a wafer enriched with the same amount of β-carotene. This, as well as results from other carefully controlled studies, contradicts the assumption that vegetables rich in provitamin A carotenoids can play an important role in the control of vitamin A deficiency. Causes of poor bioavailability of vegetable carotenoids could include: complex matrix of leaves; absorption inhibitors, such as fibre which entraps carotenoids, or other carotenoids which may compete for absorption; parasitic infestation; and genetic and/or dietary factors.<p>A very limited effect on vitamin A status should not lead to the conclusion that promoting the consumption of dark-green leafy vegetables is no longer necessary, but food approaches should be based on a variety of foods. Also, factors to calculate vitamin A activity of carotenoids should be reconsidered. In addition, we conclude that vitamin A intake questionnaires, which could be very simple, should only be used to estimate the risk of poor vitamin A status at community level. Vitamin A status and changes in status are best assessed by measuring serum retinol. The measurement of serum β-carotene is recommended for evaluating food-based interventions, because it is very responsive.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • Hautvast, J.G.A.J., Promotor
  • West, C.E., Promotor
  • Muhalil, Promotor, External person
Award date21 Jun 1996
Place of PublicationS.l.
Print ISBNs9789054855576
Publication statusPublished - 1996


  • food
  • foods
  • vitamins
  • spices
  • stimulants
  • retinol
  • nutritional disorders
  • lactating women
  • women
  • pregnancy
  • indonesia


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