| Background:Vitamin A deficiency was one of three micronutrient disorders of public health significance globally, such as iodine deficiency, iron deficiency. Vitamin A deficiency impairs numerous functions and, as a result, can lead to many health consequences, to which infants, young children and pregnant women appear to be at greatest risk. Xerophthalmia is the most specific, vitamin A deficiency and is the leading preventable cause of blindness in children throughout the world. Vitamin A deficiency has been more damaging and predominantly effect to pregnant women. The majority of studies focus on vitamin A deficiency of pregnant women; it found vitamin A deficiency was strongly associated with pregnancy and birth outcomes. They found antenatal vitamin A supplementation decreased anemia, preterm delivery, intrauterine growth retardation, low birth weight, deformity, preeclampsia/eclampsia, poor infant growth, neonatal and infant mortality, and maternal mortality. Indeed by WHO estimates,19 million pregnant women are thought to be affected by this nutritional deficiency. So far, there was little large sample data about children and pregnant women of vitamin A status in China.Objective:Our study based on China National Nutrition and Health Survey (2012) to establish high performance liquid chromatography (HPLC) method to assess human serum retinol levels and assess the status and potential influence factors of vitamin A deficiency of Chinese children at the age of 6-13 and pregnant women.Method:Our study used retinol acetate as internal standard to establish high performance liquid chromatography (HPLC) method to assess human serum retinol levels. World Health Organization recommended measure serum retinol concentrations in a population as major approach to assessing vitamin A status in a population, according to China National Nutrition and Health Survey in 2012 and 2002 designed, we chose Chinese children at the age of 6-13 and pregnant women as participant and assessed human serum retinol levels.A series of questionnaires was used for China National Nutrition and Health Survey (2012),The questionnaires included questions regarding the pregnant such as:regions; gender; height; weight; age; gestational age; parity; whether use the vitamin A supplements; pregnant women drinkers; education levels, Annual income of the pregnant women; Smoking habitResults:1. Retinol retention time was 3.337 min, retinol acetate retention time was 4.354 min. Regression equation for Y=2.37+6.17X(r=0.9996, r2=0.9996), the linear range:0.05-1.04μg/mL, the minimum detection limit of 0.02μg/mL.2. In 2012, the vitamin A level of the children 0.14+0.03μmol/L was higher than that 0.11±0.03μmol/L in 2002 (t=39.26, p=0.000). There was no difference on the incidence of vitamin A deficiency in all the children between 2002(8.95%) and 2012(8.18%). In 2012, the incidence of marginal vitamin A deficiency in the children was21.82% lower than 45.68% in 2002 (x2=861.604, p=0.000).The level of vitamin A in 10-to 13-year-old group was higher than that in 6-to 9-year-old group across areas and genders between 2002 and 2012. The incidence of vitamin A deficiency in 10-to 13-year-old group was lower than that in 10-to 13-year-old group across areas and genders between 2002 and 2012. Similar phenomena were also found in across area groups. The incidence of marginal vitamin A deficiency in 10-to 13-year-old group was lower than that in 6-to 9-year-old group across areas and genders between 2002 and 2012.Pearson’s correlation coefficient adjusted for age and gender and region was positive significant (r=0.06, P= 0.00) for BMI and serum concentrations of retinol. Our study showed that overweight (odds ratio 1.50,95% confidence interval 1.15-1.95) and non-overweight (odds ratio 1.28,95% confidence interval 0.97-1.69) compared with obesity was more likely to occurred to inadequacy serum concentrations of retinol. Lower age (odds ratio 1.08,95% confidence interval 1.04-1.13) and rural areas (odds ratio 0.82,95% confidence interval 0.70-0.97) was easy to occurred to inadequacy serum concentrations of retinol.3. The mean serum retinol level was 1.63μmol/L (95% CI 1.60-1.67), and 64[5.3% (95% CI 4.03-6.56)] of the participants had VAD, additional 137 [11.3%(95% CI 9.54-13.12)] participants had marginal VA status, normal was 1008[83.4%(95% CI 82.8-85.47)]. The serum retinol level (μmol/L) was explained by 5 independent variables (Table 2). Unit increment in age (in years) and gestational age (in months) were associated with 0.01and 0.08 μmol/L decline in serum retinol level respectively. According increment levels of region strata and anemia were associated with 0.05 and 0.11μmol/L decline in serum retinol level respectively. On the contrary, a unit increment in level of income was associated with 0.05 μmol/L rise in retinol concentration. Pregnant women in the poor rural areas had 4.73(2.67-8.41) times increased odds of vitamin A deficiency compared with those in the large cities. Pregnant women without college or university education had 3.17 times (95%CI 1.51-6.67) higher odds of vitamin A deficiency compared with pregnant with college or university education. Pregnant women’s income at 20000-30000,10000-20000,< 10000 had 3.64(1.01-13.16),4.33(1.18-15.90)and 4.91(1.31-18.46)times higher odds of vitamin A deficiency compared with pregnant women income beyond 30000. Across the group of drinkers between yes or no with pregnant women found drinkers had 3.10(1.65-5.81) times increased odds of vitamin A deficiency compared with those no drinkers. Pregnant smokers had 5.68 times (95% CI 2.23-14.49) higher odds of vitamin A deficiency compared with pregnant with non-smoker without passive smoking. Pregnant women in the second and third trimester had 2.40(95%CI 1.05-5.46) and 2.82 (95% CI 1.34-5.93) times increased odds of vitamin A deficiency compared with those in the first trimester respectively.Conclusions:1. High performance liquid chromatographic internal standard method to detect serum retinol is a kind of effective method. The large samples of serum retinol detection were using high performance liquid chromatographic internal standard method.2. Vitamin A nutritional status of the children in 2012 has been significantly improved compared with that in 2002. However, the lower the age of children is vitamin A deficiency of high-risk groups. There was positive correlation between serum concentrations of retinol and child’s BMI. Lower age children were easy to occur inadequate of retinol. Compared with obesity and urban, overweight /non-overweight and rural children were easy to occur inadequate of retinol. In further study, public health strategies should focus on overweight/obesity population and vitamin A supplement should consider the effect of retinol on Chinese children. Consequently, controlling the incidence of vitamin a deficiency is imperative for promoting Chinese children’s health.3. Chinese pregnant women and the prevalence of vitamin A deficiency was 5.3%, which was a mild public-health issue in China. In the poor rural areas and without college or university education and low-income and advanced gestational age were pertinent risk factors of vitamin A deficiency. Unhealthy lifestyles of pregnant women such as smoking and drinking were also pertinent influence factors of vitamin A deficiency. So in the future health public policy on vitamin A should be paid more attention on pregnant women with pertinent influence factors of vitamin A deficiency, accordingly, eliminate vitamin A deficiency improve the nutritional status of Chinese pregnant women.
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