| ObjectiveVitamin A deficiency and deficiency anemia affect >30% of the global population,they are the major health concern in the world, especially in developing countries. The most vulnerable groups are pregnant women, infants, and children. It is of great important to explore effective intervention for improving the hemoglobin and vitamin A nutritional statue of the preschool children.Iron deficiency disorder is regarded as the major motivation on anemia and has been studied for years. Nevertheless, only about half of anemia is thought to be related to iron deficiency, it is agreed that nutritional anemia involves not only iron and that a range of other micronutrients, including vitamin A, zinc. It has been established that there is a relationship between vitamin A deficiency and anemia, and our previous studies also showed that supplementing diet with vitamin A alone significantly enhanced the concentrations of Hb and reduced the prevalence of anemia. Moreover, it was suggested that the addition of vitamin A and zinc to the treatment for anemia can increase hemoglobin levels more than supplementing iron alone, but the mechanism of this effect is unclear. Recently, most multi-micronutrients supplementation studies showed greater effects on enhancing the concentrations of hemoglobin, improving nutritional status. It is said that nutrients supplementation is the most effective way to improve the nutritional status of children. In this present study, we conducted a randomized and controlled trial with 3 intervention groups: the vitamin A group, the vitamin A plus zinc group and the vitamin A combined with multiple micronutrients group. The main aim of this study was to investigate the efficacy of vitamin A alone or vitamin A combined with other micronutrients supplementation in increasing erythropoietin, hemoglobin concentrations, and retinol status in preschool children in Chongqing, the effect of supplementation on growth was also evaluated.Subjects and MethodsA randomized, double-blind supplementation trial was conducted in a suburb of Chongqing, China. A total of 350 preschool children aged between 3-6 years old were assigned randomly to 3 treatment groups: the vitamin A group (A group) that received 25000 IU vitamin A and supplemented on Days 14 and 28; the vitamin A plus zinc group (AZ group) that received10 mg elemental zinc 5d/week, and a vitamin A supplementation that was consistent with the vitamin A group; the vitamin A combined with multiple micronutrients group (AMM group) that received 5000 IU vitamin A, and calcium, vitamin B1, vitamin B2, vitamin B6, vitamin B12, vitamin C, folic acid, niacinamide, as well as pantothenic acid every three days. The supplementation lasted for 6 months. The children were measured height, weight, as well as hemoglobin, EPO, VA and Zn concentrations before and after the intervention. The questionnaire of the related information on children was performed, also the method of 24-hour dietary recall was use to investigate the dietary nutrients intake of the children.Results1. The overall prevalence of underweight (WAZ<-2), stunting (HAZ<-2), wasting(BAZ<-2) and overweight or obesity (2≤BAZ<3)at baseline was 3.14%,5.71%,6.86% and5.85%, respectively. The mean Hb concentration was(117.33±9.77)g/L, The overall prevalence of anemia was 25.14%; While the mean vitamin A concentration was (1.23±0.25)μmol/L, and the prevalence of VAD and MVAD was 1.14% and 22.32%, respectively. The correlation coefficients of hemoglobin and vitamin A is r=-0.412.2. The survey showed that the essential micronutrients such as vitamin A and zinc were inadequate in the children's diet. When after 6 months of supplementation, there were significant improvements in growth (weight and height as well as WAZ, HAZ and BAZ) significant in the there treatment groups. The overall prevalence of underweight, stunting, wasting and overweight or obesity was decrease. The height and HAZ gains in the AZ group were significantly greater than in the A group and AMM group. While the weight, WAZ and BAZ increment was significantly greater in the AMM group than the other two groups. After 6 months of supplementation, the prevalence of anemia decreased significantly in all three groups. Supplementation of vitamin A combined with multiple micronutrients group significantly improved the hemoglobin concentration of 6.35g/L, which was significant higher than in the A group. Supplementation of vitamin A plus zinc and vitamin A combined with multiple micronutrients group significantly improved the vitamin A concentration of 0.05μmol/L and 0.09μmol/L, respectively. However, supplementation of vitamin A only improved the vitamin A concentration of 0.03μmol/L. the slope of the regression line between Log 10 erythropoietin and hemoglobin in A group is significantly decrease -0.0099,while is significantly increase -0.0073in AMM group.Conclusions1. The overall prevalence of VAD, moderate and severe anemia of the preschoolers is low in this region, but MVAD and mild anemia remain high,while the physical development of children is remain relatively low. 2. Supplementation vitamin A only has the same effect on the increase of Hb concentration and physical development with the supplementation of vitamin A plus zinc and vitamin A combined with multiple micronutrients. Our study has demonstrated that a multiple micronutrient fortified supplementation for 6 months is more effective to improve the levels of hemoglobin and serum vitamin A in preschool children.3. After 6 months intervention, supplementation vitamin A alone can significantly increase EPO concentration, furthermore, the slope of the regression line between erythropoietin and hemoglobin in A group is significantly decrease, it is confirmed that vitamin A may increase the synthesis of EPO in the crowd.
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