Vitamin A intake of school‐aged children exceed dietary references intake in the Western Highlands of Guatemala
Authors: Escobar Marta Lucía , Vossenaar Marieke , Solomons Noel W. 
Published: November 2023

BackgroundIn Guatemala micronutrient deficiencies constitute a significant nutritional problem. Some of the problems have been addressed with nationwide public health interventions such as the vitamin A fortification in granulated table sugar, folic acid in wheat flour, iodine in salt, among others. Little is known on the adequacy of total vitamin A (provitamin A carotenoids plus preformed vitamin A) intake among school‐aged children and their main dietary sources. On the one hand, schoolchildren may avoid eating the plant foods, rich in provitamin A, but they may be prone to seeking sugar‐sweetened beverages and dishes (e.g. breakfast cereals) in disproportion, on the other hand.ObjectiveTo determine aspects of the adequacy and safety of vitamin A diet intake of school children in rural western highlands of Guatemala.MethodsA single 24‐h self‐drafted, pictorial dietary registry was administrated to 115 school‐aged children between 8–11 y (58 girls and 57 boys), in a rural public school of Chiquilajá, Quetzaltenango in the Western Highlands of Guatemala. Children were instructed in school as how to fill in the pages representing the meals and snacks of the day and given color crayons for depicting all foods and beverages consumed over a 24‐h period. Upon returning their workbooks on the following day, portion sizes were estimated in the interview with the nutritionist using standardized local household measures. A modified USDA food composition table was used to calculate pro‐vitamin A and preformed vitamin A intake and combine them to estimate total vitamin A. A standard fortification level of 10 μg/g was assumed for granulated table sugar fortification. Adequacy of total vitamin A, proportion of children with estimated intakes below the WHO/FAO Recommended Nutrient Intake (RNI) or above the Tolerable Upper Intake Level (UL) were evaluated. The RNI for children aged 8–9 y is 500 μg RE and that for children aged 10–11 y is 600 RE. The UL criterion for younger age‐group is >900 μg RAE, whereas that for the older group is >1,700 μg RAE. Only preformed vitamin A is used to estimate excess intake, whereas dietary carotenoids are not considered to contribute to toxicity.ResultsMedian estimated total vitamin A intake was 1436 RAE. Preformed vitamin A intake median (1270 μg RAE) was 10‐fold higher than the pro‐vitamin A contribution (median=127 μg RAE). The median contribution of table sugar alone to the vitamin A in the diet record was 743 μg RAE. In descending order representing the main sources of both total and preformed vitamin A intake were: table sugar; Incaparina®; chicken; and eggs. Total vitamin A covered 100% of the daily RNI for 96% of 8–9 years old and 95% of 10–11 years old children, respectively. On the day of data collection, 35% of children had estimated preformed vitamin A intakes above the UL.ConclusionDue to the sugar‐fortification mandate, Vitamin A is not a commonly‐deficient nutrient in the diet of school‐aged children among the evaluated population. Almost 4 of 10 children presented excess in the intake of preformed vitamin A. Public health efforts in promoting the consumption of vegetables as more important sources of vitamin A are in need of reinforcement.Support or Funding InformationFinanced by Hormel Foods Corporation, Austin, USA