Chronic low intakes of vitamin A-rich foods in households with xerophthalmic children: A case-control study in Nepal

Dietary patterns in 81 rural Nepali households with a 1-6 y-old child with a history of xerophthalmia were compared with dietary patterns of 81 households with an age matched nonxerophthalmic control subject. Weekly food- frequency questionnaires were collected from case and control 'focus' children, a younger sibling (if present), and the household 1-2 y after recruitment and treatment of cases. Control households and children were more likely than case households and children to consume vitamin A-rich foods during the monsoon (July-September) and major rice harvesting (October- December) seasons. Cases were less likely to consume preformed vitamin A- rich foods throughout the year [odds ratio (OR) = 1.2-4.5] with the strongest differences observed from October to December (OR = 2.0-4.2). Dietary risks were generally shared by younger siblings of cases, suggesting that infrequent intake of β-carotene and preformed vitamin-A rich foods begins early in life and clusters among siblings within households, a pattern that is consistent with their higher risk of xerophthalmia and mortality. In developing countries where vitamin A deficiency is endemic, dietary counseling for children with xerophthalmia should be extended to their younger siblings. Moreover, dietary intake of preformed vitamin A may be as, or more, important as carotenoid-containing food consumption in protecting children and other members of households from vitamin A deficiency.