Evaluation of the effect of vitamin A-fortified margarine on the vitamin A status of preschool Filipino children

Objectives: This study assessed the effects of consuming a highly hydrogenated, vitamin A (VA)-fortified margarine not requiring refrigeration on VA status of preschool children. Design: A double-masked randomized community trial. Setting: Six rural villages in Cavite, Southern Luzon, the Philippines. Subjects: 296 and 285 children 3-6 y of age in the VA-fortified (experimental) and non-fortified (control) margarine groups, respectively. Intervention: Each week for 6 months households were given 250 g of VA-fortified margarine [providing 28.8 μg retinol equivalents (RE) per g] or non-fortified (0 μg RE) margarine of identical appearance for each enrolled child. Children's vitamin A status [serum retinol, xerophthalmia, and conjunctival impression cytology (CIC) status] and dietary intake were assessed at baseline and folloiv-up; margarine intake was monitored throughout the study. Results: Daily margarine intake per child averaged 27 g in the experimental group (providing 776 μg RE) and 24 g (0 μg RE) in the control group. After 6 months, mean serum retinol increased from 26.4 to 28.8 μg/dl in the experimental group but decreased from 26.6 to 25.1 μg/dl in controls (P < 0.001 at 6 months); the multiple-adjusted increment over controls was 2.4 μg/dl (P < 0.01). More importantly, the prevalence of low serum retinol (< 20 μg/dl) decreased from 25.7 to 10.1% in the experimental group but remained unchanged in controls (26.7 to 27.7%) (P < 0.01 at 6 months). At follow-up no experimental children had developed xerophthalmia but 1.4 and 1.8% of controls developed nightblindness and Bitot's spots, respectively. There were no differences in CIC between groups. Conclusion: Consumption of VA-fortified margarine significantly improved VA status of preschool Filipino children.