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Hypercarotenodermia in Zambia: which children turned orange during mango season?

European Journal of Clinical Nutrition volume 69, pages 1346–1349 (2015)Cite this article

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Abstract

Vitamin A (VA) deficiency is a public health problem in many countries. The World Health Organization recommends high-dose VA supplements to children aged 6–59 months based on unequivocal evidence that supplements decreased mortality risk. VA supplements were meant as a temporary intervention until more sustainable approaches could be implemented. Fortification of processed foods with preformed VA is a means to improve VA status. The most recent addition of retinyl palmitate to cooking oil in countries that may also fortify margarine and milk will undoubtedly have a positive impact on VA status. However, quantitative measures have not been used to assess the underlying VA status of the groups who have adopted widespread fortification. The addition of preformed VA to otherwise adequate diets in VA may cause excessive total body stores. Monitoring population status will require accurate VA assessment to ensure that hypervitaminosis does not prevail. This perspective describes a cohort of rural Zambian children who have adequate diets in VA, mostly as provitamin A carotenoids; who were given high-dose VA supplements till the age of 5 years; who have access to VA-fortified sugar; and whose mothers had access to VA-fortified sugar throughout pregnancy and lactation. Many of these children turned orange during mango season, and this phenomenon occurred at estimated liver reserve concentrations >1 μmol retinol equivalents/g liver. It will be necessary to continue to monitor VA status, including all sectors of the population that have access to successful interventions, to optimize health with the intent to lower retinol content of fortified foods or better target VA supplementation to areas of most need.

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Acknowledgements

The fieldwork and community meetings were supported by HarvestPlus contract number 8256. HarvestPlus (www.harvestplus.org) is a global alliance of agriculture and nutrition research institutions working to increase the micronutrient density of staple food crops through biofortification. The views expressed do not necessarily reflect those of HarvestPlus. The writing was supported by University of Wisconsin-Madison Global Health funds and an endowment to Tanumihardjo entitled the 'Friday Chair for Vegetable Processing Research'.

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Authors and Affiliations

  1. Department of Nutritional Sciences, Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA

    S A Tanumihardjo & B M Gannon

  2. Research and Planning Unit, National Food and Nutrition Commission of Zambia, Lusaka, Zambia

    C Kaliwile

  3. Department of Biomedical Sciences, Tropical Diseases Research Centre, Ndola, Zambia

    J Chileshe

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  1. S A Tanumihardjo
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  2. B M Gannon
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  3. C Kaliwile
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  4. J Chileshe
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Correspondence to S A Tanumihardjo.

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Tanumihardjo, S., Gannon, B., Kaliwile, C. et al. Hypercarotenodermia in Zambia: which children turned orange during mango season?. Eur J Clin Nutr 69, 1346–1349 (2015). https://doi.org/10.1038/ejcn.2015.143

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