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FOR ESTIMATING
VITAMIN A INTAKE
TABLE OF CONTENTS
Preface ............................................................................................... 1
Introduction ......................................................................................... 2
References ........................................................................................ 10
PREFACE
F
or the work of HKI in Indonesia, Bangladesh and Nepal, a
method was needed to estimate vitamin A intake. Because the
method would be used in nutrition surveillance systems and in
relatively large surveys, its administration should be relatively quick
and easy.
Previously, such a method had been developed that was partly
based on the IVACG-method. That method was used in the evaluation
of a homegardening program in Bangladesh, in the national vitamin A
survey in Vietnam, and in the first rounds of the Central-Java Nutri-
tion Surveillance Project in Indonesia. It produced data that were
related to vegetable production and to serum retinol concentration in a
dose-responsive manner. Therefore, that method was taken as the basis
for the new method, the 24-VASQ method.
This 24-VASQ method is also based upon a 24-hr recall question-
naire and estimates vitamin A intake semi-quantitatively, but distin-
guishes four different sources of vitamin A vegetables, fruits, animal
foods and fortified foods and estimates vitamin A content per
ingredient instead of per dish.
The method was developed late 1996 and has until now been used
by HKI in surveys in Indonesia (South Sulawesi, South Kalimantan,
East Java, West Java, DKI Jakarta and West Nusa Tenggara),
Bangladesh, Cambodia and Nepal.
We will be very glad to get feedback about this manual, about
experiences in adapting the 24-VASQ method for specific locations as
well as about results obtained when using the method.
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24-VASQ Method for estimating VA intake
INTRODUCTION
T
heoretically, vitamin A intake is best assessed with a food-
frequency method, because vitamin A intake varies largely
between days and between seasons with different food availability
(1). However, it has been reported previously that in areas where a large
variety of vitamin A rich-foods, especially vegetables, is available, food-
frequency methods often overestimate vitamin A intake (2, 3). On the
contrary, those studies also showed that the general food pattern seemed
to be better captured using a 24-hr recall questionnaire (2, 3).
The method previously used in Bangladesh, Vietnam and Central-
Java, Indonesia, was based on a 24-hr recall questionnaire. The fact that
that method produced data on vitamin A intake that were related to
serum retinol concentration in a dose-responsive manner (4), encouraged
us to further refine that method into the 24-VASQ method.
Because vitamin A intake can vary widely by season, data on vitamin
A intake in different seasons are best collected by administering
questionnaires in specific seasons.
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24-VASQ Method for estimating VA intake
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24-VASQ Method for estimating VA intake
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24-VASQ Method for estimating VA intake
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24-VASQ Method for estimating VA intake
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24-VASQ Method for estimating VA intake
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24-VASQ Method for estimating VA intake
REFERENCES
1. Beaton GH, Milner J, McGuire V, Feather TE, Little JA. Source of
variance in 24-hour dietary recall data: implications for nutrition study
design and interpretation. Carbohydrate sources, vitamins and
2. Humphrey J, Friedman D, Natatisastra G, Muhilal. A 24 hour history is
more closely associated with vitamin A status and provides a better
estimate of dietary vitamin A intake of deficient preschool Indonesian
children compared to a food frequency method. J Am Diet Assoc 2000;
100: 1501-1510.
3. De Pee S, West CE, van Staveren WA, Muhilal. Vitamin A intake of
breastfeeding women in Indonesia: critical evaluation of a semi-
quantitative food frequency questionnaire. In: de Pee S. Food-based
approaches for controlling vitamin A deficiency: studies in breastfeeding
women in Indonesia. PhD thesis. Wageningen, Netherlands:
Wageningen Agricultural University, 1996.
4. De Pee S, Bloem MW, Gorstein J, Sari M, Satoto, Yip R, Shrimpton R,
Muhilal. Re-appraisal of the role of vegetables for vitamin A status of
mothers in Central-Java, Indonesia. Am J Clin Nutr, 1998; 68: 1068-1074.
5. Bloem MW, Huq N, Gorstein J, et al. Production of fruits and vegetables
at the homestead is an important source of vitamin A mong women in
rural Bangladesh. Eur J Clin Nutr 1996; 50 (3): S62-7.
6. Bloem MW, Gorstein J. Viet Nam: Xerophthalmia free. 1994 National
vitamin A deficiency and protein-energy malnutrition prevalence survey.
Consultancy report. Hanoi, National Institute of Nutrition, 1995.
7. Bloem MW, Huq N, Gorstein J, et al. Does the production of dark green
leafy vegetables and fruits play a role in the etiology of maternal
nightblindness, diarrhea and malnutrition in Bangladesh? Report of the
XVI International Vitamin A Consultative Group (IVACG) Meeting. The
Nutrition Foundation Inc, Washington DC, 1994.
8. De Pee S, West CE, Permaesih D, Martuti S, Muhilal, Hautvast JGAJ.
Orange fruits are more effective in increasing serum concentrations of
retinol and -carotene than dark-green leafy vegetables in school
children in Indonesia. Am J Clin Nutr 1998; 68: 1058-1067.
9. West CE. Poortvliet Ej. The carotenoid content of foods with special
reference to developing countries. Washington DC: USAID-VITAL, 1993
10. U.S. Institute of Medicine, Food and Nutrition Board, Standing
Committee on the Scientific Evaluation of Dietary Reference Intakes.
Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron,
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24-VASQ Method for estimating VA intake
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APPENDIX 1 24-VASQ Method for estimating VA intake
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24-VASQ Method for estimating VA intake APPENDIX 2
Sample food list
The amount of grams per household unit listed in this table made for Indonesia were obtained by measure-
ment of available foods. When similar tables were developed for Bangladesh and Nepal, fewer cells of the
table were left empty, because generalizations were made for the weight of a table spoon, serving spoon,
bundle, handful etc. The advantage of this approach is that non-nutrition fieldworkers can more easily use
the tables because they have to make fewer estimates about weights themselves, but the disadvantage is that
the estimates of weight for individual foods will be less accurate.
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APPENDIX 2 (CONTD) 24-VASQ Method for estimating VA intake
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24-VASQ Method for estimating VA intake APPENDIX 2 (CONTD)
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APPENDIX 2 (CONTD) 24-VASQ Method for estimating VA intake
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24-VASQ Method for estimating VA intake APPENDIX 2 (CONTD)
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APPENDIX 2 (CONTD) 24-VASQ Method for estimating VA intake
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24-VASQ Method for estimating VA intake APPENDIX 2 (CONTD)
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APPENDIX 3 24-VASQ Method for estimating VA intake
Summary form
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24-VASQ Method for estimating VA intake APPENDIX 4
Estimates of vitamin A intake
from breastmilk
The 24-VASQ method assesses vitamin A intake from animal foods,
vegetables, fruits and fortified foods, but breast-fed children also obtain a
substantial amount of vitamin A from breast milk. In order to assess the
adequacy of vitamin A intake at group level, a rough general estimate of
the vitamin A intake from breast milk can be made.
We suggest the following amounts of RE for breastfed children, based
upon the assumption that the vitamin A content of breast milk of mothers
in developing countries is approximately 1.00 mol/L (equivalent to 571
RE/L):
exclusively breastfed children : 800 ml containing
approximately 450 RE
partially breastfed children aged <12 mo : 500 ml containing
approximately 300 RE
partially breastfed children aged 12-18 mo : 300 ml containing
approximately 200 RE
partially breastfed children aged >18 mo : 175 ml containing
approximately 100 RE
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APPENDIX 5 24-VASQ Method for estimating VA intake
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24-VASQ Method for estimating VA intake APPENDIX 6
Table for vitamin A content of Indonesian Foods
(Based on results of HPLC analysis of carotenoids)
Indonesia, 1997
I. Background
Different dietary sources of vitamin A can be distinguished: animal
foods, which are rich in retinyl esters (preformed vitamin A); fruits and
vegetables, which are rich in provitamin A carotenoids (provitamin A); and
fortified foods, which usually contain vitamin A in the form of retinyl
esters.
Due to the introduction of new methods to analyse carotenoids, new
values on provitamin A content of fruits and vegetables have recently
become available. Because of the availability of these new values and
because of an increased availability of fortified products, this table was
compiled containing the most recent data on vitamin A content of foods
frequently eaten in Indonesia.
This table is currently being used by Helen Keller International,
Indonesia for estimating vitamin A intake using the 24-VASQ method. The
group codes for the ingredients as currently used for the 24-VASQ method
are also listed in the table.
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APPENDIX 6 (CONTD) 24-VASQ Method for estimating VA intake
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24-VASQ Method for estimating VA intake APPENDIX 6 (CONTD)
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APPENDIX 6 (CONTD) 24-VASQ Method for estimating VA intake
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24-VASQ Method for estimating VA intake APPENDIX 6 (CONTD)
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APPENDIX 6 (CONTD) 24-VASQ Method for estimating VA intake
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24-VASQ Method for estimating VA intake APPENDIX 6 (CONTD)
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APPENDIX 6 (CONTD) 24-VASQ Method for estimating VA intake
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24-VASQ Method for estimating VA intake APPENDIX 6 (CONTD)
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APPENDIX 6 (CONTD) 24-VASQ Method for estimating VA intake
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24-VASQ Method for estimating VA intake APPENDIX 6 (CONTD)
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APPENDIX 6 (CONTD) 24-VASQ Method for estimating VA intake
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24-VASQ Method for estimating VA intake APPENDIX 6 (CONTD)
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APPENDIX 6 (CONTD) 24-VASQ Method for estimating VA intake
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APPENDIX 6 (CONTD) 24-VASQ Method for estimating VA intake
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24-VASQ Method for estimating VA intake APPENDIX 6 (CONTD)
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APPENDIX 6 (CONTD) 24-VASQ Method for estimating VA intake
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24-VASQ Method for estimating VA intake APPENDIX 6 (CONTD)
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APPENDIX 6 (CONTD) 24-VASQ Method for estimating VA intake
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24-VASQ Method for estimating VA intake APPENDIX 6 (CONTD)
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APPENDIX 6 (CONTD) 24-VASQ Method for estimating VA intake
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24-VASQ Method for estimating VA intake APPENDIX 6 (CONTD)
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APPENDIX 6 (CONTD) 24-VASQ Method for estimating VA intake
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24-VASQ Method for estimating VA intake APPENDIX 6 (CONTD)
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APPENDIX 6 (CONTD)
We would like to thank the following people for the difficult and detective-like job of correcting the nomenclature
of vegetables, fruits, fish and meat:
J.F. Wienk and colleagues of the Department of Agronomy, Wageningen Agricultural University, Netherlands;
J.H. Houben of the Department of the Science of Food of Animal Origin, University of Utrecht, Netherlands;
and H. Ticheler.
24-VASQ Method for estimating VA intake
24-VASQ Method for estimating VA intake APPENDIX 6 (CONTD)
References for table of
vitamin A content of Indonesian Foods
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APPENDIX 6 (CONTD) 24-VASQ Method for estimating VA intake
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24-VASQ Method for estimating VA intake APPENDIX 6 (CONTD)
a22. Tempe [fermented soya bean] (1)
a23. Tepung [flour] (2)
a24. Sagu (4)
a25. Nangka muda [Jackfruit, raw] (2)
a26. Nangka [Jackfruit] (3)
a27. Terung panjang [Eggplant] (1)
a28. Average of values for mangoes (7)
a29. Cabe merah kering [dried red chili]/cabe merah besar [large red chili], in
ref 3, 87/71 x 150 (= cabe merah besar in ref 9) = 184
a30. Kacang kedelai [Soya bean] (9)
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Table for vitamin A content of commonly consumed foods in Bangladesh
APPENDIX 7
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APPENDIX 7 (CONTD) 24-VASQ Method for estimating VA intake
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24-VASQ Method for estimating VA intake APPENDIX 7 (CONTD)
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APPENDIX 7 (CONTD) 24-VASQ Method for estimating VA intake
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