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Vitamin E deficiency in childhood: a narrative review

Published online by Cambridge University Press:  05 August 2022

Lina Monteiro de Castro Lobo
Affiliation:
Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil
Maria Claret Costa Monteiro Hadler*
Affiliation:
Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil Graduate Program in Nutrition and Health, Faculty of Nutrition, Federal University of Goiás, Goiânia, Goiás, Brazil
*
*Corresponding author: Maria Claret Costa Monteiro Hadler, email clarethadler@uol.com.br

Abstract

Vitamin E is an important nutrient from the earliest stages of life. It plays key roles as an antioxidant and in the maintenance of the immune system, among others. Vitamin E deficiency (VED), which occurs more frequently in children, is rarely addressed in the literature. This narrative review aims to summarise the chemistry, biology, serum indicators and clinical trials that have evaluated the impact of fortification and other relevant aspects of vitamin E, in addition to the prevalence of its deficiency, in children worldwide. Vitamin E intake in recommended amounts is essential for this nutrient to perform its functions in the body. Serum α-tocopherol is the most widely used biochemical indicator to assess the prevalence of VED. VED has been associated with symptoms secondary to fat malabsorption and may lead to peripheral neuropathy and increased erythrocyte haemolysis. Reduced concentrations of α-tocopherol may be caused by the combination of diets with low amounts of vitamin E and inadequate consumption of fats, proteins and calories. The lowest prevalence of VED was found in Asia and the highest in North America and Brazil. High proportions of VED provide evidence that this nutritional deficiency is a public health problem in children and still little addressed in the international scientific literature. The planning, evaluation and implementation of health policies aimed at combatting VED in the paediatric population are extremely important.

Type
Review Article
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Nutrition Society

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References

Lima, MSR, Dimenstein, R & Ribeiro, KDS (2014) Vitamin E concentration in human milk and associated factors: a literature review. J Pediatr 90, 440448.CrossRefGoogle ScholarPubMed
Marquez, M, Yépez, CE, Sútil-Naranjo, R, et al. (2002) Basic aspects and determination of antioxidant vitamins E and A. Invest Clin 43, 191204. Portuguese.Google Scholar
Dror, DK & Allen, LH (2011) Vitamin E deficiency in developing countries. Food Nutr Bull 32, 124143.CrossRefGoogle ScholarPubMed
Nordic Nutrition Recommendations (2014) Part 3: Vitamin A, D, E, K, Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Biotin, Panthothenic Acid and Vitamin C. Nord: Nordic Council of Ministers.Google Scholar
Fernández, CF, Febles, CS, Bernabeu, AS, et al. (2002) Funciones de la vitamina E: actualización. Cubana Estomatol 40, 2832.Google Scholar
Jiang, Q (2014) Natural forms of vitamin E: metabolism, antioxidant, and anti-inflammatory activities and their role in disease prevention and therapy. Free Radic Biol Med 72, 7690.CrossRefGoogle ScholarPubMed
World Health Organization (1998) Vitamin and Mineral Requirements in Human Nutrition: Report of a Joint FAO/WHO Expert Consultation. Bangkok, Thailand: World Health Organization.Google Scholar
Morrissey, PA & Sheehy, PJA (1999) Optimal nutrition: vitamin E. Proc Nutr Soc 58, 459468.CrossRefGoogle ScholarPubMed
Abdala-Valencia, H, Berdnikovs, S, Soveg, FW & Cook-Mills, JM (2014) Alpha-tocopherol supplementation of allergic female mice inhibits development of CD11c+CD11b+ dendritic cells in utero and allergic inflammation in neonates. Am J Physiol Lung Cell Mol Physiol 307, L482L496.CrossRefGoogle ScholarPubMed
Kumar, R, Ferrie, RP, Balmert, LC, et al. (2020) Associations of α- and γ-tocopherol during early life with lung function in childhood. J Allergy Clin Immunol 146, 13491357.CrossRefGoogle ScholarPubMed
Abdala-Valencia, H, Soveg, F & Cook-Mills, JM (2016) γ-Tocopherol supplementation of allergic female mice augments development of CD11c+CD11b+ dendritic cells in utero and allergic inflammation in neonates. Am J Physiol Lung Cell Mol Physiol 310, L759L771.CrossRefGoogle ScholarPubMed
Cook-Mills, JM, Abdala-Valencia, H & Hartert, T (2013) Two faces of vitamin e in the lung. Am J Respir Crit Care Med 188, 279284.CrossRefGoogle ScholarPubMed
Abdala-Valencia, H, Berdnikovs, S & Cook-Mills, JM (2012) Vitamin E isoforms differentially regulate intercellular adhesion molecule-1 activation of PKC alpha in human microvascular endothelial cells. PLoS ONE 7, e41054.CrossRefGoogle ScholarPubMed
McCary, CA, Yoon, Y, Panagabko, C, Cho, W, Atkinson, J & Cook-Mills, JM (2012) Vitamin E isoforms directly bind PKC alpha and differentially regulate activation of PKC alpha. Biochem J 441, 189198.CrossRefGoogle Scholar
Berdnikovs, S, Abdala-Valencia, H, McCary, C, Somand, M, Cole, R, Garcia, A, Bryce, P & Cook-Mills, J (2009). Isoforms of vitamin E have opposing immunoregulatory functions during inflammation by regulating leukocyte recruitment. J Immunol 182, 43954405.CrossRefGoogle ScholarPubMed
Traber, MG (2014) Vitamin E inadequacy in humans: causes and consequences. Adv Nutr 5, 503514.CrossRefGoogle ScholarPubMed
Traber, MG (2007) Vitamin E regulatory mechanisms. Annu Rev Nutr 27, 347362.CrossRefGoogle ScholarPubMed
Institute of Medicine (2000) Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids. Washington, DC: National Academy Press.Google Scholar
Azzi, A (2018) Many tocopherols, one vitamin E. Mol Aspects Med 61, 92103.CrossRefGoogle ScholarPubMed
International Life Sciences Institute (2014). Cohen C, Silva CS, Vannucchi H. (Org). Fully Recognized Functions of Nutrients. International Life Sciences Institute. Portuguese.Google Scholar
Hiroi, M, Ogihara, T, Hirano, K, Hasegawa, M, Morinobu, T, Tamai, H & Niki, E (2005) Regulation of apoptosis by glutathione redox state in PC12 cells exposed simultaneously to iron and ascorbic acid. Free Radic Biol Med 38, 10571072.CrossRefGoogle ScholarPubMed
Freitas, JB & Naves, MMV (2010) Chemical composition of nuts and edible seeds and their relation to nutrition and health. Rev Nutr 23, 269279. Portuguese.CrossRefGoogle Scholar
Instituto Brasileiro de Geografia e Estatística (2011) Pesquisa de Orçamentos Familiares 2008–2009. Rio de Janeiro: Tabelas de Composição Nutricional dos Alimentos Consumidos no Brasil.Google Scholar
Nordic Nutrition Recommendations (2012) Integrating Nutrition and Physical Activity. Nord: Nordic Council of Ministers.Google Scholar
Brasil. Ministério da Saúde (2002) Secretaria de Política de Saúde. Dietary guideline for children under two years old . Brasília, DF: Ministério da Saúde. Portuguese.Google Scholar
Bueno, MB, Fisberg, RM & Maximino, P (2013) Nutritional risk among Brazilian children 2 to 6 years old: a multicenter study. Nutrition 29, 405410.CrossRefGoogle ScholarPubMed
Gomes, RCF, Costa, THM & Schmitz, BAS (2010) Dietary assessment of pre-school children from Federal District Brazil. Arch Latinoam Nutr 60, 168174. Portuguese.Google ScholarPubMed
Luna, RCP, Nascimento, CCC, Bandeira, GTP, et al. (2011) Low habitual consumption of food sources of vitamin E in the child population. Rev Inst Adolfo Lutz 70, 213219. Portuguese.Google Scholar
Paiva-Bandeira, GT, Rios-Asciutti, LS, Riviera, AA, et al. (2011) The relationship between income and children's habitual consumption of β-carotene, vitamin C and vitamin E in food. Rev Salud Publica 13, 386397. Portuguese.Google ScholarPubMed
Giraud, DW, Kim, YN, Cho, YO, et al. (2008) Vitamin E inadequacy observed in a group of 2 to 6-years-old children living in Kwangju, Republic of Korea. Int J Vitam Nutr Res 78,148155.CrossRefGoogle Scholar
Demmer, E, Cifelli, CJ & Houchins, JA (2018) The pattern of complementary foods in American infants and children aged 0–5 years old- a cross-sectional analysis of data from the NHANES 2011–2014. Nutrients 10, 113.CrossRefGoogle Scholar
Kayden, HJ & Traber, MG (1993) Absorption, lipoprotein transport, and regulation of plasma concentrations of vitamin E in humans. J Lipid Res 34, 343358.CrossRefGoogle ScholarPubMed
Schmolz, L, Birringer, M, Lorkowski, S, et al. (2016) Complexity of vitamin E metabolism. World J Biol Chem 7, 1443.CrossRefGoogle ScholarPubMed
Borel, P, Preveraud, D & Desmarchelier, C (2013) Bioavailability of vitamin E in humans: an update. Nutr Rev 71, 319331.CrossRefGoogle ScholarPubMed
Lodge, JK, Hall, WL & Jeanes, YM (2004) Physiological factors influencing vitamin E biokinetics. Ann N Y Acad Sci 1031, 6073.CrossRefGoogle ScholarPubMed
Jeanes, YM, Hall, WL, Ellard, S, et al. (2004) The absorption of vitamin E is influenced by the amount of fat in a meal and the food matrix. Br J Nutr 92, 575579.CrossRefGoogle Scholar
Hollander, D & Dadufalza, V (1989) Lymphatic and portal absorption of vitamin E in aging rats. Dig Dis Sci 34, 768772.CrossRefGoogle ScholarPubMed
Leonard, SW & Traber, MG (2019) Methods for assessment of vitamin E. In Harrington, D, editor. Laboratory Assessment of Vitamin Status. 1st ed. Massachusetts: Academic Press, 79105.CrossRefGoogle Scholar
Ford, ES, Schleicher, RL, Mokdad, AH, et al. (2006) Distribution of serum concentrations of alpha-tocopherol and gamma-tocopherol in the US population. Am J Clin Nutr 84, 375383.CrossRefGoogle ScholarPubMed
Traber, MG, Leonard, SW, Ebenuwa, I, et al. (2019) Vitamin E absorption and kinetics in healthy women, as modulated by food and by fat, studied using 2 deuterium-labeled alpha-tocopherols in a 3-phase crossover design. Am J Clin Nutr 110, 11481167.CrossRefGoogle Scholar
Schaus, EE, Lumen, BO, Chow, FI, et al. (1985) Bioavailability of vitamin E in rats fed graded levels of pectin. J Nutr 115, 263270.CrossRefGoogle ScholarPubMed
Omaye, ST & Chow, FI (1984) Effect of hard red spring wheat bran on the bioavailability of lipid-soluble vitamins and growth of rats fed for 56 days. J Food Sci 49, 504506.CrossRefGoogle Scholar
Bates, CJ & Heseker, H (1994) Human bioavailability of vitamins. Nutr Res Rev 7, 93127.CrossRefGoogle ScholarPubMed
Traber, MG, Sokol, RJ, Burton, GW, et al. (1990) Impaired ability of patients with familial isolated vitamin E deficiency to incorporate α-tocopherol into lipoproteins secreted by the liver. J Clin Invest 85, 397407.CrossRefGoogle ScholarPubMed
Niki, E & Traber, MG (2012) A history of vitamin E. Ann Nutr Metab 61, 207212.CrossRefGoogle ScholarPubMed
Traber, MG (2006) Vitamin E. In Shils, ME, Shike, M, Ross, AC, Caballero, B and Cousins, RJ, editors. Modern Nutrition in Health and Disease. Baltimore, MD: Lippincott Williams and Wilkins, 396411.Google Scholar
Traber, MG, Leonard, SW, Ebenuwa, I, et al. (2020) Vitamin E catabolism in women, as modulated by food and by fat, studied using 2 deuterium-labeled alpha-tocopherols in a 3-phase, nonrandomized crossover study. Am J Clin Nutr 113, 92103.CrossRefGoogle Scholar
Baydas, G, Karatas, F, Gursu, MF, et al. (2002) Antioxidant vitamin levels in term and preterm infants and their relation to maternal vitamin status. Arch Med Res 33, 276280.CrossRefGoogle ScholarPubMed
Gomez-Pomar, E, Hatfield, E, Garlitz, K, et al. (2017). Vitamin E in preterm infant: a forgotten cause of hemolytic anemia. Am J Perinatol 35, 305310.Google ScholarPubMed
Eggermont, E (2006) Recent advances in vitamin E metabolism and deficiency. Eur J Pediatr 165, 429434.CrossRefGoogle ScholarPubMed
Traber, MG (2012) Vitamin E. In Erdman, JW Jr, Macdonald, IA, Zeisel, SH, Editors. Present Knowledge in Nutrition. 10th ed. International Life Sciences Institute, 214229.CrossRefGoogle Scholar
European Food Safety Authority (2015) Scientific opinion on dietary reference values for vitamin E as α-tocopherol. EFSA J 13, 172.Google Scholar
Pfeiffer, CM, Sternberg, MR, Schleicher, RL, et al. (2013) The CDC’s second national report on biochemical indicators of diet and nutrition in the US population is a valuable tool for researchers and policy makers. J Nutr 143, 938S947S.CrossRefGoogle ScholarPubMed
Thurnham, DI, Davies, JA, Crump, BJ, et al. (1986) The use of different lipids to express serum tocopherol: lipid ratios for the measurement of vitamin E status. Ann Clin Biochem 23, 514520.CrossRefGoogle ScholarPubMed
Kalra, V, Grover, J, Ahuja, GK, et al. (1998) Vitamin E deficiency and associated neurological deficits in children with protein-energy malnutrition. J Trop Pediatr 44, 291295.CrossRefGoogle ScholarPubMed
Kalra, V, Grover, J, Ahuja, GK, et al. (2001) Vitamin E administration and reversal of neurological deficits in protein-energy malnutrition. J Trop Pediatr 47, 3945.CrossRefGoogle ScholarPubMed
Schulze, KJ, Christian, P, Wu, LS, et al. (2014) Micronutrient deficiencies are common in 6- to 8-year-old of rural Nepal, with prevalence estimates modestly affected by inflammation. J Nutr 144, 979987.CrossRefGoogle ScholarPubMed
Alfin-Slater, RB, Hansen, H, Morris, RS & Melnick, D (1969) Dietary fat composition and tocopherol requirement. I. Lack of correlation between nutritional indices and results of in vitro peroxide hemolysis tests. J Am Oil Chem Soc 46, 563568.CrossRefGoogle ScholarPubMed
Wang, J, Huang, CJ & Chow, CK (1996) Red cell vitamin E and oxidative damage: a dual role of reducing agents. Free Radic Res 24, 291298.CrossRefGoogle ScholarPubMed
Di Donato, I, Bianchi, S & Federico, A (2010) Ataxia with vitamin E deficiency: update of molecular diagnosis. Neurol Sci 31, 511515.CrossRefGoogle ScholarPubMed
Morley, S, Cecchini, M, Zhang, W, et al. (2008) Mechanisms of ligand transfer by hepatic tocopherol transfer protein. J Biol Chem 283, 77977804.CrossRefGoogle ScholarPubMed
Chen, K, Zhang, X & Wei, XP (2009) Antioxidant vitamin status during pregnancy in relation to cognitive development in the first two years of life. Early Hum Dev 85, 421427.CrossRefGoogle ScholarPubMed
Sathe, MN & Patel, AS (2010) Update in pediatrics: focus on fat-soluble vitamins. Nutr Clin Prac 25, 340346.CrossRefGoogle Scholar
Tessitore, M, Sorrentino, E, Schiano Di Cola, G, Colucci, A, Vajro, P & Mandato, C (2021) Malnutrition in pediatric chronic cholestatic disease: an up-to-date overview. Nutrients 13, 2785.CrossRefGoogle ScholarPubMed
Okebukola, PO, Kansra, S & Barrett, J (2017) Vitamin E supplementation in people with cystic fibrosis. Cochrane Database Syst Rev 1, 131.Google Scholar
Sapiejka, E, Krzyżanowska-Jankowskab, P, Wenska-Chyżyb, E, et al. (2018) Vitamin E status and its determinants in patients with cystic fibrosis. Adv Med Sci 63, 341346.CrossRefGoogle ScholarPubMed
Malik, A, Eggersdorfer, M & Kumar, GT (2019) Vitamin E status in healthy population in Asia: a review of current literature. Int J Vitam Nutr Res 24, 114.Google Scholar
Péter, S, Friedel, A, Roos, FF, et al. (2015) A systematic review of global alpha-tocopherol status as assessed by nutritional intake levels and blood serum concentrations. Int J Vitam Nutr Res 85, 261281.CrossRefGoogle ScholarPubMed
Al-Saleh, I, Billedo, G & El-Dou, I (2006) Selenium and vitamins status in Saudi children. Clin Chim Acta 368, 99109.CrossRefGoogle ScholarPubMed
Kang, M, Lin, Y, Yeh, W, et al. (2004) Vitamin E status and its dietary determinants in Taiwanese. Eur J Nutr 43, 8692.CrossRefGoogle ScholarPubMed
Farrell, PM, Levine, SL, Murphy, D, et al. (1978) Plasma tocopherol levels and tocopherol-lipid relationships in a normal population of children as compared to healthy adults. Am J Clin Nutr 31, 17201726.CrossRefGoogle Scholar
Allen, LH, Rosado, JL, Casterline, JE, et al. (2000) Lack of hemoglobin response to iron supplementation in anemic Mexican preschoolers with multiple micronutrient deficiencies. Am J Clin Nutr 71, 14851494.CrossRefGoogle ScholarPubMed
Kim, Y, Lora, KR, Giraud, DW, et al. (2006) Nonsupplemented children of latino immigrants have low vitamin E intakes and plasma concentrations and normal vitamin C, selenium, and carotenoid intakes and plasma concentrations. J Am Diet Assoc 106, 385391.CrossRefGoogle ScholarPubMed
Van Biervliet, S, Van Biervliet, J, Bernard, D, et al. (2001) Serum α-tocopherol and selenium in Belgian infants and children. Biol Trace Elem Res 79, 115120.CrossRefGoogle ScholarPubMed
Sirivichayakul, C, Changbumrung, S, Chanthavanich, P, et al. (2001) Plasma retinol and alpha-tocopherol level and growth índices of 7 months old healthy Thai infants in Bangkok. Southeast Asian J Trop Med Public Health 32, 408412.Google ScholarPubMed
Ulak, M, Chandyo, RK, Thorne-Lyman, AL, et al. (2016) Vitamin status among breastfed infants in Bhaktapur, Nepal. Nutrients 8, 113.CrossRefGoogle ScholarPubMed
West, KP Jr, Cole, RN, Shrestha, S, et al. (2015) A plasma a-tocopherome can be identified from proteins associated with vitamin E status in school-aged children of Nepal. J Nutr 145, 26462656.CrossRefGoogle ScholarPubMed
Mai, TTT, Hung, NTK, Kawakami, M, et al. (2003) Micronutrient status of primary school girls in rural and urban areas of South Vietnam. Asia Pac J Clin Nutr 12, 178185.Google Scholar
Dancheck, B, Nussenblatt, V, Kumwenda, N, et al. (2005) Status of carotenoids, vitamin A, and vitamin E in the mother-infant dyad and anthropometric status of infants in Malawi. J Health Popul Nutr 23, 343350.Google ScholarPubMed
Fares, S, Chahed, MK, Feki, M, et al. (2010) Status of vitamins A and E in schoolchildren in the centre west of Tunisia: a population-based study. Public Health Nutr 14, 255260.CrossRefGoogle Scholar
Fares, S, Sethom, MM, Khouaja-Mokrani, C, et al. (2014) Vitamin A, E, and D deficiencies in Tunisian very low birth weight neonates: prevalence and risk factors. Pediatr Neonatol 55, 196201.CrossRefGoogle Scholar
Monteiro, JP, Cruz, MLS, Mussi-Pinhata, MM, et al. (2014) Vitamin A, vitamin E, iron and zinc status in a cohort of HIV-infected mothers and their uninfected infants. Rev Soc Bras Med Trop 46, 692700.CrossRefGoogle Scholar
Augusto, RA, Cobayashi, F & Cardoso, MA (2014) Associations between low consumption of fruits and vegetables and nutritional deficiencies in Brazilian schoolchildren. Public Health Nutr 18, 927935.CrossRefGoogle ScholarPubMed
Cardoso, MA, Augusto, RA, Bortolini, GA, et al. (2016) Effect of providing multiple micronutrients in powder through primary healthcare on anemia in young Brazilian children: a multi-centre pragmatic controlled trial. PLos ONE 11, 113.Google Scholar
Morais, GC (2016) Factors associated with the nutritional status of vitamin E in infants attended at primary health care in Goiânia-GO. Dissertação (Mestrado em Nutrição e Saúde) – Faculdade de Nutrição. Goiânia: Universidade Federal de Goiás. Portuguese.Google Scholar
Oliveira, CSM, Sampaio, P, Muniz, P, et al. (2016) Multiple micronutrients in powder delivered through primary health care reduce iron and vitamin A deficiencies in young Amazonian children. Public Health Nutr 19, 30393047.CrossRefGoogle ScholarPubMed
Oliveira, CSM, Augusto, RA, Muniz, PT, et al. (2016) Anemia and micronutrient deficiencies in infants attending at Primary Health Care in Rio Branco, Acre, Brazil. Cienc Saude Colet 21, 517529. Portuguese.CrossRefGoogle ScholarPubMed
Untoro, J, Karyadi, E, Wibowo, L, et al. (2005) Multiple micronutrient supplements improve micronutrient status and anemia but not growth and morbidity of Indonesian infants: a randomized, double-blind, placebo-controlled trial. J Nutr 135, S639S645.CrossRefGoogle Scholar
De Romaña, GL, Cusirramos, S, De Romaña, DL, et al. (2005) Efficacy of multiple micronutrient supplementation for improving anemia, micronutrient status, growth and morbidity of Peruvian infants. J Nutr 135, S646S652.CrossRefGoogle Scholar
Smuts, CM, Lombard, CJ, Benadé, AJS, et al. (2005) Efficacy of a foodlet-based multiple micronutrient supplement for preventing growth faltering, anemia, and micronutrient deficiency of infants: the four country IRIS trial pooled data analysis. J Nutr 135, 631S638S.CrossRefGoogle ScholarPubMed
Smuts, CM, Dhansay, MA, Faber, M, et al. (2005) Efficacy of multiple micronutrient supplementation for improving anemia, micronutrient status, and growth in South African infants. J Nutr 135, 653S659S.CrossRefGoogle ScholarPubMed
Hop, LT & Berger, J (2005) Multiple micronutrient supplementation improves anemia, micronutrient nutrient status, and growth of Vietnamese infants: double-blind, randomized, placebo-controlled trial. J Nutr 135, 660S665S.CrossRefGoogle ScholarPubMed
Kumar, MV & Rajagopalan, S (2006) Impact of a multiple-micronutrient food supplement on the nutritional status of schoolchildren. Food Nutr Bull 27, 203210.CrossRefGoogle Scholar
Lobo, LMC, Schincaglia, RM, Peixoto, MRG, et al. (2019) Multiple micronutrient powder reduces vitamin E deficiency in Brazilian children: a pragmatic, controlled clinical trial. Nutrients 11, 112.Google Scholar
Tomkins, A (2003) Assessing micronutrient status in the presence of inflammation. J Nutr 133, 1649S1655S.CrossRefGoogle ScholarPubMed
Thurnham, DI & Northrop-Clewes, CA (2016) Inflammation and biomarkers of micronutrient status. Curr Opin Clin Nutr Metab Care 19, 458463.CrossRefGoogle ScholarPubMed
Bhutta, ZA (2006) Effect of infections and environmental factors on growth and nutritional status in developing countries. J Pediatr Gastroenterol Nutr 43, S13S21.CrossRefGoogle ScholarPubMed
Raiten, DJ, Ashour, FAS, Ross, AC, et al. (2015) Inflammation and nutritional science for programs/policies and interpretation of research evidence (INSPIRE). J Nutr 145, 1039S1108S.CrossRefGoogle ScholarPubMed
Scrimshaw, NS (2003) Historical concepts of interactions, synergism and antagonism between nutrition and infection. J Nutr 133, 316321.CrossRefGoogle ScholarPubMed
Brasil. Ministério da Saúde (2015) Child health: breastfeeding and complementary feeding. Brasília, DF: Ministério da Saúde. Portuguese.Google Scholar
Lewis, ED, Meydani, SN & Wu, D (2019) Regulatory role of vitamin E in the immune system and inflammation. IUBMB 71, 487494.CrossRefGoogle ScholarPubMed
Lee, G & Han, SN (2018) The role of vitamin E in immunity. Nutrients 10, 16141632.CrossRefGoogle ScholarPubMed
Wu, D, Lewis, ED, Pae, M et al. (2019) Nutritional modulation of immune function: analysis of evidence, mechanisms, and clinical relevance. Front Immunol 9, 31603179.CrossRefGoogle ScholarPubMed
Duncan, A, Talwar, D, Mcmillan, DC, et al. (2012) Quantitative data on the magnitude of the systemic inflammatory response and its effects on micronutrient status based on plasma measurement. Am J Clin Nutr 95, 6471.CrossRefGoogle Scholar
Galloway, P, Mcmillan, DC & Sattar, N (2000) Effect of inflammatory response on trace elements and vitamin status. Ann Clin Biochem 37, 289297.CrossRefGoogle ScholarPubMed
Ulatowski, L, Dreussi, C, Noy, N, et al. (2012) Expression of the alpha-tocopherol transfer protein gene is regulated by oxidative stress and common single-nucleotide polymorphisms. Free Radic Biol Med 53, 122.CrossRefGoogle ScholarPubMed
Kalayci, O, Besler, T, Kilinc, K, Sekerel, BE & Saraclar, Y (2000) Serum levels of antioxidant vitamins (alpha tocopherol, beta carotene, and ascorbic acid) in children with bronchial asthma. Turk J Peds 42, 1721.Google ScholarPubMed
Kelly, FJ, Mudway, I, Blomberg, A, Frew, A & Sandstrom, T (1999) Altered lung antioxidant status in patients with mild asthma [letter]. Lancet 354, 482483.CrossRefGoogle ScholarPubMed
Schunemann, HJ, Grant, BJ, Freudenheim, JL, Muti, P, Browne, RW, Drake, JA, Klocke, RA & Trevisan, M (2001). The relation of serum levels of antioxidant vitamins C and E, retinol and carotenoids with pulmonary function in the general population. Am J Respir Crit Care Med 163, 12461255.CrossRefGoogle Scholar
Troisi, RJ, Willett, WC, Weiss, ST, Trichopoulos, D, Rosner, B & Speizer, FE (1995) A prospective study of diet and adult-onset asthma [see comments]. Am J Respir Crit Care Med 151, 14011408.CrossRefGoogle ScholarPubMed
Dow, L, Tracey, M, Villar, A, Coggon, D, Margetts, BM, Campbell, MJ & Holgate, ST (1996) Does dietary intake of vitamins C and E influence lung function in older people? Am J Respir Crit Care Med 154, 14011404.CrossRefGoogle Scholar
Al-Abdulla, NO, Al Naama, LM & Hassan, MK (2010) Antioxidant status in acute asthmatic attack in children. J Pak Med Assoc 60, 10231027.Google ScholarPubMed
Shvedova, AA, Kisin, ER, Kagan, VE & Karol, MH (1995) Increased lipid peroxidation and decreased antioxidants in lungs of guinea pigs following an allergic pulmonary response. Tox Appl Pharm 132, 7281.CrossRefGoogle ScholarPubMed
Silva, RPP (2016) Fat soluble vitamins, overweight and inflammatory status in adolescents. Tese (doutorado em Nutrição) – Centro de Ciências da Saúde. Recife: Universidade Federal de Pernambuco. Portuguese.Google Scholar
Gibson, RS, Hotz, C, Temple, L, et al. (2000) Dietary strategies to combat deficiencies of iron, zinc, and vitamin A in developing countries: development, implementation, monitoring, and evaluation. Food Nutr Bull 21, 219231.CrossRefGoogle Scholar
Vellozo, EP & Fisberg, M (2010) The impact of food fortification on the prevention of iron deficiency. Rev Bras Hematol Hemoter 32, 134139. Portuguese.CrossRefGoogle Scholar
Ministério da Saúde (2007) Primary care notebooks: micronutrient deficiencies. Brasília, DF, Brasil: Ministério da Saúde. Portuguese.Google Scholar
Ministério da Saúde (2015) NutriSUS NutriSUS Operational Manual: strategy for fortifying infant feeding with micronutrients (vitamins and minerals) in powder. Brasília, DF, Brasil: Ministério da Saúde. Portuguese.Google Scholar
Ministério da Saúde (2002) Secretaria de Política de Saúde. Dietary guidelines for children under two years old. Brasília, DF, Brasil: Ministério da Saúde. Portuguese.Google Scholar
Ministério da Saúde (2019) Secretaria de Atenção Primária à Saúde. Dietary Guidelines for Brazilian children under 2 years old. Brasília, DF: Ministério da Saúde. Portuguese.Google Scholar
Batista, ES, Costa, AGV & Pinheiro-Sant’ana, HM (2007) Addition of vitamin E to foods: implications for the foods and for human health. Rev Nutr 20, 525535. Portuguese.CrossRefGoogle Scholar
Osendarp, SJM, Martinez, H, Garrett, GS, et al. (2018) Large-scale food fortification and biofortification in low and middle-income countries: a review of programs, trends, challenges, and evidence gaps. Food Nutr Bull 39, 315331.CrossRefGoogle ScholarPubMed
Serdula, M (2010) The opportunity of flour fortification: building on the evidence to move forward. Food Nutr Bull 31, 36.Google ScholarPubMed
Bailey, RL, West, K.P Jr, Black, RE (2015) The epidemiology of global micronutrient deficiencies. Ann Nutr Metab 66, 2233.CrossRefGoogle ScholarPubMed
Tam, E, Keats, EC, Rind, F, et al. (2020) Micronutrient supplementation and fortification interventions on health and development outcomes among children under-five in low- and middle income countries: a systematic review and meta-analysis. Nutrients 12, 289321.CrossRefGoogle ScholarPubMed
Hayes, KC, Pronczuk, A & Perlman, D (2001) Vitamin E in fortified cow milk uniquely enriches human plasma lipoproteins. Am J Clin Nutr 74, 211218.CrossRefGoogle ScholarPubMed
Van Het Hof, KH, Tijburg, LB, De Boer, HS, et al. (1998) Antioxidant fortified margarine increases the antioxidant status. Eur J Clin Nutr 52, 292299.CrossRefGoogle ScholarPubMed
Liberato, SA & Pinheiro-Sant’ana, HM (2006) Fortification of industrialized foods with vitamins. Rev Nutr 19, 215231.CrossRefGoogle Scholar
Serra-Majem, L (2001) Vitamin and mineral intakes in European children: is food fortificaton needed? Public Health Nutr 4, 101107.CrossRefGoogle ScholarPubMed
Sichert-Hellert, W, Kersting, M, Alexy, U, et al. (2000) Ten-year trends in vitamin and mineral intake from fortified food in German children and adolescents. Eur J Clin Nutr 54, 8186.CrossRefGoogle ScholarPubMed
World Health Organization (2016) WHO Guideline: Use of Multiple Micronutrient Powders for Point-of-Use Fortification of Foods Consumed by Infants and Young Children Aged 6–23 Months and children Aged 2–12 Years. Geneva: World Health Organization.Google Scholar
Das, JK, Salam, RA, Mahmood, SB, et al. (2019) Food fortification with multiple micronutrientes: impact on health outcomes in general population. Cochrane Database Syst Rev 1, 1129.Google Scholar
De Regil, LM, Suchdev, PS, Vist, GE, et al. (2013) Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age. Evid Based Child Health 8, 112201.CrossRefGoogle ScholarPubMed
Silva, LLS, Augusto, RA, Tietzmann, DC, et al. (2017) The impact of home fortification with multiple micronutrient powder on vitamin A status in young children: a multicenter pragmatic controlled trial in Brazil. Matern Child Nutr 13, 18.CrossRefGoogle ScholarPubMed
Ministério da Saúde (2013) Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Evidence guide: fortification of infant feeding with micronutrients (vitamins and minerals) powder. Brasília, DF, Brasil: Ministério da Saúde. Portuguese.Google Scholar
Fundo das Nações Unidas para a Infância (2014) NutriDash: Global Report 2014. New York: UNICEF.Google Scholar