Vitamin A deficiency in Central America was first identified as a public health problem in the 1950s. It affected primarily children. The main underlying cause was a deficient intake of pre-formed vitamin A, but infection and intestinal parasitism also played important roles. INCAP focused its efforts on overcoming this problem and developed, as a short-term solution, the technology to fortify sugar with vitamin A. Fortification programs were implemented in several Central American countries. Evaluation of these programs revealed a significant impact—not only on vitamin A status, but also on iron nutrition and hematological condition. Longer-term solutions, like increasing the availability and consumption of vitamin A-rich foods, were later suggested and operational tools were developed to assist the countries in the region in the implementation, evaluation and monitoring of their own fortification programs.
FloresMRehE. Studies of dietetic habits of communities of Guatemala. I. Magdalena Milpas Altas. Bol Oficina Sanit Panam1955:90–128.
2.
FloresMRehE. Studies of dietetic habits in communities of Guatemala. II. Santo Domingo Xenacoj. Bol Oficina Sanit Panam1955:129–48.
3.
FloresMRehE. Studies of dietetic habits in communities of Guatemala. III. San Antonio Aguas Calientes and its village, San Andres Ceballos. Bol Oficina Sanit Panam1955:149–62.
4.
FloresMRehE. Studies of dietetic habits in communities of Guatemala. IV. Santa María Cauqué. Bol Oficina Sanit Panam1955:163–73.
5.
RehEFernándezC. Condiciones de vida y de alimentación en cuatro grupos de población de la zona central de Costa Rica. Bol Oficina Sanit Panam1955;suppl 2:66–89.
6.
SogandaresLde GalindoAPMejíaMP. Estudios dietéticos de grupos urbanos y rurales de la Republica de El Salvador. Bol Oficina Sanit Panam1953;suppl 1:27–37.
7.
Moen ML, Institute of Nutrition of Central America and Panama, eds. Consumo de alimentos de trece familias de los empleados de una fábrica de textiles en Quetzaltenango, Guatemala, C.A. Bol Oficina Sanit Panam1953;suppl 1:37–49.
8.
SogandaresLde BarriosG. Estudios dietéticos en Panamá. I. La Mesa, Provincia de Veraguas. Bol Oficina Sanit Panam1955;suppl 2:38–46.
9.
SogandaresLde BarriosGde CorcóEZ. Estudios dietéticos en Panamá. II. Barrio “El Chirrillo”, Ciudad de Panamá. Bol Oficina Sanit Panam1955;suppl 2:47–53.
10.
CastilloAFloresM. Dietetic studies in El Salvador. II. Canton Platanillos, Municipio de Quezaltepeque, Departamento de la Libertad. Bol Oficina Sanit Panam1955;suppl 2:54–65.
11.
FloresMGarcíaBSáenzCde SierraD. Estudios dietéticos en poblaciones de Guatemala. La Fragua, Departamento de Zacapa. Bol Oficina Sanit Panam1962;suppl 4:106–16.
12.
FloresMGarcíaB. Estado nutricional de niños de edad preescolar en la población de Amatitlán, Guatemala. Bol Oficina Sanit Panam1966;suppl 5:25–36.
13.
Food and Agriculture Organization/World Health Organization. Necesidades de vitamina A, riboflavina y niacina. Informe de un Grupo Mixto FAO/OMS de Expertos. In: FAO Reuniones sobre Nutrición No. 41. Rome: FAO/WHO, 1967.
14.
FloresMMenchúMTLaraMYArroyaveG. Vitamin A content of food included in the Food Composition Table for Use in Latin America. Arch Latinoam Nutr1969;19:318–41.
15.
SogandaresLde GalindoAPMejíaHP. Encuestas dietéticas de grupos urbanos y rurales de la República de El Salvador. Sanid El Salv1953;4:3–12.
16.
FloresMGarcíaB. The nutritional status of children of pre-school age in the Guatemalan community of Amatitlan. 1. Comparison of family and child diets. Br J Nutr1960;14:207–15.
17.
GuzmánMAScrimshawNS. Niveles de ácido ascórbico, vitamina A, caroteno, vitamina E, riboflavina y fosfatasa alcalinaencontrados en el suero sanguíneo de escolares centroamericanos. Bol Oficina Sanit Panam1953;suppl 1:21.
18.
ViteriF. La deficiencia de vitamina A en Guatemala como problema de salud pública. Universidad de San Carlos de Guatemala, Guatemala City: Facultad de Ciencias Médicas, 1955.
19.
GuzmánMAArroyaveGScrimshawNS. Serum ascorbic acid, riboflavin, carotene, vitamin A, vitamin E and alkaline phosphatase values in Central American school children. Am J Clin Nutr1961;9:164–9.
20.
ArroyaveG. Vitamin A and protein-caloric malnutrition. Bol Oficina Sanit Panam1970;69:198–211.
21.
ContrerasGElíasLGBressaniR. Effect of vitamin and mineral supplements on the protein utilization of mixtures of corn and beans. Arch Latinoam Nutr1981;31:808–26.
22.
MejíaLATorúnBCaballeroBArroyaveG. Correlation between protein-energy malnutrition and vitamin-mineral deficiencies in the young. Int J Vitam Nutr Res Suppl1984;26:45–58.
23.
SmithFRGoodmanDSArroyaveGViteriF. Serum vitamin A, retinol-binding protein, and prealbumin concentrations in protein-calorie malnutrition. II. Treatment including supplemental vitamin A. Am J Clin Nutr1973;26:982–7.
24.
GuzmánMAScrimshawNS. Serum ascorbic acid, vitamin A, carotene, vitamin E, riboflavin and alkaline phosphatase values in Central American school children. Fed Proc1952;11:445.
25.
ReverteJMPérezC. Estudios clínicos nutricionales en poblaciones de Panamá. I. La Mesa, Provincia de Veraguas. Bol Oficina Sanit Panam1955;suppl 2:27–32.
26.
PérezCPedreschiC. Estudios clínico-nutricionales en poblaciones de Panamá II. Barrio El Chorillo, Ciudad de Panamá. Bol Oficina Sanit Panam1955;suppl 2:33–7.
27.
PérezCArce-PaizAMazaE. Estudios clínico-nutricionales en poblaciones de El Salvador. I. Cantón Platanillos, Municipio de Quetzaltepeque, Departamento de la Libertad. Bol Oficina Sanit Panam1955;suppl 2:22–6.
28.
BéharMArroyaveGFloresMScrimshawNS. The nutritional status of children of pre-school age in the Guatemalan community of Amatitlán. 2. Comparison of dietary, clinical and biochemical findings. Br J Nutr1960;14:217–30.
29.
ArroyaveGViteriFBéharMScrimshawNS. Impairment of intestinal absorption of vitamin A palmitate in severe protein malnutrition (kwashiorkor). Am J Clin Nutr1959;7:185–90.
30.
ArroyaveGWilsonDMéndezJBéharMScrimshawNS. Serum and liver vitamin A and lipids in children with severe protein malnutrition. Am J Clin Nutr1961;9:180–5.
31.
ArroyaveGWilsonDContrerasCBéharM. Alterations in serum concentration of vitamin A associated with the hypoproteinemia of severe protein malnutrition. J Pediatr1963;62:920–5.
32.
ArroyaveG. Interrelations between protein and vitamin A and metabolism. Am J Clin Nutr1969;22:1119–28.
33.
ArroyaveGCalcanoM. Decrease in serum levels of retinol and its binding protein (RBP) in infection. Arch Latinoam Nutr1979;29:233–60.
34.
Institute of Nutrition of Central America and Panama. Evaluación nutricional de la población de Centro América y Panamá: El Salvador. Guatemala City: INCAP, 1969.
35.
Institute of Nutrition of Central America and Panama. Evaluación nutricional de la población de Centro América y Panamá: Costa Rica. Guatemala City: INCAP, 1969.
36.
Institute of Nutrition of Central America and Panama. Evaluación nutricional de la población de Centro América y Panamá: Honduras. Guatemala City: INCAP, 1969.
37.
Institute of Nutrition of Central America and Panama. Evaluación nutricional de la población de Centro América y Panamá: Panamá. Guatemala City: INCAP, 1969.
38.
Institute of Nutrition of Central America and Panama. Evaluación nutricional de la población de Centro América y Panamá: Guatemala. Guatemala City: INCAP, 1969.
39.
Institute of Nutrition of Central America and Panama. Evaluación nutricional de la población de Centro América y Panamá: Nicaragua. Guatemala City: INCAP, 1969.
40.
Institute of Nutrition of Central America and Panama/Centers for Disease Control and Prevention. Nutritional evaluation of the population of Central America and Panama: Regional summary. Washington, DC: Department of Health, Education, and Welfare, 1972.
41.
Pan American Health Organization. Hypovitaminosis A in the Americas. Washington, DC: PAHO, 1970.
42.
ArroyaveG. Distribution of vitamin A to population groups. In: Proceedings Western Hemisphere Nutrition Congress III. Miami Beach, Florida, USA. Mount Kisco, NY, USA: Futura Publishing Company, 1972.
43.
AscoliWArroyaveG. Epidemiología del bocio endémico en Centro América. Relación entre prevalencia y excreción urinaria de yodo. Arch Latinoam Nutr1970;20:309–20.
44.
ArroyaveGBeghinIFloresM. Efectos del consumo de azúcar fortificado con retinol por la madre embarazada y lactante cuya dieta habitual es baja en vitamina A. Estudio de la madre y del niño. Arch Latinoam Nutr1974;24:485–502.
45.
Brenes-BrenesEA. Prueba de la efectividad del enriquecimiento de azúcar común con vitamina A en una población rural guatemalteca. Thesis, Escuela de Nutrición, Facultad de Ciencias Químicas y Farmacia, Universidad de San Carlos de Guatemala, Institute de Nutrición de Centro America y Panama, Guatemala, 1971.
46.
Institute of Nutrition of Central America and Panama. Fortification of sugar with vitamin A in Central America and Panama. Guatemala City: INCAP, 1974.
47.
AguilarJRArroyaveGGallardoC. Manual de supervisión y control de programas de fortificación de azúcar con vitamina A. Guatemala City: Institute of Nutrition of Central America and Panama, 1973.
48.
ArroyaveGAguilarJRPortelaE. Manual de operaciones para la fortificación de azúcar con vitamina A. Guatemala City: Institute of Nutrition of Central America and Panama, 1975.
49.
ArroyaveGPinedaOde FunesC. Enriquecimiento de azúcar con vitamina A: Método rápido para la fácil inspección delproceso. Arch Latinoam Nutr1974;_155–9.
50.
ArroyaveGde FunesC. Enriquecimiento de azúcar con vitamina A. Método para la determinación cuantitativa de retinol en azúcar blanca de mesa. Arch Latinoam Nutr1974;24:147–53.
51.
Honduras, Government Decree No. 38. 1976.
52.
Costa Rica, Government Presidential Decree No. 3702-SPPS. 1974.
53.
Guatemala, Government Decree No. 5674. 1974.
54.
Panama, Government Law No. 66. 1976.
55.
ArroyaveGAguilarJRFloresMGuzmánMA. Evaluation of sugar fortification with vitamin A at the national level. Washington, DC: Pan American Health Organization, 1979.
56.
ArroyaveGMejíaLAAguilarJR. The effect of vitamin A fortification of sugar on the serum vitamin A levels of preschool Guatemalan children: A longitudinal evaluation. Am J Clin Nutr1981;34:41–9.
57.
ArroyaveG. Fortification of sugar with retinol: Proposed approach for control of hypovitaminosis A in population groups. In: StewartSS, ed. Sugar, growth, and development. Fifth International Sugar Research Symposium, Mexico City, September 6, 1972, in association with IX International Congress of Nutrition. Bethesda, Md, USA: International Sugar Research Foundation, 1972.
58.
ArroyaveG. The program of fortification of sugar with vitamin A in Guatemala. Some factors bearing on its implementation and maintenance. In: ScrimshawNSWallersteinMS, eds. Nutrition Policy Implementation: Issues and Experience. New York, Plenum Press, 1982;75–88.
59.
ArroyaveG. Fortification of sugar with vitamin A: Bases, implementation and evaluation. In: McLarenDS, ed. Nutrition in the community. London: John Wiley & Sons, 1983.
60.
ArroyaveG. Vitamin deficiency control in Central America. In: BauernfeindJC, ed. Vitamin deficiency and its control. New York: Academic Press, 1986.
61.
MolinaMR. Foods considered for nutrient addition: Sugar. In: BauernfeindJCLachanceP, eds. Nutrient addition to foods. Gainesville, Fla, USA: Food and Nutrition Press, 1991.
62.
MejíaLAHodgesREArroyaveGViteriFTorúnB. Vitamin A deficiency and anemia in Central American children. Am J Clin Nutr1977;30:1175–84.
63.
MejíaLAHodgesRERuckerRB. Clinical signs of anemia in vitamin A deficient rats. Am J Clin Nutr1979;109:129–37.
64.
MejíaLAArroyaveG. The effect of vitamin A fortification of sugar on iron metabolism in preschool children in Guatemala. Am J Clin Nutr1982;36:87–93.
65.
MejíaLAChewF. Hematological effect of supplementing anemic children with vitamin A alone and in combination with iron. Am J Clin Nutr1988;189:595–600.
66.
MejíaLA. Vitamin A nutrient interrelationships. In: BauernfeindJC, ed. Vitamin A deficiency and its control. New York: Academic Press, 1986:69–100.
67.
MejíaLA. Role of vitamin A in iron deficiency anemia. In: FomonSJZlotkinS, eds. Nutritional anemias. New York: Raven Press, 1992: 93–104.
68.
DaryOArroyaveGFloresHCamposFLinsM. Manual for sugar fortification with vitamin A. Part 3. Analytical methods for the control and evaluation of sugar fortification with vitamin A, 2nd ed.Arlington, Va, USA: John Snow, 1996.
69.
ArroyaveGDaryO. Manual for sugar fortification with vitamin A. Part 1. Guidelines for the development, implementation, monitoring, and evaluation of a vitamin A sugar fortification program, 2nd ed.Guatemala City: Institute of Nutrition of Central America and Panama, 1996.
70.
DaryOArroyaveG. Manual for sugar fortification with vitamin A. Part 2. Technical and operational guidelines for preparing vitamin A premix and fortified sugar, 2nd ed.Guatemala City: Institute of Nutrition of Central America and Panama, 1996.
