Lack of improvement in vitamin A status with increased consumption of dark-green leafy vegetables

Lancet. 1995 Jul 8;346(8967):75-81. doi: 10.1016/s0140-6736(95)92111-7.


There is little evidence to support the general assumption that dietary carotenoids can improve vitamin A status. We investigated in Bogor District, West Java, Indonesia, the effect of an additional daily portion of dark-green leafy vegetables on vitamin A and iron status in women with low haemoglobin concentrations (< 130 g/L) who were breastfeeding a child of 3-17 months. Every day for 12 weeks one group (n = 57) received stir-fried vegetables, a second (n = 62) received a wafer enriched with beta-carotene, iron, vitamin C, and folic acid, and a third (n = 56) received a non-enriched wafer to control for additional energy intake. The vegetable supplement and the enriched wafer contained 3.5 mg beta-carotene, 5.2 mg and 4.8 mg iron, and 7.8 g and 4.4 g fat, respectively. Assignment to vegetable or wafer groups was by village. Wafers were distributed double-masked. In the enriched-wafer group there were increases in serum retinol (mean increase 0.32 [95% CI 0.23-0.40] mumol/L), breastmilk retinol (0.59 [0.35-0.84] mumol/L), and serum beta-carotene (0.73 [0.59-0.88] mumol/L). These changes differed significantly from those in the other two groups, in which the only significant changes were small increases in breastmilk retinol in the control-wafer group (0.16 [0.02-0.30] mumol/L) and in serum beta-carotene in the vegetable group (0.03 [0-0.06] mumol/L). Changes in iron status were similar in all three groups. An additional daily portion of dark-green leafy vegetables did not improve vitamin A status, whereas a similar amount of beta-carotene from a simpler matrix produced a strong improvement. These results suggest that the approach to combating vitamin A deficiency by increases in the consumption of provitamin A carotenoids from vegetables should be re-examined.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anemia / blood
  • Ascorbic Acid / administration & dosage
  • Breast Feeding
  • Carotenoids / administration & dosage
  • Carotenoids / blood
  • Diet*
  • Double-Blind Method
  • Energy Intake
  • Female
  • Folic Acid / administration & dosage
  • Follow-Up Studies
  • Food, Fortified
  • Hemoglobins / analysis
  • Humans
  • Indonesia
  • Infant
  • Iron / administration & dosage
  • Iron / blood
  • Milk, Human / chemistry
  • Nutritional Status*
  • Vegetables*
  • Vitamin A / analysis
  • Vitamin A / blood*
  • beta Carotene


  • Hemoglobins
  • beta Carotene
  • Vitamin A
  • Carotenoids
  • Folic Acid
  • Iron
  • Ascorbic Acid