RESUMEN
BACKGROUND: Several studies have suggested an association between vitamin deficiency and the development of tuberculosis; however, the precise impact remains unclear. This study aimed to elucidate the relationship between distinct vitamin statuses and the occurrence of tuberculosis. MATERIALS AND METHODS: Retrieval was conducted using several databases without language restrictions to capture the eligible studies on tuberculosis and vitamin status. Pooled odds ratios (ORs), relative risks (RRs), and hazard ratios (HRs) were used with 95% confidence intervals (CIs) to clarify the relationship between the different vitamin statuses (A, B, D, and E) and the occurrence of tuberculosis. Subgroup analysis, sensitivity analysis, meta-regression analysis, and Galbraith plot were performed to determine sources of heterogeneity. Potential publication biases were detected using Begg's test, Egger's test, and the trim-and-fill test. RESULTS: We identified 10,266 original records from our database searches, and 69 eligible studies were considered in this study. The random-effect model showed that people with tuberculosis may exhibit vitamin A deficiency (OR = 10.66, 95%CI: 2.61-43.63, p = .001), while limited cohort studies showed that vitamin A supplementation may reduce tuberculosis occurrence. Additionally, vitamin D deficiency was identified as a risk factor for tuberculosis development (RR = 1.69, 95%CI: 1.06-2.67, p = .026), and people with tuberculosis generally had lower vitamin D levels (OR = 2.19, 95%CI: 1.76-2.73, p < .001) compared to other groups. No publication bias was detected. CONCLUSIONS: This meta-analysis indicated that people with tuberculosis exhibited low levels of vitamins A and D, while vitamin D deficiency was identified as a risk factor for tuberculosis. More randomized controlled interventions at the community levels should be recommended to determine the association between specific vitamin supplementation and tuberculosis onset.
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Tuberculosis , Deficiencia de Vitamina A , Deficiencia de Vitamina D , Humanos , Tuberculosis/epidemiología , Deficiencia de Vitamina D/epidemiología , Deficiencia de Vitamina D/complicaciones , Deficiencia de Vitamina A/epidemiología , Deficiencia de Vitamina A/complicaciones , Deficiencia de Vitamina A/sangre , Factores de Riesgo , Vitamina A/sangre , Suplementos Dietéticos , Vitaminas/sangre , Vitamina D/sangre , Deficiencia de Vitamina E/epidemiología , Deficiencia de Vitamina E/complicaciones , Deficiencia de Vitamina E/sangre , Femenino , Masculino , Oportunidad Relativa , Adulto , Vitamina E/sangreRESUMEN
BACKGROUND: This study evaluates the association between vitamin A levels, AIP (the atherogenic index of plasma), and subclinical hypothyroidism. METHODS: A cross-sectional analysis was conducted involving a representative sample of 3530 Chinese adults. Linear and logistic regression models were utilized to evaluate the associations between AIP and subclinical hypothyroidism, stratified by vitamin A levels. These analyses were further differentiated by sex and age groups to identify any demographic-specific associations. RESULTS: In the vitamin A-sufficient group, an increase in AIP was associated with elevated total triiodothyronine (TT3) levels (ß = 0.26, 95%CI: 0.09, 0.41, p = 0.003). Conversely, in the group with severe vitamin A deficiency, higher AIP levels were linked to increased free triiodothyronine (fT3) and TT3 levels and decreased free thyroxine (fT4) levels (ß = 0.12, 0.03, and -0.29, respectively). Additionally, severe vitamin A deficiency increased the risk associated with AIP and subclinical hypothyroidism (OR = 1.66, 95%CI: 1.07, 2.58, p = 0.025). This risk was notably more pronounced in women and older adults, with odds ratios of 2.44 (95%CI: 1.55, 3.86, p < 0.001) and 2.14 (95%CI: 1.36, 3.38, p = 0.001), respectively. CONCLUSIONS: Vitamin A deficiency may increase the risk of the association between AIP and subclinical hypothyroidism, particularly among women and the elderly.
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Hipotiroidismo , Deficiencia de Vitamina A , Vitamina A , Humanos , Hipotiroidismo/sangre , Hipotiroidismo/epidemiología , Femenino , Masculino , Estudios Transversales , China/epidemiología , Persona de Mediana Edad , Adulto , Deficiencia de Vitamina A/sangre , Deficiencia de Vitamina A/epidemiología , Vitamina A/sangre , Aterosclerosis/sangre , Aterosclerosis/epidemiología , Aterosclerosis/etiología , Anciano , Triyodotironina/sangre , Factores de Riesgo , Tiroxina/sangre , Enfermedades AsintomáticasRESUMEN
BACKGROUND: Micronutrient deficiencies associated with malnutrition in patients with inflammatory bowel disease (IBD) can lead to complications including anemia, coagulopathy, poor wound healing, and colorectal cancer. This study aimed to investigate micronutrient deficiencies (copper, vitamins A, B 9 , E, and K) in IBD patients and highlight associated symptoms to aid in the recognition of micronutrient deficiencies. METHODS: A retrospective electronic chart review was performed on adults diagnosed with Crohn's disease or ulcerative colitis hospitalized at a tertiary care center for IBD flare between January 2013 and June 2017. Patients with serum or whole blood micronutrient levels were included. Pregnant and incarcerated patients were excluded. RESULTS: A total of 611 IBD patients (440 Crohn's disease, 171 ulcerative colitis) met the inclusion criteria. Micronutrients were assessed in a subset of IBD patients (copper: 12.3%, A: 10.1%, B 9 â :â 95.9%, E: 10.3%, and K: 4.6%). Overall, 10.1% of patients had micronutrient deficiencies. The proportion of patients with copper, A, B 9 , E, and K deficiencies were 25.4, 53.3, 1.9, 23.7, and 29.4% for Crohn's disease and 50, 52.9, 1.2, 43.8, and 18.2% for ulcerative colitis, respectively. The most common symptoms or historical features associated with micronutrient deficiency were anemia (copper, B 9 ), muscle weakness (copper, E) thrombocytopenia, fatigue (copper, B 9 ), diarrhea (B 9 ), dry skin, hyperkeratosis, pruritus, significant weight loss, elevated C-reactive protein (A), bleeding, and osteoporosis (K). CONCLUSION: Micronutrient deficiencies are common in IBD patients, yet they are not routinely assessed. Copper, vitamins A, E, and K deficiencies are particularly underrecognized. Associated historical features should raise suspicion and prompt assessment and treatment.
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Colitis Ulcerosa , Cobre , Enfermedad de Crohn , Micronutrientes , Humanos , Femenino , Masculino , Estudios Retrospectivos , Adulto , Micronutrientes/deficiencia , Micronutrientes/sangre , Persona de Mediana Edad , Enfermedad de Crohn/epidemiología , Enfermedad de Crohn/sangre , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/diagnóstico , Colitis Ulcerosa/epidemiología , Colitis Ulcerosa/diagnóstico , Colitis Ulcerosa/complicaciones , Colitis Ulcerosa/sangre , Cobre/deficiencia , Cobre/sangre , Incidencia , Deficiencia de Vitamina A/epidemiología , Deficiencia de Vitamina A/complicaciones , Deficiencia de Vitamina A/sangre , Deficiencia de Vitamina A/diagnóstico , Deficiencia de Vitamina E/epidemiología , Deficiencia de Vitamina E/sangre , Deficiencia de Vitamina E/complicaciones , Deficiencia de Vitamina E/diagnóstico , Desnutrición/epidemiología , Desnutrición/diagnóstico , Desnutrición/sangre , Vitamina E/sangre , Vitamina A/sangre , Anciano , Estado Nutricional , Adulto JovenRESUMEN
Introduction: Maternal nutritional and vitamin status during pregnancy may have long-term effects on offspring health and disease. The aim of this study was to examine the associations between maternal vitamin A and D status in pregnancy and offspring bone mineral content (BMC) at nine years of age. Methods: This is a post-hoc study of a randomized control trial including 855 pregnant women from two Norwegian cities; Trondheim and Stavanger. The women were randomized into an exercise intervention or standard antenatal care. Mother and child pairs for the present study were recruited from those still living in Trondheim after 8-10 years. Serum vitamin A (retinol) and vitamin D (25(OH)D) were measured in the 2nd and 3rd trimesters of pregnancy, and active vitamin D (1,25(OH)2D) in serum was measured in a subgroup. Spine BMC and trabecular bone score were measured in the children at nine years of age. Associations were analyzed with linear regression models. Results: A total of 119 mother and child pairs were included in the analyses. Vitamin A insufficiency (retinol< 1.05 µmol/L) and vitamin D deficiency (25(OH)D< 50 mmol/L) increased from ~7% to ~43% and from ~28% to ~33%, respectively, from the 2nd to the 3rd trimester. An increase in serum 1,25(OH)2D from the 2nd to the 3rd trimester was observed in the subgroup. There was a negative association between serum retinol in the 2nd trimester and spine BMC in the boys, but not in the girls, when adjusted for maternal and child confounders. No other associations between maternal serum vitamin A or D and BMC in the children were found. Conclusion: We observed a high prevalence of vitamin A insufficiency and vitamin D deficiency during pregnancy. A negative association between mid-pregnancy vitamin A status and spine BMC was observed in boys, but not girls, while no associations were found between maternal vitamin D status and child BMC. The implications of optimal vitamin A and D status in pregnancy for offspring bone health, remains a subject for further investigations.
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Densidad Ósea , Segundo Trimestre del Embarazo , Tercer Trimestre del Embarazo , Vitamina A , Vitamina D , Humanos , Femenino , Embarazo , Vitamina A/sangre , Vitamina D/sangre , Tercer Trimestre del Embarazo/sangre , Masculino , Niño , Adulto , Segundo Trimestre del Embarazo/sangre , Deficiencia de Vitamina D/epidemiología , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina A/sangre , Deficiencia de Vitamina A/epidemiología , Noruega/epidemiología , Fenómenos Fisiologicos Nutricionales Maternos , Efectos Tardíos de la Exposición Prenatal/sangre , Efectos Tardíos de la Exposición Prenatal/epidemiologíaRESUMEN
INTRODUCTION: Traditionally associated with undernutrition, increasing evidence suggests micronutrient deficiencies can coexist with overnutrition. Therefore, this work aimed to systematically review the associations between iron, zinc and vitamin A (VA) status and weight status (both underweight and overweight) in children and young people. METHODS: Ovid Medline, Ovid Embase, Scopus and Cochrane databases were systematically searched for observational studies assessing micronutrient status (blood, serum or plasma levels of iron, zinc or VA biomarkers) and weight status (body mass index or other anthropometric measurement) in humans under 25 years of any ethnicity and gender. Risk of bias assessment was conducted using the American Dietetic Association Quality Criteria Checklist. Where possible, random effects restricted maximum likelihood meta-analyses were performed. RESULTS: After screening, 83 observational studies involving 190 443 participants from 44 countries were identified, with many studies having reported on more than one micronutrient and/or weight status indicator. Iron was the most investigated micronutrient, with 46, 28 and 27 studies reporting data for iron, zinc and VA status, respectively. Synthesising 16 records of OR from seven eligible studies, overnutrition (overweight and obesity) increased odds of iron deficiency (ID) (OR (95% CI): 1.51 (1.20 to 1.82), p<0.0001, I2=40.7%). Odds appeared to be higher for children living with obesity (1.88 (1.33 to 2.43), p<0.0001, I2=20.6%) in comparison to those with overweight (1.31 (0.98 to 1.64), p<0.0001, I2=40.5%), although between group differences were not significant (p=0.08). CONCLUSIONS: Overnutrition is associated with increased risk of ID, but not zinc or VA deficiencies, with an inverted U-shaped relationship observed between iron status and bodyweight. Our results highlight significant heterogeneity in the reporting of micronutrient biomarkers and how deficiencies were defined. Inflammation status was rarely adequately accounted for, and the burden of ID may well be under-recognised, particularly in children and young people living with overnutrition. PROSPERO REGISTRATION NUMBER: CRD42020221523.
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Hipernutrición , Deficiencia de Vitamina A , Zinc , Humanos , Zinc/deficiencia , Zinc/sangre , Niño , Deficiencia de Vitamina A/sangre , Factores de Riesgo , Adolescente , Deficiencias de Hierro , Preescolar , Adulto Joven , Masculino , Femenino , Estado Nutricional , Vitamina A/sangre , Hierro/sangreRESUMEN
OBJECTIVE: To study the relationship between umbilical cord blood vitamin A (VA) and neonatal lung diseases and explore the impact of umbilical cord blood VA on neonatal lung diseases. METHOD: Umbilical vein blood was collected at birth, and its VA content was measured. According to the VA levels in umbilical cord blood, a VA deficiency (VAD) group, a marginal deficiency group and a normal group were created and followed up until 28 days after birth. RESULTS: The umbilical cord blood VA level in the neonatal group with lung disease was 0.13 ± 0.05 mg/L, while the result for the VA level in the non-lung disease group was 0.15 ± 0.05 mg/L. The umbilical cord blood VA levels in the neonatal lung disease group were significantly lower than those in the non-lung disease group. The incidence of neonatal pulmonary diseases was highest in the VAD group, and the incidence decreased as the level of VA in umbilical cord blood increased. Umbilical cord blood VAD and premature birth were found to be independent risk factors for neonatal respiratory disease. CONCLUSION: Umbilical cord blood VAD and premature birth are independent risk factors for neonatal pulmonary diseases. The lower the level of VA in umbilical cord blood, the more susceptible infants will be to neonatal respiratory infections in the neonatal period.
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Sangre Fetal , Enfermedades Pulmonares , Vitamina A , Humanos , Sangre Fetal/química , Vitamina A/sangre , Recién Nacido , Femenino , Masculino , Enfermedades Pulmonares/sangre , Enfermedades Pulmonares/etiología , Deficiencia de Vitamina A/sangre , Factores de Riesgo , Nacimiento Prematuro/sangreRESUMEN
Vitamin A (retinol) is essential for normal fetal development, but the recommendation for maternal dietary intake (Retinol Activity Equivalent, RAE) does not differ for singleton vs. twin pregnancy, despite the limited evaluation of retinol status. Therefore, this study aimed to evaluate plasma retinol concentrations and deficiency status in mother-infant sets from singleton vs. twin pregnancies as well as maternal RAE intake. A total of 21 mother-infant sets were included (14 singleton, 7 twin). The HPLC and LC-MS/HS evaluated the plasma retinol concentration, and data were analyzed using the Mann-Whitney U test. Plasma retinol was significantly lower in twin vs. singleton pregnancies in both maternal (192.2 vs. 312.1 vs. mcg/L, p = 0.002) and umbilical cord (UC) samples (102.5 vs. 154.4 vs. mcg/L, p = 0.002). The prevalence of serum-defined vitamin A deficiency (VAD) <200.6 mcg/L was higher in twins vs. singletons for both maternal (57% vs. 7%, p = 0.031) and UC samples (100% vs. 0%, p < 0.001), despite a similar RAE intake (2178 vs. 1862 mcg/day, p = 0.603). Twin pregnancies demonstrated a higher likelihood of vitamin A deficiency in mothers, with an odds ratio of 17.3 (95% CI: 1.4 to 216.6). This study suggests twin pregnancy may be associated with VAD deficiency. Further research is needed to determine optimal maternal dietary recommendations during twin gestation.
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Deficiencia de Vitamina A , Vitamina A , Vitamina A/sangre , Deficiencia de Vitamina A/sangre , Deficiencia de Vitamina A/epidemiología , Humanos , Femenino , Embarazo , Madres , Embarazo Gemelar , Ingestión de Alimentos , Recién Nacido , Lactante , Salud Materna , Salud del LactanteRESUMEN
N-[4-hydroxyphenyl]retinamide, commonly known as fenretinide, a synthetic retinoid with pleiotropic benefits for human health, is currently utilized in clinical trials for cancer, cystic fibrosis, and COVID-19. However, fenretinide reduces plasma vitamin A levels by interacting with retinol-binding protein 4 (RBP4), which often results in reversible night blindness in patients. Cell culture and in vitro studies show that fenretinide binds and inhibits the activity of ß-carotene oxygenase 1 (BCO1), the enzyme responsible for endogenous vitamin A formation. Whether fenretinide inhibits vitamin A synthesis in mammals, however, remains unknown. The goal of this study was to determine if the inhibition of BCO1 by fenretinide affects vitamin A formation in mice fed ß-carotene. Our results show that wild-type mice treated with fenretinide for ten days had a reduction in tissue vitamin A stores accompanied by a two-fold increase in ß-carotene in plasma (P < 0.01) and several tissues. These effects persisted in RBP4-deficient mice and were independent of changes in intestinal ß-carotene absorption, suggesting that fenretinide inhibits vitamin A synthesis in mice. Using Bco1-/- and Bco2-/- mice we also show that fenretinide regulates intestinal carotenoid and vitamin E uptake by activating vitamin A signaling during short-term vitamin A deficiency. This study provides a deeper understanding of the impact of fenretinide on vitamin A, carotenoid, and vitamin E homeostasis, which is crucial for the pharmacological utilization of this retinoid.
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Fenretinida/farmacología , Vitamina A/farmacología , beta Caroteno/metabolismo , Animales , Peso Corporal/efectos de los fármacos , Dioxigenasas/metabolismo , Absorción Intestinal/efectos de los fármacos , Intestinos/efectos de los fármacos , Hígado/efectos de los fármacos , Hígado/patología , Ratones Endogámicos C57BL , Modelos Biológicos , Proteínas Plasmáticas de Unión al Retinol/deficiencia , Proteínas Plasmáticas de Unión al Retinol/metabolismo , Vitamina A/sangre , Deficiencia de Vitamina A/sangre , Deficiencia de Vitamina A/patología , Vitamina E/sangre , Vitamina E/metabolismo , beta Caroteno/sangreRESUMEN
Anemia in older adults is a growing public health issue in Mexico; however, its etiology remains largely unknown. Vitamin A deficiency (VAD) and vitamin D deficiency (VDD) have been implicated in the development of anemia, though by different mechanisms. The aim of this study is to analyze the etiology of anemia and anemia-related factors in older Mexican adults. This is a cross-sectional study of 803 older adults from the southern region of Mexico in 2015. The anemia etiologies analyzed were chronic kidney disease (CKD), nutritional deficiencies (ND), anemia of inflammation (AI), anemia of multiple causes (AMC) and unexplained anemia (UEA). VAD was considered to be s-retinol ≤ 20 µg/dL, and VDD if 25(OH)D < 50 nmol/L. IL-6 and hepcidin were also measured. Multinomial regression models were generated and adjusted for confounders. Anemia was present in 35.7% of OA, independent of sex. UEA, CKD, AI and ND were confirmed in 45%, 29.3%, 14.6% and 7% of older adults with anemia, respectively. Hepcidin and log IL-6 were associated with AI (p < 0.05) and CKD (p < 0.001). VAD was associated with AI (p < 0.001), and VDD with ND and AMC (p < 0.05). Log-IL6 was associated with UEA (p < 0.001). In conclusion, anemia in older adults has an inflammatory component. VAD was associated to AI and VDD with ND and AMC.
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Anemia/etiología , Hepcidinas/sangre , Desnutrición/sangre , Vitamina A/sangre , Vitamina D/análogos & derivados , Anciano , Anciano de 80 o más Años , Causalidad , Estudios Transversales , Femenino , Humanos , Inflamación/sangre , Inflamación/complicaciones , Interleucina-6/sangre , Masculino , Desnutrición/complicaciones , Desnutrición/epidemiología , México/epidemiología , Persona de Mediana Edad , Análisis de Regresión , Insuficiencia Renal Crónica/sangre , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/epidemiología , Deficiencia de Vitamina A/sangre , Deficiencia de Vitamina A/complicaciones , Deficiencia de Vitamina A/epidemiología , Vitamina D/sangre , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/complicaciones , Deficiencia de Vitamina D/epidemiologíaRESUMEN
BACKGROUND: Vitamin A (VA) plays critical roles in prenatal and postnatal development; however, limited information is available regarding maternal VA metabolism during pregnancy and lactation. OBJECTIVES: We investigated the impact of pregnancy and lactation on VA metabolism and kinetics in rats, hypothesizing that changes in physiological status would naturally perturb whole-body VA kinetics. METHODS: Eight-week old female rats (n = 10) fed an AIN-93G diet received an oral tracer dose of 3H-labeled retinol to initiate the kinetic study. On d 21 after dosing, six female rats were mated. Serial blood samples were collected from each female rat at selected times after dose administration until d 14 of lactation. Model-based compartmental analysis was applied to the plasma tracer data to develop VA kinetic models. RESULTS: Our compartmental model revealed that pregnancy resulted in a gradual increase in hepatic VA mobilization, presumably to support different stages of fetal development. Additionally, the model indicates that during lactation, VA derived from dietary intake was the primary source of VA delivered to the mammary gland for milk VA secretion. CONCLUSION: During pregnancy and lactation in rats with an adequate VA intake and previous VA storage, the internal redistribution of VA and increased uptake from diet supported the maintenance of VA homeostasis.
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Lactancia/metabolismo , Glándulas Mamarias Animales/metabolismo , Complicaciones del Embarazo/prevención & control , Deficiencia de Vitamina A/prevención & control , Vitamina A/farmacocinética , Adaptación Fisiológica , Administración Oral , Alimentación Animal , Animales , Femenino , Lactancia/sangre , Fenómenos Fisiologicos Nutricionales Maternos , Modelos Biológicos , Estado Nutricional , Valor Nutritivo , Embarazo , Complicaciones del Embarazo/sangre , Complicaciones del Embarazo/fisiopatología , Ratas Sprague-Dawley , Vitamina A/administración & dosificación , Vitamina A/sangre , Deficiencia de Vitamina A/sangre , Deficiencia de Vitamina A/fisiopatologíaRESUMEN
BACKGROUND: Vitamin A is necessary for an adequate immune response to infections. Infection also alters vitamin A biomarkers, which interferes with assessment of vitamin A deficiency and thus impairs clinical management. Here we apply multiple strategies to adjust vitamin A biomarkers for inflammation during acute infection and evaluate associations between adjusted vitamin A status and immunologic response markers. METHODS: We measured biomarkers in pediatric patients presenting with acute febrile illness in Guayaquil, Ecuador at paired acute and convalescent visits. Four adjustment strategies were applied to retinol-binding protein (RBP) concentrations: Thurnham correction factor (TCF), BRINDA regression correction (BRC), CRP-only adjustment factor (CRP), and proof-of-concept for a proposed interleukin 6 regression model (IL-6 RM). Adjusted RBP concentrations were compared between visits using the paired Wilcoxon signed-rank test. Multivariate regression analysis was used to assess associations between adjusted vitamin A status and immunologic response markers. RESULTS: A sample of 57 participants completed the acute visit 1, and 18 of these individuals completed the convalescent visit 2. The IL-6 RM was the only strategy resulting in adjusted RBP concentrations that were not significantly different between paired visits (p = 0.20). Following RBP adjustment, 0.0% of participants were classified as vitamin A deficient (RBP ≤ 0.70 µmol/L) and 14.0% were classified as vitamin A insufficient (RBP ≤ 1.05 µmol/L). Adjusted vitamin A insufficiency was associated with an increase in macrophage inflammatory protein 1-alpha (MIP-1α, p = 0.03) and a pro-inflammatory immune response profile (p = 0.03) during the acute visit. CONCLUSIONS: We introduce a strategy for adjusting vitamin A in the context of clinical illness based on IL-6 concentrations that will need to be validated in larger studies. Assessment of vitamin A during infection allows for further understanding of how vitamin A status modulates immunopathology and enables targeted strategies for vitamin A supplementation in the context of infection among children in settings with high burdens of undernutrition and infectious diseases.
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Fiebre/sangre , Inflamación/metabolismo , Deficiencia de Vitamina A/sangre , Vitamina A/sangre , Adolescente , Biomarcadores , Proteína C-Reactiva , Niño , Preescolar , Estudios de Cohortes , Citocinas/genética , Citocinas/metabolismo , Femenino , Regulación de la Expresión Génica/efectos de los fármacos , Humanos , Lactante , Masculino , Estado Nutricional , Proyectos Piloto , Adulto JovenRESUMEN
BACKGROUND: The retinol isotope dilution (RID) method has been used to evaluate vitamin A (VA) status in healthy adults and children in low- and middle-income countries (LMIC) and to assess the efficacy of various VA interventions. OBJECTIVE: The study was designed to examine whether dried serum spots (DSS) can be applied to RID when conducting VA total body store (TBS) assessments in community settings. METHODS: Four days after an oral dose of 0.4 mg [13C10]retinyl acetate was administered to Filipino children (12-18 mo), a single blood draw was divided to isolate both serum and plasma. Serum (40 µL) was spotted and dried on Whatman 903 cards and shipped at ambient temperature whereas liquid plasma (LP) was frozen at -80°C and shipped on dry ice. The VA tracer to tracee ratio from DSS and LP was quantified by LC-MS/MS. Comparisons between DSS and LP paired samples (n = 72) were made for [13C10]retinol specific activity (SAp) by Pearson's correlation and for VA TBS by Bland-Altman analysis. RESULTS: The sum of 3 coextracted DSS were required to consistently detect [13C10]retinol above the LC-MS/MS limit of quantitation (LOQ). [13C10]retinol SAp from DSS was highly correlated with SAp from LP (r = 0.945; P < 0.01). A comparison of methods for TBS determination using Bland-Altman analysis indicated agreement with an intraindividual difference of 24.7 µmol (4.6%). Mean total liver reserve (TLR) values from DSS and LP were 1.7 µmol/g (± 0.6 SD) and 1.6 µmol/g (± 0.6 SD), respectively. CONCLUSIONS: VA TBS can be determined from DSS thereby reducing the logistics and cost of maintaining a cold chain by shipping samples at ambient temperature and, thus, making the RID technique more feasible in LMIC community settings. This trial was registered at https://clinicaltrials.gov as NCT03030339.
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Países en Desarrollo , Evaluación Nutricional , Estado Nutricional , Suero , Deficiencia de Vitamina A/diagnóstico , Vitamina A/sangre , Cromatografía Liquida/métodos , Diterpenos/sangre , Femenino , Humanos , Técnicas de Dilución del Indicador , Lactante , Isótopos , Hígado/metabolismo , Masculino , Filipinas , Plasma/química , Refrigeración , Reproducibilidad de los Resultados , Ésteres de Retinilo/sangre , Espectrometría de Masas en Tándem/métodos , Temperatura , Deficiencia de Vitamina A/sangreRESUMEN
BACKGROUND: High-dose vitamin A (VA) supplements (VAS) can temporarily affect VA status. Hence, micronutrient surveys might need to be timed around VAS campaigns to accurately estimate VA deficiency (VAD) prevalence. Little is known about optimal timing of micronutrient surveys when the modified-relative-dose-response (MRDR) is used as a VA indicator. OBJECTIVES: We evaluated the association between days since the end of a VAS campaign and MRDR values in children aged 12-23 mo in Uganda. METHODS: We pooled data from 2 cross-sectional, population-based surveys in eastern Uganda conducted in 2015-2016 (n = 118 children). We estimated the prevalence of VAD (MRDR ≥0.060). Days since the end of a VAS campaign ("days since VAS") was calculated as the interview date minus the end date of the VAS campaign. The MRDR value was assessed using HPLC. We excluded children whose MRDR values were below the limit of detection (<0.007). We used linear regression to evaluate the association between days since VAS and log-transformed MRDR. In adjusted analyses, we controlled for potential confounders. Statistical analyses accounted for the surveys' complex design. RESULTS: The prevalence of VAD was 5.2% (95% CI: 1.1%, 9.3%). Mean days since VAS was 54.1 d (range 39-68 d). Days since VAS was not associated with log-transformed MRDR in unadjusted analyses ($\hat{\beta } = \ $0.0055; 95% CI: -0.009, 0.020; P = 0.45) or adjusted analyses ($\hat{\beta } = $ -0.0073; 95% CI: -0.024, 0.010; P = 0.39). CONCLUSIONS: MRDR measurement through a nutrition survey began as early as 1.3 mo after the end of a VAS campaign in eastern Uganda. Days since the end of a VAS campaign was not associated with MRDR in Ugandan children aged 12-23 mo. Future studies should consider longitudinal designs and evaluate time since VAS and MRDR in children of different ages and in regions with higher VAD prevalence.
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Deficiencia de Vitamina A/tratamiento farmacológico , Vitamina A/administración & dosificación , Estudios Transversales , Suplementos Dietéticos , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Lactante , Modelos Lineales , Masculino , Micronutrientes/administración & dosificación , Micronutrientes/sangre , Encuestas Nutricionales , Estado Nutricional , Prevalencia , Factores de Tiempo , Uganda/epidemiología , Vitamina A/sangre , Deficiencia de Vitamina A/sangre , Deficiencia de Vitamina A/epidemiologíaRESUMEN
BACKGROUND: Vitamin A (VA) deficiency is prevalent in preschool-aged children in sub-Saharan Africa. OBJECTIVES: We assessed the effect of small-quantity lipid-based nutrient supplements (SQ-LNS) given to women during pregnancy and lactation and their children from 6 to 18 mo of age on women's plasma and milk retinol concentrations in Malawi, and children's plasma retinol concentration in Malawi and Ghana. METHODS: Pregnant women (≤20 wk of gestation) were randomized to receive daily: 1) iron and folic acid (IFA) during pregnancy only; 2) multiple micronutrients (MMN; 800 µg retinol equivalent (RE)/capsule), or 3) SQ-LNS (800 µg RE/20g) during pregnancy and the first 6 mo postpartum. Children of mothers in the SQ-LNS group received SQ-LNS (400 µg RE/20 g) from 6 to 18 mo of age; children of mothers in the IFA and MMN groups received no supplement. Plasma retinol was measured in mothers at ≤20 and 36 wk of gestation and 6 mo postpartum, and in children at 6 and 18 mo of age. Milk retinol was measured at 6 mo postpartum. VA status indicators were compared by group. RESULTS: Among Malawian mothers, geometric mean (95% CI) plasma retinol concentrations at 36 wk of gestation and 6 mo postpartum were 0.97 µmol/L (0.94, 1.01 µmol/L) and 1.35 µmol/L (1.31, 1.39 µmol/L), respectively; geometric mean (95% CI) milk retinol concentration at 6 mo postpartum was 1.04 µmol/L (0.97, 1.13 µmol/L); results did not differ by intervention group. Geometric mean (95% CI) plasma retinol concentrations for Malawian children at 6 and 18 mo of age were 0.78 µmol/L (0.75, 0.81 µmol/L) and 0.81 µmol/L (0.78, 0.85 µmol/L), respectively, and for Ghanaian children they were 0.85 µmol/L (0.82, 0.88 µmol/L) and 0.88 µmol/L (0.85, 0.91 µmol/L), respectively; results did not differ by intervention group in either setting. CONCLUSIONS: SQ-LNS had no effect on VA status of mothers or children, possibly because of low responsiveness of the VA status indicators.
Asunto(s)
Suplementos Dietéticos , Lípidos/administración & dosificación , Leche Humana/metabolismo , Vitamina A/sangre , Vitamina A/metabolismo , Adolescente , Adulto , Femenino , Ghana/epidemiología , Humanos , Lactante , Fenómenos Fisiológicos Nutricionales del Lactante , Recién Nacido , Lactancia , Malaui/epidemiología , Fenómenos Fisiologicos Nutricionales Maternos , Madres , Estado Nutricional , Embarazo , Prevalencia , Deficiencia de Vitamina A/sangre , Deficiencia de Vitamina A/dietoterapia , Deficiencia de Vitamina A/epidemiología , Adulto JovenRESUMEN
BACKGROUND: College students may have a risk of fat-soluble vitamin deficiencies due to unhealthy dietary habits, especially for vitamin A and E. They are important members of the human antioxidant network; deficiencies of these vitamins may increase the risk of many critical diseases. OBJECTIVE: The current study was undertaken to determine the status of vitamin A and E in college students. METHODS: Healthy college students were recruited, and fasting blood samples of them were collected and used for determining serum levels of retinol and α-tocopherol by the HPLC method. RESULTS: We found that there was no vitamin A deficiency in college students. However, vitamin E deficiency existed in 34.5% of college students, especially in males. All the students had no vitamin E adequacy. In addition, our findings showed that BMI was inversely associated with serum α-- tocopherol, but not serum retinol. CONCLUSION: These results suggest that vitamin E deficiency in college students should be given more attention, and it is necessary to consider using vitamin E supplements.
Asunto(s)
Índice de Masa Corporal , Hambre/fisiología , Estudiantes , Universidades/tendencias , Deficiencia de Vitamina E/sangre , Vitamina E/sangre , Estudios Transversales , Dieta con Restricción de Grasas/efectos adversos , Dieta con Restricción de Grasas/tendencias , Femenino , Humanos , Masculino , Vitamina A/sangre , Deficiencia de Vitamina A/sangre , Deficiencia de Vitamina A/diagnóstico , Vitamina E/administración & dosificación , Deficiencia de Vitamina E/diagnóstico , Deficiencia de Vitamina E/tratamiento farmacológico , Adulto JovenRESUMEN
BACKGROUND: Autism spectrum disorder (ASD) is a neurodevelopmental disorder, and many individuals with ASD have gastrointestinal (GI) comorbidities. Vitamin A (VA) is an essential micronutrient that plays an important role in brain development and GI function. METHODS: A total of 323 children with ASD and 180 control children were enrolled in this study. Symptoms of ASD were assessed with the Child Autism Rating Scale (CARS), the Social Responsiveness Scale (SRS), and the Autism Behavior Checklist (ABC). Caregivers of the children completed questionnaires about GI symptoms. Serum retinol levels were detected with high-performance liquid chromatography (HPLC). RESULTS: Children with ASD and with GI comorbidity and constipation had considerably lower serum VA levels than autistic children without these symptoms. VA level was associated with CARS, SRS, and ABC scores, whereas GI symptoms were associated some SRS and ABC scores. The interaction of VAD and GI symptoms appeared to aggravate some of the core symptoms of children with ASD. CONCLUSIONS: VAD exacerbates core symptoms in children with ASD, and ASD children with GI comorbidities also have more serious core symptoms than ASD children without GI comorbidities. VAD comorbid with GI symptoms aggravates autistic children's core symptoms. IMPACT: VAD exacerbates core symptoms in children with ASD. ASD children with GI comorbidities have more serious core symptoms than ASD children without GI comorbidities. VAD comorbid with GI symptoms aggravates autistic children's core symptoms. We speculate that VAD might be related to a subtype of ASD that involves GI comorbidities. We believe that our findings will be of fundamental importance to the scientific community.
Asunto(s)
Trastorno del Espectro Autista/epidemiología , Enfermedades Gastrointestinales/epidemiología , Deficiencia de Vitamina A/epidemiología , Trastorno del Espectro Autista/diagnóstico , Biomarcadores/sangre , Estudios de Casos y Controles , Niño , Preescolar , China/epidemiología , Comorbilidad , Estreñimiento/epidemiología , Estreñimiento/fisiopatología , Defecación , Progresión de la Enfermedad , Femenino , Enfermedades Gastrointestinales/diagnóstico , Enfermedades Gastrointestinales/fisiopatología , Humanos , Masculino , Medición de Riesgo , Factores de Riesgo , Vitamina A/sangre , Deficiencia de Vitamina A/sangre , Deficiencia de Vitamina A/diagnósticoRESUMEN
AIMS: Many gastrointestinal (GI) disorders are developmental in origin and are caused by abnormal enteric nervous system (ENS) formation. Maternal vitamin A deficiency (VAD) during pregnancy affects multiple central nervous system developmental processes during embryogenesis and fetal life. Here, we evaluated whether maternal diet-induced VAD during pregnancy alone can cause changes in the ENS that lead to GI dysfunction in rat offspring. MAIN METHODS: Rats were selected to construct animal models of normal VA, VA deficiency and VA supplementation. The fecal water content, total gastrointestinal transmission time and colonic motility were measured to evaluate gastrointestinal function of eight-week-old offspring rats. The expression levels of RARß, SOX10, cholinergic (ChAT) and nitrergic (nNOS) enteric neurons in colon tissues were detected through western blot and immunofluorescence. Primary enteric neurospheres were treated with retinoic acid (RA), infection with Ad-RARß and siRARß adenovirus, respectively. KEY FINDINGS: Our data revealed marked reductions in the mean densities of cholinergic and nitrergic enteric neurons in the colon and GI dysfunction evidenced by mild intestinal flatulence, increased fecal water content, prolonged total GI transit time and reduced colon motility in adult offspring of the VAD group. Interestingly, maternal VA supplementation (VAS) during pregnancy rescued these changes. In addition, in vitro experiments demonstrated that exposure to appropriate doses of RA promoted enteric neurosphere differentiation into cholinergic and nitrergic neurons, possibly by upregulating RARß expression, leading to enhanced SOX10 expression. SIGNIFICANCE: Maternal VAD during pregnancy is an environmental risk factor for GI dysfunction in rat offspring.
Asunto(s)
Neuronas Colinérgicas/metabolismo , Enfermedades Gastrointestinales/metabolismo , Tracto Gastrointestinal/metabolismo , Neuronas Nitrérgicas/metabolismo , Receptores de Ácido Retinoico/biosíntesis , Deficiencia de Vitamina A/sangre , Animales , Células Cultivadas , Neuronas Colinérgicas/patología , Femenino , Enfermedades Gastrointestinales/patología , Tracto Gastrointestinal/patología , Neuronas Nitrérgicas/patología , Embarazo , Efectos Tardíos de la Exposición Prenatal , Ratas , Ratas Sprague-Dawley , Receptores de Ácido Retinoico/antagonistas & inhibidores , Deficiencia de Vitamina A/complicacionesRESUMEN
BACKGROUND: Vitamin A (VA) deficiency (VAD) affects â¼19 million pregnant women worldwide. The extent of VAD in Zambian women of reproductive age is unknown owing to lack of survey inclusion or the use of static serum retinol concentrations, a low-sensitivity biomarker. OBJECTIVES: This cross-sectional study employed isotopic techniques to determine VA status with serum and milk among women aged 18-49 y (n = 197) either lactating with infants aged 0-24 mo or nonlactating with or without infants. METHODS: Assistants were trained and piloted data collection. Demographic data, anthropometry, and relevant histories were obtained including malaria and anemia. For retinol isotope dilution (RID), baseline fasting blood and casual breast milk samples were collected before administration of 2.0 µmol 13C2-retinyl acetate and 24-h dietary recalls. On day 14, blood (n = 144) and milk (n = 66) were collected. Prevalence of total liver VA reserves (TLR) ≤0.10 µmol/g was defined as VAD with comparison to the DRI assumption of 0.07 µmol/g as minimally acceptable for North Americans. RESULTS: When a 20% adjustment for dose lost to milk was made in the RID equation for lactation, mean total body VA stores (TBS) for lactating women were 25% lower than for nonlactating women (P < 0.01), which was not the case without adjustment (P = 0.3). Mean ± SD TLR for all women were 0.15 ± 0.11 µmol/g liver. Using retinol purified from breast milk instead of serum for RID analysis yielded similar TBS and TLR, which were highly correlated between methods (P < 0.0001). Serum retinol ≤0.70 µmol/L had 0% sensitivity using either VAD liver cutoff and milk retinol ≤1.0 µmol/L had 42% sensitivity for VAD at 0.10 µmol/g. CONCLUSIONS: Determining accurate VA status among women of reproductive age, especially lactating women, forms a basis for extrapolation to the general population and informing policy development and program implementation.
Asunto(s)
Leche Humana/química , Deficiencia de Vitamina A/sangre , Vitamina A/sangre , Vitamina A/química , Adulto , Biomarcadores , Isótopos de Carbono , Femenino , Humanos , Lactancia , Adulto Joven , ZambiaRESUMEN
Patients with intestinal fat malabsorption and urolithiasis are particularly at risk of acquiring fat-soluble vitamin deficiencies. The aim of the study was to evaluate the vitamin status and metabolic profile before and after the supplementation of fat-soluble vitamins A, D, E and K (ADEK) in 51 patients with fat malabsorption due to different intestinal diseases both with and without urolithiasis. Anthropometric, clinical, blood and 24-h urinary parameters and dietary intake were assessed at baseline and after ADEK supplementation for two weeks. At baseline, serum aspartate aminotransferase (AST) activity was higher in stone formers (SF; n = 10) than in non-stone formers (NSF; n = 41) but decreased significantly in SF patients after supplementation. Plasma vitamin D and E concentrations increased significantly and to a similar extent in both groups during intervention. While plasma vitamin D concentrations did not differ between the groups, vitamin E concentrations were significantly lower in the SF group than the NSF group before and after ADEK supplementation. Although vitamin D concentration increased significantly in both groups, urinary calcium excretion was not affected by ADEK supplementation. The decline in plasma AST activity in patients with urolithiasis might be attributed to the supplementation of ADEK. Patients with fat malabsorption may benefit from the supplementation of fat-soluble vitamins ADEK.
Asunto(s)
Síndromes de Malabsorción/sangre , Urolitiasis/sangre , Vitamina A/sangre , Vitamina D/sangre , Vitamina E/sangre , Vitamina K/sangre , Adulto , Anciano , Aspartato Aminotransferasas/sangre , Colesterol/sangre , Suplementos Dietéticos , Femenino , Humanos , Síndromes de Malabsorción/complicaciones , Síndromes de Malabsorción/terapia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Triglicéridos/sangre , Urolitiasis/complicaciones , Urolitiasis/terapia , Vitamina A/administración & dosificación , Deficiencia de Vitamina A/sangre , Deficiencia de Vitamina A/etiología , Deficiencia de Vitamina A/terapia , Vitamina D/administración & dosificación , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/etiología , Deficiencia de Vitamina D/terapia , Vitamina E/administración & dosificación , Deficiencia de Vitamina E/sangre , Deficiencia de Vitamina E/etiología , Deficiencia de Vitamina E/terapia , Vitamina K/administración & dosificación , Deficiencia de Vitamina K/sangre , Deficiencia de Vitamina K/etiología , Deficiencia de Vitamina K/terapia , Vitaminas/administración & dosificación , Vitaminas/sangreRESUMEN
BACKGROUND & AIMS: Treatment of children with uncomplicated severe acute malnutrition (SAM) is based on ready-to-use therapeutic foods (RUTF) and aims for quick regain of lost body tissues while providing sufficient micronutrients to restore diminished body stores. Little evidence exists on the success of the treatment to establish normal micronutrient status. We aimed to assess the changes in vitamin A and iron status of children treated for SAM with RUTF, and explore the effect of a reduced RUTF dose. METHODS: We collected blood samples from children 6-59 months old with SAM included in a randomised trial at admission to and discharge from treatment and analysed haemoglobin (Hb) and serum concentrations of retinol binding protein (RBP), ferritin (SF), soluble transferrin receptor (sTfR), C-reactive protein (CRP) and α1-acid glycoprotein (AGP). SF, sTfR and RBP were adjusted for inflammation (CRP and AGP) prior to analysis using internal regression coefficients. Vitamin A deficiency (VAD) was defined as RBP < 0.7 µmol/l, anaemia as Hb < 110 g/l, storage iron deficiency (sID) as SF < 12 µg/l, tissue iron deficiency (tID) as sTfR > 8.3 mg/l and iron deficiency anaemia (IDA) as both anaemia and sID. Linear and logistic mixed models were fitted including research team and study site as random effects and adjusting for sex, age and outcome at admission. RESULTS: Children included in the study (n = 801) were on average 13 months of age at admission to treatment and the median treatment duration was 56 days [IQR: 35; 91] in both arms. Vitamin A and iron status markers did not differ between trial arms at admission or at discharge. Only Hb was 1.7 g/l lower (95% CI -0.3, 3.7; p = 0.088) in the reduced dose arm compared to the standard dose, at recovery. Mean concentrations of all biomarkers improved from admission to discharge: Hb increased by 12% or 11.6 g/l (95% CI 10.2, 13.0), RBP increased by 13% or 0.12 µmol/l (95% CI 0.09, 0.15), SF increased by 36% or 4.4 µg/l (95% CI 3.1, 5.7) and sTfR decreased by 16% or 1.5 mg/l (95% CI 1.0, 1.9). However, at discharge, micronutrient deficiencies were still common, as 9% had VAD, 55% had anaemia, 35% had sID, 41% had tID and 21% had IDA. CONCLUSION: Reduced dose of RUTF did not result in poorer vitamin A and iron status of children. Only haemoglobin seemed slightly lower at recovery among children treated with the reduced dose. While improvement was observed, the vitamin A and iron status remained sub-optimal among children treated successfully for SAM with RUTF. There is a need to reconsider RUTF fortification levels or test other potential strategies in order to fully restore the micronutrient status of children treated for SAM.