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Yamada F, Kato K, Nagashima R, Yonekawa Y, Kashima Y, Kondo M. Case of persistent corneal epithelial damage after cataract surgery leading to diagnosis of vitamin A deficiency. Doc Ophthalmol 2024; 148:121-128. [PMID: 38265517 DOI: 10.1007/s10633-023-09963-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/21/2023] [Indexed: 01/25/2024]
Abstract
PURPOSE To report our findings of reduced full-field electroretinograms (ff-ERGs) and abnormal optical coherence tomographic (OCT) images in a patient with poor visual acuity after cataract surgery who was eventually diagnosed with vitamin A deficiency (VAD). METHODS This was a clinical study of a patient who complained of blurred vision after cataract surgery. To determine the cause of the reduced vision, we recorded full-field electroretinograms (ff-ERGs) to determine the scotopic and photopic status of the retina. We also performed optical coherence tomography to assess the changes in the retinal structure. Serological tests were performed. RESULTS A 74-year-old man presented with persistent corneal epithelial damages and reduced vision that developed after conventional cataract surgery. OCT showed an interrupted ellipsoid zone, and fundus autofluorescence (FAF) showed a severe hypofluorescence in the retina of the left eye. The scotopic ff-ERGs were severely reduced, and the photopic ff-ERGs were mildly reduced. Serological examinations revealed a vitamin A concentration < 7 IU/dL (normal, 97-316 IU/dL). Based on these findings, we diagnosed the patient with VAD and started treatment with oral vitamin A supplements. After three months, his visual acuity, ff-ERGs, and OCT findings recovered to normal levels. The amplitudes and implicit times of the RETeval flicker ERGs increased to be within the normal range, and the hypofluorescence of the left eye disappeared. The length of the photoreceptor outer segments increased after the vitamin A supplementation. CONCLUSION Our findings indicate that the ERGs are helpful for diagnosing patients with VAD associated with persistent corneal epithelial damages.
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Affiliation(s)
- Fuyuki Yamada
- Department of Ophthalmology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Kumiko Kato
- Department of Ophthalmology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Ryunosuke Nagashima
- Department of Ophthalmology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Yuka Yonekawa
- Department of Ophthalmology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Yuzen Kashima
- Department of Ophthalmology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Mineo Kondo
- Department of Ophthalmology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
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Levine DA, Mathew NE, Jung EH, Yan J, Newman NJ, Thulasi P, Yeh S, Ziegler TR, Wells J, Jain N. Characteristics of Vitamin A Deficiency Retinopathy at a Tertiary Referral Center in the United States. Ophthalmol Retina 2024; 8:126-136. [PMID: 37673395 DOI: 10.1016/j.oret.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/14/2023] [Accepted: 08/29/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE To explore the risk factors and fundus imaging features of vitamin A deficiency retinopathy (VADR) in an academic tertiary referral center in Atlanta, GA, United States, and to propose guidance regarding diagnostic workup and management of affected patients. DESIGN Single-center retrospective case series. SUBJECTS Nine patients seen between 2015 and 2021 at the Emory Eye Center diagnosed with VADR. METHODS Retrospective chart review. MAIN OUTCOME MEASURES Baseline serum retinol level, Snellen visual acuity, multimodal fundus imaging findings, and electroretinography findings. RESULTS Nine patients, 4 (44.4%) female, with a median (range) age of 68 (50-75) years were identified. The most common underlying etiologies for vitamin A deficiency included history of gastrointestinal surgery (55.6%), liver disease (44.4%), and nutritional depletion due to low-quality diet (44.4%). Only 1 (11.1%) patient had a history of bariatric surgery. Four (44.4%) patients were on some form of vitamin A supplementation before the diagnosis of VADR. Median (range) serum retinol level was 0.06 (< 0.06-0.19) mg/L. All patients had macular subretinal hyperreflective deposits resembling subretinal drusenoid deposits, although in some cases, these were scant and sparsely distributed. Six eyes of 3 patients with longstanding deficiency had defects in the external limiting membrane (ELM). Three of these eyes additionally had macular areas of complete retinal pigment epithelium and outer retinal atrophy (cRORA). Full-field electroretinography demonstrated severe rod dysfunction and mild to moderate cone system dysfunction. Many findings of VADR were reversible with vitamin A repletion. However, all eyes with ELM defects or cRORA had persistence or continued growth of these lesions. CONCLUSION Vitamin A deficiency retinopathy is uncommon in the developed world. However, given that early intervention can lead to dramatic visual improvement and avoid potentially permanent retinal damage, retina specialists should be familiar with its clinical presentation. The presence of nyctalopia and subretinal hyperreflective deposits in a patient with a history of gastrointestinal surgery, liver disease, and/or poor diet can be suggestive of this diagnosis, even in the presence of ongoing vitamin A supplementation. Vitamin A supplementation can vary in route and dosage and can be tailored to the individual with serial testing of serum retinol. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- David A Levine
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Namita E Mathew
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Emily H Jung
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Jiong Yan
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Nancy J Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia; Department of Neurology, Emory University School of Medicine, Atlanta, Georgia; Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Praneetha Thulasi
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Steven Yeh
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Thomas R Ziegler
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Jill Wells
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Nieraj Jain
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.
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Gunzinger JM, Muth DR, Hanson JVM, Al-Sheikh M, Fasler K, Barthelmes D, Zweifel SA. Vitamin A deficiency retinopathy related to medical interventions in a Swiss cohort: a case series. Swiss Med Wkly 2023; 153:40097. [PMID: 37921090 DOI: 10.57187/smw.2023.40097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Abstract
AIMS OF THE STUDY Vitamin A deficiency retinopathy is a potentially blinding disease. In developed countries, vitamin A deficiency due to malnutrition is rare. However, vitamin A deficiency can be caused by malabsorption resulting from bowel resection or medication. In this retrospective study, we present five cases of vitamin A deficiency retinopathy related to malabsorption secondary to medical interventions. METHODS Electronic charts over a ten-year period (2012-2022) were screened for vitamin A deficiency retinopathy. Only patients with vitamin A deficiency confirmed by laboratory tests were included. Symptoms, medical history, visual acuity, optical coherence tomography, fundus autofluorescence, electrophysiological examination, and vitamin A levels were reviewed. RESULTS Five eligible cases were identified. Median age was 44.7 years (range 22.2-88.9), median duration of ocular symptoms prior to diagnosis was 14 months, and median visual acuity was 1.0 (range 0.5-1.0, Snellen, decimal). Three patients had a history of bariatric surgery, one patient had a small bowel resection and was on octreotide treatment, and one patient suffered from cystic fibrosis and had a history of small bowel resection and severe hepatopathy. Optical coherence tomography showed various abnormalities, including a reduced interdigitation zone, subretinal drusenoid deposits, and a thinned outer nuclear layer. Electroretinogram findings ranged from abnormal oscillatory potentials to non-recordable rod responses. CONCLUSIONS Vitamin A deficiency retinopathy can occur following medical interventions associated with malabsorption. In cases of night blindness, vitamin A levels should be measured.
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Affiliation(s)
| | - Daniel R Muth
- The Save Sight Institute, The University of Sydney, Sydney, Australia
| | - James V M Hanson
- The Save Sight Institute, The University of Sydney, Sydney, Australia
| | - Mayss Al-Sheikh
- The Save Sight Institute, The University of Sydney, Sydney, Australia
| | - Katrin Fasler
- The Save Sight Institute, The University of Sydney, Sydney, Australia
| | - Daniel Barthelmes
- The Save Sight Institute, The University of Sydney, Sydney, Australia
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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4
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Ali MJ. Vitamin-A Deficiency: Peripunctal Bitot's Spots. Ophthalmic Plast Reconstr Surg 2023; 39:648-649. [PMID: 37922047 DOI: 10.1097/iop.0000000000002438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
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5
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Das S, Chandra A. Bitot Spots: A Pathognomonic Sign of Vitamin A Deficiency. Am J Med 2023; 136:e195-e196. [PMID: 37356642 DOI: 10.1016/j.amjmed.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 06/27/2023]
Affiliation(s)
- Souvik Das
- Department of Internal Medicine, RG Kar Medical College and Hospital, Kolkata, India
| | - Atanu Chandra
- Department of Internal Medicine, RG Kar Medical College and Hospital, Kolkata, India.
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Breazzano MP, Oh JK, Batson SA, Kucherich JA, Karani R, Rohrmann CM, Sparrow JR, Fragiotta S, Tsang SH. Vitamin A deficiency and the retinal "double carrot" sign with optical coherence tomography. Eye (Lond) 2023; 37:1489-1495. [PMID: 35840717 PMCID: PMC10169789 DOI: 10.1038/s41433-022-02137-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 04/30/2022] [Accepted: 06/10/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Spectral-domain optical coherence tomography (SD-OCT) and full-field electroretinography (ERG) allow retinal assessment with vitamin A deficiency (VAD). Using SD-OCT, this study aimed to characterize and follow a novel retinal abnormality in patients with VAD and intramuscular supplementation. METHODS Patients with VAD were retrospectively reviewed, including SD-OCT and electroretinography. RESULTS Three patients had VAD following bariatric or colon surgery and varying supplementation. All had nyctalopia, extinguished scotopic rod-specific function with ERG, and decreased serum vitamin A. None demonstrated surface abnormalities. All received intramuscular vitamin A with subjective resolution of symptoms. On SD-OCT, four of six eyes exhibited homogenous foveal hyperreflectivity anterior to retinal pigment epithelium-Bruch complex, reminiscent of a "double carrot", which improved following supplementation. ERG findings demonstrated improved scotopic rod-specific function in all cases; however, photopic function remained diminished in two cases. CONCLUSIONS Structural improvement of the proposed "double carrot" sign occurs soon after vitamin A supplementation. While scotopic function improves rapidly following supplementation, cone function recovers more slowly. Therefore, foveal changes such as the "double carrot" sign suggest that structural recovery of cones precedes functional recovery.
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Grants
- R01 EY024091 NEI NIH HHS
- R21 AG050437 NIA NIH HHS
- R01 EY018213 NEI NIH HHS
- U01 EY030580 NEI NIH HHS
- U54 OD020351 NIH HHS
- R01 EY026682 NEI NIH HHS
- R24 EY027285 NEI NIH HHS
- P30 CA013696 NCI NIH HHS
- R24 EY028758 NEI NIH HHS
- R01 EY024698 NEI NIH HHS
- P30 EY019007 NEI NIH HHS
- U.S. Department of Health & Human Services | NIH | National Eye Institute (NEI)
- Foundation Fighting Blindness (Foundation Fighting Blindness, Inc.)
- Research to Prevent Blindness (RPB) Physician-Scientist Award, and unrestricted funds from RPB, New York, NY, USA
- U.S. Department of Health & Human Services | NIH | National Cancer Institute (NCI)
- U.S. Department of Health & Human Services | NIH | NIH Office of the Director (OD)
- U.S. Department of Health & Human Services | NIH | National Institute on Aging (U.S. National Institute on Aging)
- The Schneeweiss Stem Cell Fund, New York State [SDHDOH01-C32590GG-3450000], Nancy & Kobi Karp, the Crowley Family Funds, The Rosenbaum Family Foundation, Alcon Research Institute, the Gebroe Family Foundation, the Research to Prevent Blindness (RPB) Physician-Scientist Award, and unrestricted funds from RPB, New York, NY, USA.
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Affiliation(s)
- Mark P Breazzano
- Jonas Children's Vision Care, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY, USA
- Department of Ophthalmology, New York University Langone Health, New York, NY, USA
- Manhattan Eye, Ear and Throat Hospital, Lenox Hill Hospital, Northwell Health, New York, NY, USA
- Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Retina-Vitreous Surgeons of Central New York, Liverpool, NY, USA
- Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Jin Kyun Oh
- Jonas Children's Vision Care, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY, USA
| | | | - Julia A Kucherich
- Department of Nutrition & Therapeutic Services, Morgan Stanley Children's Hospital at New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Johns Hopkins Hospital, Johns Hopkins Children's Center, Baltimore, MD, USA
| | - Rabia Karani
- Jonas Children's Vision Care, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY, USA
| | - Caitlin M Rohrmann
- Department of Nutrition & Therapeutic Services, Morgan Stanley Children's Hospital at New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA
| | - Janet R Sparrow
- Jonas Children's Vision Care, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY, USA
- Department of Pathology & Cell Biology, Columbia University, New York, NY, USA
| | - Serena Fragiotta
- Department of Medical-Surgical Sciences and Biotechnologies, U.O.S.D. Ophthalmology, Sapienza University of Rome, Rome, Italy
| | - Stephen H Tsang
- Jonas Children's Vision Care, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY, USA.
- Department of Pathology & Cell Biology, Columbia University, New York, NY, USA.
- Columbia Stem Cell Initiative, and Institute of Human Nutrition, Columbia University, New York, NY, USA.
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Thapa R, Addo EK, Ruit S, Bernstein PS. Assessment of Skin Carotenoid Measurement as a Means to Detect Vitamin A Deficiency in Children and Pregnant Women of Nepal. J Nutr 2023; 153:1211-1219. [PMID: 36780945 PMCID: PMC10356995 DOI: 10.1016/j.tjnut.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/04/2023] [Accepted: 02/08/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Vitamin A deficiency (VAD) is an ongoing public health concern among children and pregnant women in Nepal despite robust national efforts to screen and treat this vision- and life-threatening condition. OBJECTIVES This study aimed to evaluate skin carotenoid scores measured using the Veggie Meter as a rapid, noninvasive screening tool for VAD in Nepali children and pregnant women. METHODS This comparative cross-sectional study enrolled 164 pregnant women and 168 children (aged 8 to 12 y) from public hospitals in three distinct outlying ecological regions of Nepal (Terai, Hill, and Mountain). The primary outcome assessed whether skin carotenoid status could be a biomarker for VAD. We determined skin carotenoid scores using the Veggie Meter and compared them with serum retinol and total carotenoid concentrations assessed by HPLC. Correlation analysis was used to determine bivariate associations between serum retinol and total carotenoid concentrations, and the Veggie Meter assessed skin carotenoid status. Receiver operating characteristics curves were determined, and a P value <0.05 was considered statistically significant. RESULTS We found that 8.5% of pregnant women and 13.0% of children in this study had severe VAD (serum retinol < 200 ng/mL). There were significant correlations between skin carotenoid scores with serum retinol and total carotenoid concentrations among pregnant women and children (r = 0.253-0.530, P ≤ 0.001). The Veggie Meter detected severe VAD with 57.1% sensitivity and 82.7% specificity in pregnant women and 61.9% sensitivity and 75.9% specificity in children. CONCLUSIONS Although sensitivity and specificity were moderate for detecting VAD with the Veggie Meter, skin carotenoid assessment using this rapid, noninvasive portable device could still be valuable for high-risk VAD screening in Nepal and similar developing countries with limited access to laboratory measurement of serum vitamin A concentrations.
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Affiliation(s)
- Raba Thapa
- Department of Ophthalmology, Tilganga Institute of Ophthalmology, Kathmandu, Nepal.
| | - Emmanuel K Addo
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT, United States; Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, United States.
| | - Sanduk Ruit
- Department of Ophthalmology, Tilganga Institute of Ophthalmology, Kathmandu, Nepal.
| | - Paul S Bernstein
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT, United States; Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, United States.
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Jevnikar K, Šuštar M, Kozjek NR, Štrucl AM, Markelj Š, Hawlina M, Fakin A. DISRUPTION OF THE OUTER SEGMENTS OF THE PHOTORECEPTORS ON OPTICAL COHERENCE TOMOGRAPHY AS A FEATURE OF VITAMIN A DEFICIENCY. Retin Cases Brief Rep 2022; 16:658-662. [PMID: 33181799 PMCID: PMC9394498 DOI: 10.1097/icb.0000000000001060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the optical coherence tomography features of vitamin A deficiency. METHODS Case series includes three male patients aged 50 to 66 years with vitamin A deficiency and visual symptoms ranging from 2 to 8 months. Examination included optical coherence tomography (OCT), fundus autofluorescence imaging, full-field electroretinography6 and laboratory work-up. RESULTS Patient 1 had inoperable pancreatic neuroendocrine tumor and presented with worsening nyctalopia. The electroretinography showed absent rod function 2 months after the onset of symptoms, followed by a decrease of the cone function eight months after the onset. Optical coherence tomography showed poorly distinguishable outer segments of the photoreceptors with the disappearance of the interdigitation zone. At that time, vitamin A deficiency along with several other deficiencies was confirmed. After the initiation of parenteral nutrition, a substantial improvement of the patient's overall well-being was noted and the OCT showed normalization of the retinal structure. Two other patients were diagnosed with vitamin A deficiency based on similar OCT features. CONCLUSION Disruption of the outer segments of the photoreceptors and the disappearance of the interdigitation zone on OCT may be helpful in recognition of vitamin A deficiency. Early detection and malnutrition evaluation are especially important in patients with a history of gastrointestinal disorders who may have several other underlying deficiencies. Treatment with either enteral or parenteral nutrition not only leads to resolution of visual symptoms but vastly improves their general condition and quality of life.
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Affiliation(s)
- Kristina Jevnikar
- Eye Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia; and
| | - Maja Šuštar
- Eye Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia; and
| | | | - Ana M. Štrucl
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Špela Markelj
- Eye Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia; and
| | - Marko Hawlina
- Eye Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia; and
| | - Ana Fakin
- Eye Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia; and
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Sapkota J, Rana R. Bilateral keratomalacia secondary to xerophthalmia. Nepal J Ophthalmol 2022; 14:161-165. [PMID: 37609977 DOI: 10.3126/nepjoph.v14i2.43679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
INTRODUCTION Vitamin A deficiency leads to a wide spectrum of ocular manifestations ranging from conjunctival xerosis to corneal ulceration and perforation. Penetrating keratoplasty along with vitamin A supplementation can save the eye and useful vision. CASE A 10-year-old boy presented with decreased vision in both eyes for 3 months. Slit-lamp examination with diffuse light revealed bilateral corneal thinning with iris prolapse at inferior aspect of cornea. He underwent therapeutic penetrating keratoplasty in both eyes. Vitamin A supplementation was given as per national protocol. Till 1 year postoperatively visual acuity in RE was 6/18 and LE was pre-phthisical. CONCLUSION Vitamin A deficiency is potentially a sight threatening condition, which may lead to keratomalacia and corneal perforation if neglected. Timely management with Vitamin A supplementation and penetrating keratoplasty can save the eye and vision.
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Sriram A, Kodali S, Kim G, Kang JJ. Light Perception Vision and Xerophthalmia in an 11-Year-Old Boy. J Pediatr Ophthalmol Strabismus 2022; 59:e35-e38. [PMID: 35603950 DOI: 10.3928/01913913-20220420-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The authors present a case of a child who had severe dietary restriction with consumption of french fries only. He presented to the ophthalmology clinic with light perception vision in both eyes, and was found to have dry, leathery conjunctivae with Bitot's spots and hazy corneas with diffuse punctate epithelial erosions. Electroretinography testing showed an absent rod response and a decreased cone response. Laboratory testing results were positive for vitamin A deficiency. After prompt initiation of treatment, he had improvement in his vision and anterior segment findings. This case serves as a reminder that vitamin A deficiency can present in high-income countries, and that ophthalmologists may play a key role in diagnosing the condition, initiating treatment, and sending patients to the appropriate subspecialists for further evaluation and management of the underlying condition. For patients with vitamin A deficiency, ophthalmologists can play an essential role in preventing permanent vision loss and the systemic consequences of deficiency such as infection or death. [J Pediatric Opthalmology & Strabismus. 2022;59(3):e35-e38.].
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Song A, Mousa HM, Soifer M, Perez VL. Recognizing vitamin A deficiency: special considerations in low-prevalence areas. Curr Opin Pediatr 2022; 34:241-247. [PMID: 35125379 PMCID: PMC8891082 DOI: 10.1097/mop.0000000000001110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Although vitamin A deficiency (VAD) is rare in well resourced countries, there is a growing trend of VAD in at-risk pediatric populations. Early diagnosis is critically important to prevent its associated morbidity and mortality. This review highlights key lessons for evaluation, diagnosis, and management of children with xerophthalmia in the United States. It synthesizes the latest findings from the literature on the pathophysiology, epidemiology, risk factors, evaluation, and management of VAD in low-prevalence areas. RECENT FINDINGS Vitamin A is crucial for maintaining the functional integrity of the eye, immune system, skin, and mucous membranes. Despite the scarcity of VAD in developed countries, there are increasing reports of VAD in at-risk children, including those with autism spectrum disorder and gastrointestinal conditions. There is a broad range of manifestations of VAD, posing a diagnostic challenge. Familiarity with the variable presentations of VAD and having a high index of suspicion in at-risk populations can aid in its early diagnosis. Systemic vitamin A supplementation and a multidisciplinary approach are important components of the management of VAD. SUMMARY Even in well resourced countries, VAD should remain on the differential in patients with risk factors who present with relevant signs and symptoms. Early diagnosis and appropriate involvement of a multidisciplinary care team can help prevent morbidity and mortality associated with VAD.
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Affiliation(s)
- Ailin Song
- Duke University School of Medicine, Durham, NC, USA
| | - Hazem M Mousa
- Foster Center for Ocular Immunology, Duke Eye Institute, 2351 Erwin Road, Durham, NC, USA
- Department of Ophthalmology, Duke University Medical Center, 2351 Erwin Road, Durham, NC, USA
| | - Matias Soifer
- Foster Center for Ocular Immunology, Duke Eye Institute, 2351 Erwin Road, Durham, NC, USA
- Department of Ophthalmology, Duke University Medical Center, 2351 Erwin Road, Durham, NC, USA
| | - Victor L Perez
- Foster Center for Ocular Immunology, Duke Eye Institute, 2351 Erwin Road, Durham, NC, USA
- Department of Ophthalmology, Duke University Medical Center, 2351 Erwin Road, Durham, NC, USA
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12
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Chung IY, Tavassoli S, Wong N, Cleary G. Vitamin A deficiency presenting with fungal keratitis and bilateral corneal perforations. BMJ Case Rep 2022; 15:e247853. [PMID: 35288431 PMCID: PMC8921861 DOI: 10.1136/bcr-2021-247853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- In Young Chung
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Department of Ophthalmology, Austin Health, Heidelberg, Victoria, Australia
| | - Shokufeh Tavassoli
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Department of Ophthalmology, Royal United Hospital NHS Trust, Bath, UK
| | - Nathan Wong
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Department of Ophthalmology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Georgia Cleary
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
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13
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Enekvint A, Wonneberger W, Zetterberg M. [Xerophthalmia in a 7-year-old autistic child]. Lakartidningen 2021; 118:21130. [PMID: 34783001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Vitamin A deficiency and xerophthalmia is a rare finding in developed countries. We report a severe case of xerophthalmia in a 7-year-old autistic child with restricted diet. Both eyes had Bitot's spots and ulceration. The right cornea had a perforation at admission. After treatment with high doses of vitamin A the right cornea epithelialized with formation of the anterior chamber and the left eye healed completely. This case adds to the increasing number of reports on cases of xerophthalmia particularly in autistic children and highlights the importance of considering vitamin A deficiency in patients with risk of malnutrition also in developed countries.
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Affiliation(s)
- Arman Enekvint
- ST-läkare i ögonsjukdomar, Ögonsjukvård, Sahlgrenska universitetssjukhuset
| | - Wolf Wonneberger
- doktorand, överläkare, korneateam, Ögonsjukvård, Sahlgrenska universitetssjukhuset, Mölndal; Sahlgrenska akademin, Göteborgs universitet
| | - Madeleine Zetterberg
- professor, överläkare, Ögonsjukvård, Sahlgrenska universitetssjukhuset, Mölndal; Sahlgrenska akademin, Göteborgs universitet
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Fieldhouse H, Nestel A, Theron B, Knox Cartwright N. Corneal perforation due to vitamin A deficiency in a patient with short bowel syndrome. BMJ Case Rep 2021; 14:e242776. [PMID: 34511420 PMCID: PMC8438734 DOI: 10.1136/bcr-2021-242776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 11/03/2022] Open
Abstract
A 55-year-old Caucasian woman presented with a 1-week history of left eye redness and blurred vision. Her medical history included previous small bowel resection and ileostomy for ischaemic bowel. Ophthalmic examination revealed a left corneal ulcer requiring hospital admission for intensive topical antibiotics. Overnight she became systemically unwell and was diagnosed with urinary tract infection requiring intravenous antibiotics. Her corneal condition deteriorated resulting in corneal perforation, which required a surgical gluing procedure. Despite surgery, the cornea perforated on two further occasions. At this stage, vitamin A deficiency (VAD) was suspected, due to the corneal melting response that was occurring. VAD was subsequently confirmed by serology and had occurred in this case due to malabsorption as a result of short bowel syndrome caused by previous small bowel surgery. The patient was treated with intramuscular vitamin A and eventually made a good visual and systemic recovery.
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Affiliation(s)
| | - Achim Nestel
- Ophthalmology, North Devon District Hospital, Barnstaple, UK
| | - Byron Theron
- Gastroenterology, North Devon District Hospital, Barnstaple, UK
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15
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Addo OY, Yu EX, Williams AM, Young MF, Sharma AJ, Mei Z, Kassebaum NJ, Jefferds MED, Suchdev PS. Evaluation of Hemoglobin Cutoff Levels to Define Anemia Among Healthy Individuals. JAMA Netw Open 2021; 4:e2119123. [PMID: 34357395 PMCID: PMC8346941 DOI: 10.1001/jamanetworkopen.2021.19123] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/27/2021] [Indexed: 11/14/2022] Open
Abstract
Importance Anemia, defined as low hemoglobin (Hb) concentration insufficient to meet an individual's physiological needs, is the most common blood condition worldwide. Objective To evaluate the current World Health Organization (WHO) Hb cutoffs for defining anemia among persons who are apparently healthy and to assess threshold validity with a biomarker of tissue iron deficiency and physiological indicator of erythropoiesis (soluble transferrin receptor [sTfR]) using multinational data. Design, Setting, and Participants In this cross-sectional study, data were collected and evaluated from 30 household, population-based nutrition surveys of preschool children aged 6 to 59 months and nonpregnant women aged 15 to 49 years during 2005 to 2016 across 25 countries. Data analysis was performed from March 2020 to April 2021. Exposure Anemia defined according to WHO Hb cutoffs. Main Outcomes and Measures To define the healthy population, persons with iron deficiency (ferritin <12 ng/mL for children or <15 ng/mL for women), vitamin A deficiency (retinol-binding protein or retinol <20.1 μg/dL), inflammation (C-reactive protein >0.5 mg/dL or α-1-acid glycoprotein >1 g/L), or known malaria were excluded. Survey-specific, pooled Hb fifth percentile cutoffs were estimated. Among individuals with Hb and sTfR data, Hb-for-sTfR curve analysis was conducted to identify Hb inflection points that reflect tissue iron deficiency and increased erythropoiesis induced by anemia. Results A total of 79 950 individuals were included in the original surveys. The final healthy sample was 13 445 children (39.9% of the original sample of 33 699 children; 6750 boys [50.2%]; mean [SD] age 32.9 [16.0] months) and 25 880 women (56.0% of the original sample of 46 251 women; mean [SD] age, 31.0 [9.5] years). Survey-specific Hb fifth percentile among children ranged from 7.90 g/dL (95% CI, 7.54-8.26 g/dL in Pakistan) to 11.23 g/dL (95% CI, 11.14-11.33 g/dL in the US), and among women from 8.83 g/dL (95% CI, 7.77-9.88 g/dL in Gujarat, India) to 12.09 g/dL (95% CI, 12.00-12.17 g/dL in the US). Intersurvey variance around the Hb fifth percentile was low (3.5% for women and 3.6% for children). Pooled fifth percentile estimates were 9.65 g/dL (95% CI, 9.26-10.04 g/dL) for children and 10.81 g/dL (95% CI, 10.35-11.27 g/dL) for women. The Hb-for-sTfR curve demonstrated curvilinear associations with sTfR inflection points occurring at Hb of 9.61 g/dL (95% CI, 9.55-9.67 g/dL) among children and 11.01 g/dL (95% CI, 10.95-11.09 g/dL) among women. Conclusions and Relevance Current WHO cutoffs to define anemia are higher than the pooled fifth percentile of Hb among persons who are outwardly healthy and from nearly all survey-specific estimates. The lower proposed Hb cutoffs are statistically significant but also reflect compensatory increased erythropoiesis. More studies based on clinical outcomes could further confirm the validity of these Hb cutoffs for anemia.
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Affiliation(s)
- O. Yaw Addo
- Nutrition Branch, International Micronutrient Malnutrition Prevention and Control Program Unit, Centers for Disease Control and Prevention, Atlanta, Georgia
- Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Emma X. Yu
- Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Anne M. Williams
- Nutrition Branch, International Micronutrient Malnutrition Prevention and Control Program Unit, Centers for Disease Control and Prevention, Atlanta, Georgia
- Emory University Rollins School of Public Health, Atlanta, Georgia
- McKing Consulting Corporation, Atlanta, Georgia
| | | | - Andrea J. Sharma
- Nutrition Branch, International Micronutrient Malnutrition Prevention and Control Program Unit, Centers for Disease Control and Prevention, Atlanta, Georgia
- USPHS Commissioned Corps, Atlanta, Georgia
| | - Zuguo Mei
- Nutrition Branch, International Micronutrient Malnutrition Prevention and Control Program Unit, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Maria Elena D. Jefferds
- Nutrition Branch, International Micronutrient Malnutrition Prevention and Control Program Unit, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Parminder S. Suchdev
- Nutrition Branch, International Micronutrient Malnutrition Prevention and Control Program Unit, Centers for Disease Control and Prevention, Atlanta, Georgia
- Emory University Rollins School of Public Health, Atlanta, Georgia
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16
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Khan S, Beavers S, Rice C, Atan D. Why can't I see in the dark? BMJ 2021; 373:n1573. [PMID: 34193459 DOI: 10.1136/bmj.n1573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | | | - Claire Rice
- Bristol Medical School, University of Bristol, UK
| | - Denize Atan
- Bristol Medical School, University of Bristol, UK
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17
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Oxley A, Engle-Stone R, Miller JC, Reario MFD, Stormer A, Capanzana MV, Cabanilla CVD, Haskell MJ, Lietz G. Determination of Vitamin A Total Body Stores in Children from Dried Serum Spots: Application in a Low- and Middle-Income Country Community Setting. J Nutr 2021; 151:1341-1346. [PMID: 33755155 PMCID: PMC8112776 DOI: 10.1093/jn/nxaa446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/15/2020] [Accepted: 12/21/2020] [Indexed: 12/24/2022] Open
Abstract
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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Affiliation(s)
- Anthony Oxley
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Reina Engle-Stone
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, CA, USA
| | - Jody C Miller
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, CA, USA
| | | | - Ame Stormer
- Helen Keller International, Malate, Manila, Philippines
| | - Mario V Capanzana
- Food and Nutrition Research Institute, Department of Science and Technology, Bicutan, Taguig City, Philippines
| | - Carl V D Cabanilla
- Food and Nutrition Research Institute, Department of Science and Technology, Bicutan, Taguig City, Philippines
| | - Marjorie J Haskell
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, CA, USA
| | - Georg Lietz
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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18
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Abstract
Vitamin A is a fat-soluble vitamin involved in essential functions including growth, immunity, reproduction, and vision. The vitamin A Dietary Reference Intakes (DRIs) for North Americans suggested that a minimally acceptable total liver vitamin A reserve (TLR) is 0.07 µmol/g, which is not explicitly expressed as a vitamin A deficiency cutoff. The Biomarkers of Nutrition for Development panel set the TLR cutoff for vitamin A deficiency at 0.1 µmol/g based on changes in biological response of several physiological parameters at or above this cutoff. The criteria used to formulate the DRIs include clinical ophthalmic signs of vitamin A deficiency, circulating plasma retinol concentrations, excretion of vitamin A metabolites in the bile, and long-term storage of vitamin A as protection against vitamin A deficiency during times of low dietary intake. This review examines the biological responses that occur as TLRs are depleted. In consideration of all of the DRI criteria, the review concludes that induced biliary excretion and long-term vitamin A storage do not occur until TLRs are >0.10 µmol/g. If long-term storage is to continue to be part of the DRI criteria, vitamin A deficiency should be set at a minimum cutoff of 0.10 µmol/g and should be set higher during times of enhanced requirements where TLRs can be rapidly depleted, such as during lactation or in areas with high infection burden. In population-based surveys, cutoffs are important when using biomarkers of micronutrient status to define the prevalence of deficiency and sufficiency to inform public health interventions. Considering the increasing use of quantitative biomarkers of vitamin A status that indirectly assess TLRs, i.e. the modified-relative-dose response and retinol-isotope dilution tests, setting a TLR as a vitamin A deficiency cutoff is important for users of these techniques to estimate vitamin A deficiency prevalence. Future researchers and policymakers may suggest that DRIs should be set with regard to optimal health and not merely to prevent a micronutrient deficiency.
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Affiliation(s)
- Sherry A Tanumihardjo
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI 53706, USA
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19
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Likoswe BH, Joy EJM, Sandalinas F, Filteau S, Maleta K, Phuka JC. Re-Defining the Population-Specific Cut-Off Mark for Vitamin A Deficiency in Pre-School Children of Malawi. Nutrients 2021; 13:849. [PMID: 33807563 PMCID: PMC8000145 DOI: 10.3390/nu13030849] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/23/2021] [Accepted: 03/02/2021] [Indexed: 11/23/2022] Open
Abstract
Retinol Binding Protein (RBP) is responsible for the transport of serum retinol (SR) to target tissue in the body. Since RBP is relatively easy and cheap to measure, it is widely used in national Micronutrient Surveys (MNS) as a proxy for SR to determine vitamin A status. By regressing RBP concentration against SR concentration measured in a subset of the survey population, one can define a population-specific threshold concentration of RBP that indicates vitamin A deficiency (VAD). However, the relationship between RBP and SR concentrations is affected by various factors including inflammation. This study, therefore, aimed to re-define the population-specific cut-off for VAD by examining the influence of inflammation on RBP and SR, among pre-school children (PSC) from the 2015-16 Malawi MNS. The initial association between RBP and SR concentrations was poor, and this remained the case despite applying various methods to correct for inflammation. The World Health Organization (WHO) recommends the threshold of 0.7 µmol/L to define VAD for SR concentrations. Applying this threshold to the RBP concentrations gave a VAD prevalence of 24%, which reduced to 10% after inflammation adjustments following methods developed by the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA). Further research is required to identify why SR and RBP were poorly associated in this population. Future MNS will need to account for the effect of inflammation on RBP to measure the prevalence of VAD in Malawi.
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Affiliation(s)
- Blessings H. Likoswe
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi;
| | - Edward J. M. Joy
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (E.J.M.J.); (F.S.); (S.F.)
| | - Fanny Sandalinas
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (E.J.M.J.); (F.S.); (S.F.)
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (E.J.M.J.); (F.S.); (S.F.)
| | - Kenneth Maleta
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi;
| | - John C. Phuka
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi;
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20
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Abstract
AIMS Vitamin A (VA) deficiency triggers many diseases and is a worldwide nutrition problem. The Retinol acyltransferase (LRAT) is an indicator of VA storage function, and the relationship between LRAT and blood pressure level and the regulation mechanism will be elucidated. METHODS 160 children aged 6-12 years were included, and the serum VA and, the transcription levels of LRAT and RARs, were measured. Spontaneously hypertensive rats (SHRs) and WKY rats were treated with VA deficiency (VAD) or normal (VAN) fodder for 20 weeks. LRAT, retinoic acid, renin angiotensin system (RAS) biomarkers, and the structure and function of the heart for SHRs were measured. RESULTS The serum retinol and serum retinol/BMI levels were lower in children in the low LRAT group (LRAT<P50) compared with the high LRAT group (LRAT≥P50)(0.82 μmol/L vs. 0.94 μmol/L, 0.04 vs. 0.05, all P < .01). Moreover, SBP, DBP, and Ang Ⅱ were lower in the low LRAT group (all P < .01). Compared with VAN-treated SHRs, LRAT, retinoic acid receptor alpha (RARα), ACE2, and Ang (1-7) protein expression levels were decreased, while ACE and AT1R expression levels were increased in VAD SHRs. Notably, heart weight (HW), left ventricle weight, the HW-to-body weight ratio and the left ventricle weight-to-body weight ratio were significantly increased in VAD SHRs compared with those in VAN SHRs (P < .01). Cardiomyocyte hypertrophy and ventricular fibrosis were significantly increased in VAD SHRs compared with those in VAN SHRs (both P < .01). CONCLUSIONS LRAT may be an important biomarker of vitamin A deficiency in target organs and may regulate BP by affecting RAS biomarkers.
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Affiliation(s)
- Xiaohua Liang
- Clinical Epidemiology and Biostatistics Department, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Center of Child Development and Critical Disorders , Chongqing, China
| | - Min Chen
- Clinical Epidemiology and Biostatistics Department, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Center of Child Development and Critical Disorders , Chongqing, China
| | - Dong Wang
- Department of Ultrasound, First Affiliated Hospital of Chongqing Medical University , Chongqing, China
| | - Jin Wen
- Kidney Disease Department, Yongchuan Hospital of Chongqing Medical University , Chongqing, China
| | - Jie Chen
- Clinical Epidemiology and Biostatistics Department, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Center of Child Development and Critical Disorders , Chongqing, China
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21
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Kishimoto N, Hayashi T, Mizobuchi K, Kubota M, Nakano T. Vitamin A deficiency after prolonged intake of an unbalanced diet in a Japanese hemodialysis patient. Doc Ophthalmol 2021; 143:85-91. [PMID: 33544296 DOI: 10.1007/s10633-021-09823-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/20/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND In industrialized countries, vitamin A deficiency (VAD) is extremely rare, except association with bariatric surgeries and hepatobiliary disorders. It is unusual that VAD develops during hemodialysis due to reduced glomerular filtration of vitamin A-binding protein. We reported the case of a 58-year-old Japanese male hemodialysis patient diagnosed with VAD. CASE PRESENTATION The patient undergoing hemodialysis for more than 15 years presented with progressive photophobia and night blindness and was ophthalmologically examined. He denied a history of cancer or hepatobiliary disease and reported that he loved eating prepackaged noodle bowls and foods, with prolonged low intake of fruits/vegetables. He had good visual acuity. Fundus images showed numerous white dots in the midperipheral retinae, but no degenerative changes. In baseline full-field electroretinography (ERG), b-wave responses were extremely reduced in rod ERG, a-wave amplitudes in standard-flash/strong-flash ERG were reduced to 20-25% of our controls, a- and b-wave amplitudes in cone ERG were reduced to 40-50% of the controls. Whole-exome sequencing identified no pathogenic variant for any inherited retinal disorder. He was diagnosed with VAD because of reduced serum vitamin A levels and treated with retinol palmitate. Two months after treatment commencement, the serum vitamin A level was within the normal range. Full-field ERG showed that the scotopic ERG responses markedly improved compared with baseline. CONCLUSIONS This is the first report of VAD associated with undernutrition in the Japanese hemodialysis population.
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Affiliation(s)
- Nanami Kishimoto
- Department of Ophthalmology, Katsushika Medical Center, The Jikei University School of Medicine, 6-41-2 Aoto, Katsushika-ku, Tokyo, 125-8506, Japan
| | - Takaaki Hayashi
- Department of Ophthalmology, Katsushika Medical Center, The Jikei University School of Medicine, 6-41-2 Aoto, Katsushika-ku, Tokyo, 125-8506, Japan.
| | - Kei Mizobuchi
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
| | - Masaomi Kubota
- Department of Ophthalmology, Katsushika Medical Center, The Jikei University School of Medicine, 6-41-2 Aoto, Katsushika-ku, Tokyo, 125-8506, Japan
| | - Tadashi Nakano
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
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22
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Affiliation(s)
- Uddalak Chakraborty
- Department of Internal Medicine, College of Medicine and Sagore Dutta Hospital, Kolkata, India.
| | - Atanu Chandra
- Department of Internal Medicine, R G Kar Medical College and Hospital, Kolkata, India
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23
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Ellis MP, Chang MY, Yiu G. Anti-Retinal Antibodies in Vitamin A Deficiency. Ophthalmic Surg Lasers Imaging Retina 2020; 51:723-726. [PMID: 33339054 DOI: 10.3928/23258160-20201202-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/07/2020] [Indexed: 11/20/2022]
Abstract
Vitamin A is an important component of the visual cycle, and its deficiency causes a retinal degeneration that may be reversed with retinol supplementation. Here, the authors present a patient with vitamin A deficiency and rod-mediated retinopathy who was found to have multiple anti-retinal antibodies that gradually dissipated after vitamin A supplementation. This interesting case suggests the possibility that the photoreceptor degeneration induced by vitamin A deficiency may lead to transient immune exposure to retinal antigens and development of anti-retinal antibodies. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:723-726.].
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24
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Panda L, Nayak S, Das T. Tribal Odisha Eye Disease Study Report # 6. Opportunistic screening of vitamin A deficiency through School Sight Program in tribal Odisha (India). Indian J Ophthalmol 2020; 68:351-355. [PMID: 31957725 PMCID: PMC7003593 DOI: 10.4103/ijo.ijo_1154_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/12/2019] [Accepted: 09/21/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose To explore the possibility of vitamin A deficiency (VAD) detection through School Sight Program (SSP) in a tribal district of Odisha, India. Methods In a cross-sectional observational study, we tracked school children with ocular signs/symptoms of VAD to their villages. The ophthalmologist examined their under-5 siblings and other under-5 children in the village. Information pertaining to family belief and practices of food, water, sanitation, and the socioeconomic status of the family were collected. Results The ocular features of VAD were detected in 207 of 4801 (4.3%) examined children. This included 70 children (mean age 11 ± 2.6 years) detected in the school, 22 siblings (mean age 3.2 ± 1.2 years) of these children detected at their home, and 115 children (mean age 3 ± 1.5 years) detected in their habitat. The average family size was 5.8 ± 2.02 and the birth order of the child with VAD was 2.3 ± 1.25. Most parents were farmer, living in asbestos-roofed house, depended on public underground water, and practiced open-air defecation. The distribution of VAD in 207 children was conjunctival xerosis (X1A = 207; 100% of VAD and 4.3% of all children), Bitot's spot (X1B = 169; 81.6% of VAD and 3.5% of all children), corneal scar (XS = 3; 1.4% of VAD and 0.06% of all children), and night blindness (XN = 35; 16.9% of VAD and 0.72% of all children). Conclusion An opportunistic screening for detection of VAD through a SSP could be cost-effective and complement the existing strategy.
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Affiliation(s)
- Lapam Panda
- Indian Oil Centre for Rural Eye Care, L V Prasad Eye Institute, Bhubaneswar, India
| | - Suryasmita Nayak
- Indian Oil Centre for Rural Eye Care, L V Prasad Eye Institute, Bhubaneswar, India
| | - Taraprasad Das
- Indian Oil Centre for Rural Eye Care, L V Prasad Eye Institute, Bhubaneswar, India
- Indian Oil Centre for Rural Eye Care, L V Prasad Eye Institute, Bhubaneswar; Srimati Kanuri Shantamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
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25
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Affiliation(s)
- K Mishra
- Department of Internal Medicine, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Jandial
- Department of Internal Medicine, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - R Sandal
- Department of Internal Medicine, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Khadwal
- Department of Internal Medicine, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P Malhotra
- Department of Internal Medicine, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
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Hanson C, Lyden E, Anderson-Berry A, Kocmich N, Rezac A, Delair S, Furtado J, Van Ormer M, Izevbigie N, Olateju EK, Akaba GO, Anigilaje EA, Yunusa T, Obaro S. Status of Retinoids and Carotenoids and Associations with Clinical Outcomes in Maternal-Infant Pairs in Nigeria. Nutrients 2018; 10:E1286. [PMID: 30213044 PMCID: PMC6165164 DOI: 10.3390/nu10091286] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 09/07/2018] [Accepted: 09/10/2018] [Indexed: 01/22/2023] Open
Abstract
Vitamin A is an essential nutrient in pregnancy, and other carotenoids have been independently associated with maternal-infant outcomes. The objective of this study was to quantify the status of vitamin A and carotenoids in Nigerian maternal-infant pairs at delivery, compare these to a cohort from a developed nation, and determine the impact on clinical outcomes. Maternal and cord blood samples were collected in 99 Nigerian mother-infant pairs. Concentrations of lutein + zeaxanthin, β-cryptoxanthin, lycopene, α- and β-carotenes, and retinol were measured using HPLC. Descriptive statistics were calculated and Spearman coefficients were used to assess correlations between maternal and cord measurements; Mann-Whitney tests were used to compare median plasma values between dichotomous variables. Linear regression models were used to adjust for relevant confounders. A p < 0.05 was considered statistically significant. Thirty-five percent of mothers had plasma retinol concentrations ≤0.70 µmol/L; 82% of infants had plasma retinol concentrations ≤0.70 µmol/L at delivery. Maternal and infant concentrations of vitamin A compounds were highly correlated and were associated with newborn growth and Apgar scores. Despite plasma concentrations of pro-vitamin A carotenoids higher than those reported in other populations, pregnant Nigerian women have a high prevalence of vitamin A deficiency. As vitamin A related compounds are modifiable by diet, future research determining the clinical impact of these compounds is warranted.
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Affiliation(s)
- Corrine Hanson
- College of Allied Health Professions Medical Nutrition Education, University of Nebraska Medical Center, Omaha, NE 68198-4045, USA.
| | - Elizabeth Lyden
- College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198-4375, USA.
| | - Ann Anderson-Berry
- Pediatrics 981205 Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE 68198-1205, USA.
| | - Nicholas Kocmich
- Pediatrics 981205 Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE 68198-1205, USA.
| | - Amy Rezac
- Pediatrics 981205 Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE 68198-1205, USA.
| | - Shirley Delair
- Pediatrics 981205 Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE 68198-1205, USA.
| | - Jeremy Furtado
- Department of Nutrition, Harvard School of Public Health 655 Huntington Avenue, Boston, MA 02215, USA.
| | - Matthew Van Ormer
- Pediatrics 981205 Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE 68198-1205, USA.
| | - N Izevbigie
- University of Abuja Teaching Hospital Gwagwalada-Zuba, Gwagwalada P.M.B. 228, Nigeria.
| | - E K Olateju
- University of Abuja Teaching Hospital Gwagwalada-Zuba, Gwagwalada P.M.B. 228, Nigeria.
| | - Godwin O. Akaba
- University of Abuja Teaching Hospital Gwagwalada-Zuba, Gwagwalada P.M.B. 228, Nigeria.
| | - E A Anigilaje
- University of Abuja Teaching Hospital Gwagwalada-Zuba, Gwagwalada P.M.B. 228, Nigeria.
| | - Thairu Yunusa
- University of Abuja Teaching Hospital Gwagwalada-Zuba, Gwagwalada P.M.B. 228,
| | - Stephen Obaro
- Pediatrics 981205 Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE 68198-1205, USA.
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Affiliation(s)
- Jagat Ram
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jitender Jinagal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Gannon BM, Valentine AR, Davis CR, Howe JA, Tanumihardjo SA. Duration of Retinol Isotope Dilution Studies with Compartmental Modeling Affects Model Complexity, Kinetic Parameters, and Calculated Vitamin A Stores in US Women. J Nutr 2018; 148:1387-1396. [PMID: 30137477 PMCID: PMC6075605 DOI: 10.1093/jn/nxy095] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 02/26/2018] [Accepted: 04/11/2018] [Indexed: 11/14/2022] Open
Abstract
Background Retinol isotope dilution (RID) indirectly estimates vitamin A (VA) status. Multicompartment modeling of RID data is used to refine study designs and equations to calculate VA stores. Previous studies suggest that VA in slowly turning over pools is not traced if follow-up is not long enough; however, shorter RID studies are being investigated. Few long-term models have been published. Objective We determined the effect of time on mathematical models of VA kinetics, model parameters, and outcomes. Methods In this longitudinal study, women (mean ± SD age: 22 ± 3 y; n = 7) were given 2.0 µmol [14,15]-13C2-retinyl acetate. Blood samples were staggered from 4 h to 152 d; the fraction of dose in serum was modeled with compartmental models. Four model-time categories were created: full models that used all data (median: 137 d; range 97-152 d) and truncated shorter studies of 14, 27, and 52 d (range: 42-62 d). Outcomes included number of compartments to adequately model serum data, kinetic parameters, total traced VA mass, and time-to-dose equilibration. To gain insight into longer follow-up, an additional participant was given 17.5 µmol 13C4-VA, and data were modeled as long as enrichment was above baseline (5 y). Results Longer follow-up times affected kinetic parameters and outcomes. Compared with the 14-d models, long-term full models required an additional compartment for adequate fit (14.3% compared with 100%; P = 0.0056) and had longer [median (quartile 1, quartile 3)] whole-body half-life [15.0 d (10.5, 72.6 d) compared with 135 d (115, 199 d); P = 0.0006], time-to-dose equilibration [3.40 d (3.14, 6.75 d) compared with 18.9 d (11.2, 25.7 d); P < 0.0001], and total traced mass [166 µmol VA (162, 252 µmol VA) compared with 476 µmol VA (290, 752 µmol VA); P = 0.0031]. Conclusions Extended RID sampling alters numerous mathematically modeled, time-dependent outcomes in women. Length of study should be considered when using mathematical models for calculating total-body VA stores or kinetic parameters related to VA turnover. This study is registered at www.clinicaltrials.gov as NCT03248700.
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Affiliation(s)
- Bryan M Gannon
- University of Wisconsin-Madison, Interdepartmental Graduate Program in Nutritional Sciences, Department of Nutritional Sciences, Madison, WI
| | - Ashley R Valentine
- University of Wisconsin-Madison, Interdepartmental Graduate Program in Nutritional Sciences, Department of Nutritional Sciences, Madison, WI
| | - Christopher R Davis
- University of Wisconsin-Madison, Interdepartmental Graduate Program in Nutritional Sciences, Department of Nutritional Sciences, Madison, WI
| | - Julie A Howe
- University of Wisconsin-Madison, Interdepartmental Graduate Program in Nutritional Sciences, Department of Nutritional Sciences, Madison, WI
| | - Sherry A Tanumihardjo
- University of Wisconsin-Madison, Interdepartmental Graduate Program in Nutritional Sciences, Department of Nutritional Sciences, Madison, WI
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Lee YQ, Collins CE, Gordon A, Rae KM, Pringle KG. The Relationship between Maternal Nutrition during Pregnancy and Offspring Kidney Structure and Function in Humans: A Systematic Review. Nutrients 2018; 10:nu10020241. [PMID: 29466283 PMCID: PMC5852817 DOI: 10.3390/nu10020241] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/14/2018] [Accepted: 02/15/2018] [Indexed: 12/30/2022] Open
Abstract
The intrauterine environment is critical for fetal growth and organ development. Evidence from animal models indicates that the developing kidney is vulnerable to suboptimal maternal nutrition and changes in health status. However, evidence from human studies are yet to be synthesised. Therefore, the aim of the current study was to systematically review current research on the relationship between maternal nutrition during pregnancy and offspring kidney structure and function in humans. A search of five databases identified 9501 articles, of which three experimental and seven observational studies met the inclusion criteria. Nutrients reviewed to date included vitamin A (n = 3), folate and vitamin B12 (n = 2), iron (n = 1), vitamin D (n = 1), total energy (n = 2) and protein (n = 1). Seven studies were assessed as being of "positive" and three of "neutral" quality. A variety of populations were studied, with limited studies investigating maternal nutrition during pregnancy, while measurements of offspring kidney outcomes were diverse across studies. There was a lack of consistency in the timing of follow-up for offspring kidney structure and/or function assessments, thus limiting comparability between studies. Deficiencies in maternal folate, vitamin A, and total energy during pregnancy were associated with detrimental impacts on kidney structure and function, measured by kidney volume, proteinuria, eGFRcystC and mean creatinine clearance in the offspring. Additional experimental and longitudinal prospective studies are warranted to confirm this relationship, especially in Indigenous populations where the risk of renal disease is greater.
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Affiliation(s)
- Yu Qi Lee
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW 2308, Australia.
- Priority Research Centre for Reproductive Sciences, University of Newcastle, Newcastle, NSW 2308, Australia.
| | - Clare E Collins
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW 2308, Australia.
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Newcastle, NSW 2308, Australia.
| | - Adrienne Gordon
- Charles Perkins Centre, University of Sydney, Camperdown, NSW 2006, Australia.
| | - Kym M Rae
- Priority Research Centre for Reproductive Sciences, University of Newcastle, Newcastle, NSW 2308, Australia.
- Gomeroi Gaaynggal Centre, Faculty of Health and Medicine, University of Newcastle, Tamworth, NSW 2340, Australia.
- Department of Rural Health, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Tamworth, NSW 2340, Australia.
- Priority Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, NSW 2308, Australia.
| | - Kirsty G Pringle
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW 2308, Australia.
- Priority Research Centre for Reproductive Sciences, University of Newcastle, Newcastle, NSW 2308, Australia.
- Gomeroi Gaaynggal Centre, Faculty of Health and Medicine, University of Newcastle, Tamworth, NSW 2340, Australia.
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Abolurin OO, Adegbola AJ, Oyelami OA, Adegoke SA, Bolaji OO. Prevalence of Vitamin A deficiency among under-five children in South-Western Nigeria. Niger Postgrad Med J 2018; 25:13-16. [PMID: 29676339 DOI: 10.4103/npmj.npmj_20_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND AIM Vitamin A deficiency (VAD) constitutes a major nutritional concern in developing countries. It contributes significantly to the morbidity and mortality of under-five children and can result in impaired resistance to infection as well as increased risk of death. The aim of this study was to determine the prevalence of VAD among Southwestern Nigerian children. METHODS Apparently healthy children aged between 6 months and 5 years were recruited for the study. Their serum retinol levels were determined by high-performance liquid chromatography. RESULTS Of the 170 children studied, nine (5.3%) had VAD, although none had severe VAD. The prevalence of VAD did not show statistically significant variation with age (P = 0.159), sex (P = 1.000), social class (P = 0.740), immunisation status (P = 0.197) or nutritional status (P = 0.090). CONCLUSION The prevalence of VAD among Nigerian children appears to have reduced, compared with previous reports; however, further studies are required to assess the current national prevalence, so as to design programmes that can achieve further reduction in the proportion of children affected.
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Affiliation(s)
- Olufunmilola O Abolurin
- Department of Paediatrics, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Adebanjo J Adegbola
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Oyeku A Oyelami
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Samuel A Adegoke
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Oluseye O Bolaji
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria
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Kopecký A, Benda F, Němčanský J. Xerosis in Patient with Vitamin A Deficiency - a Case Report. Cesk Slov Oftalmol 2018; 73:222-224. [PMID: 30541304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Xerosis is a corneal and ocular surface disease caused by vitamin A deficiency. It is a rare disease in developed countries, but in third world countries it is a common cause of blindness. We describe a typical xerosis in patient with vitamin A deficiency and long-term malnutrition and alcoholism in our case. In spite of initially serious presentation of the disease, the patients response to treatment was prompt and there was complete regression of the disease. Key words: xerosis, vitamin A deficiency.
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Affiliation(s)
- Suparna Ghosh-Jerath
- Public Health Foundation of India, Indian Institute of Public Health-Delhi, Gurgaon, Haryana 122002, India
| | - Archna Singh
- Biochemistry Department, All India Institute of Medical Sciences, New Delhi, India
| | - Nameet Jerath
- Indraprastha Apollo Hospital, Pediatrics, New Delhi, India
| | - Suruchi Gupta
- Public Health Foundation of India, Indian Institute of Public Health-Delhi, Gurgaon, Haryana 122002, India
| | - Elizabeth F Racine
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte NC, USA
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Abstract
The association between inflammation and vitamin A (VA) metabolism and status assessment has been documented in multiple studies with animals and humans. The relation between inflammation and carotenoid status is less clear. Nonetheless, it is well known that carotenoids are associated with certain health benefits. Understanding these relations is key to improving health outcomes and mortality risk in infants and young children. Hyporetinolemia, i.e., low serum retinol concentrations, occurs during inflammation, and this can lead to the misdiagnosis of VA deficiency. On the other hand, inflammation causes impaired VA absorption and urinary losses that can precipitate VA deficiency in at-risk groups of children. Many epidemiologic studies have suggested that high dietary carotenoid intake and elevated plasma concentrations are correlated with a decreased risk of several chronic diseases; however, large-scale carotenoid supplementation trials have been unable to confirm the health benefits and in some cases resulted in controversial results. However, it has been documented that dietary carotenoids and retinoids play important roles in innate and acquired immunity and in the body's response to inflammation. Although animal models have been useful in investigating retinoid effects on developmental immunity, it is more challenging to tease out the effects of carotenoids because of differences in the absorption, kinetics, and metabolism between humans and animal models. The current understanding of the relations between inflammation and retinoid and carotenoid metabolism and status are the topics of this review.
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Affiliation(s)
- Lewis P Rubin
- Texas Tech Health Sciences Center El Paso, El Paso, TX
| | | | | | - Torsten Bohn
- Luxembourg Institute of Health, Population Health Department, Strassen, Luxembourg; and
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Affiliation(s)
- Krishna R Surapaneni
- University of Wisconsin - Madison, Department of Ophthalmology and Visual Sciences, Madison, Wisconsin
| | | | - Paul O Phelps
- University of Wisconsin - Madison, Department of Ophthalmology and Visual Sciences, Madison, Wisconsin
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Ayogu RN, Nnam NM, Ibemesi O, Okechukwu F. Prevalence and factors associated with anthropometric failure, vitamin A and iron deficiency among adolescents in a Nigerian urban community. Afr Health Sci 2016; 16:389-98. [PMID: 27605954 DOI: 10.4314/ahs.v16i2.7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Under nutrition is a problem of severe magnitude in low income countries like Nigeria. Adolescent school children might also be vulnerable. The dearth of data hinders planning of school health and nutrition programmes for school children. OBJECTIVE To determine the prevalence of stunting, thinness; vitamin A and iron deficiencies among adolescent students in Nsukka urban, Nigeria and to determine factors that are associated with these nutritional problems. METHODS A total of 400 participants were randomly selected from 717 students aged 12 - 18 years in 3 randomly selected secondary schools. Questionnaires, anthropometric measurements, and blood analyses were the data collection methods employed. RESULTS The prevalence of stunting was 33.3% and thinness 31.0%. Neither overweight nor obesity was observed. While 64.0% were anaemic; 44.0% had vitamin A deficiency (VAD). A total of 48.0% had both anaemia and stunting, 42% had VAD + thinness; while 40% had anaemia + VAD. Household income was a predictor of vitamin A status. Children from medium/high income households had higher odds of having VAD than those from low income households (AOR=0.14; 95% CI=0.031, 0.607; P=0.009). Household income (AOR=0.12; 95% CI=0.021, 0.671; P=0.016), and age (AOR=0.09; 95% CI=0.014, 0.587; P=0.012) were independent determinants of height-for-age status. CONCLUSION Among urban adolescent students in Nigeria, stunting, thinness, anaemia and VAD were problems of public health significance. Age and household monthly income played major roles.
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Wirth JP, Rohner F, Woodruff BA, Chiwile F, Yankson H, Koroma AS, Russel F, Sesay F, Dominguez E, Petry N, Shahab-Ferdows S, de Onis M, Hodges MH. Anemia, Micronutrient Deficiencies, and Malaria in Children and Women in Sierra Leone Prior to the Ebola Outbreak - Findings of a Cross-Sectional Study. PLoS One 2016; 11:e0155031. [PMID: 27163254 PMCID: PMC4862671 DOI: 10.1371/journal.pone.0155031] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 03/25/2016] [Indexed: 12/15/2022] Open
Abstract
To identify the factors associated with anemia and to document the severity of micronutrient deficiencies, malaria and inflammation, a nationally representative cross-sectional survey was conducted. A three-stage sampling procedure was used to randomly select children <5 years of age and adult women from households in two strata (urban and rural). Household and individual data were collected, and blood samples from children and women were used to measure the prevalence of malaria, inflammation, and deficiencies of iron, vitamin A, folate, and vitamin B12. 839 children and 945 non-pregnant women were included in the survey. In children, the prevalence rates of anemia (76.3%; 95% CI: 71.8, 80.4), malaria (52.6%; 95% CI: 46.0, 59.0), and acute and chronic inflammation (72.6%; 95% CI: 67.5, 77.1) were high. However, the prevalence of vitamin A deficiency (17.4%; 95% CI: 13.9, 21.6) was moderate, and the prevalence of iron deficiency (5.2%; 95% CI: 3.3, 8.1) and iron-deficiency anemia (3.8%; 95% CI: 2.5, 5.8) were low. Malaria and inflammation were associated with anemia, yet they explained only 25% of the population-attributable risk. In women, 44.8% (95% CI: 40.1, 49.5), 35.1% (95% CI: 30.1, 40.4), and 23.6% (95% CI: 20.4, 27.3) were affected by anemia, malaria, or inflammation, respectively. The prevalence rates of iron deficiency (8.3%; 95% CI: 6.2, 11.1), iron-deficiency anemia (6.1%; 95% CI: 4.4, 8.6), vitamin A deficiency (2.1%; 95% CI: 1.1, 3.1) and vitamin B12 deficiency (0.5%; 95% CI: 0.2, 1.4) were low, while folate deficiency was high (79.2%; 95% CI: 74.1, 83.5). Iron deficiency, malaria, and inflammation were significantly associated with anemia, but explained only 25% of cases of anemia. Anemia in children and women is a severe public health problem in Sierra Leone. Since malaria and inflammation only contributed to 25% of anemia, other causes of anemia, such as hemoglobinopathies, should also be explored.
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Affiliation(s)
| | | | | | | | | | | | - Feimata Russel
- Ministry of Health and Sanitation, Freetown, Sierra Leone
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Affiliation(s)
- Samantha K Simkin
- Blind and Low Vision Education Network New Zealand, Auckland, New Zealand; Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Katie Tuck
- Blind and Low Vision Education Network New Zealand, Auckland, New Zealand
| | - John Garrett
- Department of Paediatrics, Canterbury District Health Board, Christchurch, New Zealand
| | - Shuan Dai
- Blind and Low Vision Education Network New Zealand, Auckland, New Zealand.
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Yang C, Chen J, Liu Z, Yun C, Li Y, Piao J, Yang X. Association of Vitamin A Status with Overnutrition in Children and Adolescents. Int J Environ Res Public Health 2015; 12:15531-9. [PMID: 26690192 PMCID: PMC4690934 DOI: 10.3390/ijerph121214998] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/21/2015] [Accepted: 11/24/2015] [Indexed: 12/21/2022]
Abstract
This study was conducted to examine the possible association between vitamin A status and overnutrition in Chinese urban children and adolescents. Weight, height and serum retinol were assessed in total 3457 children (7–9.9 years of age) and adolescents (10–17 years of age), using urban region data from the China National Nutrition and Health Survey 2010–2013 (CHNNS2010-2013) which is a nationally representative cross-sectional study. Prevalence of low serum concentration of retinol was 26.8% and 12.24% for overweight. Retinol inadequacy was significantly higher in children (32.13%) than in adolescents (24.48%). The average of retinol was significantly higher in overnutrified 42.32 μg/dL versus non-overnutrified 41.05 μg/dL (p = 0.00) children and adolescents. Overnutrified children and adolescents presented a greater chance of an increase in serum concentration of retinol (odds ratio 1.34, 95% confidence interval 1.10–1.63, and 1.48, 95% confidence interval (1.26–1.74) when compared with non-overnutrified children. An important correspondence between vitamin A deficiency and overnutrition was found. Non-overnutrified children and adolescents may have a greater chance of presenting low concentrations of retinol. Future public health strategies focused on the overnutrified population and vitamin A supplements should consider the effect of retinol on urban children and adolescents in China.
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Affiliation(s)
- Chun Yang
- Key Laboratory of Trace Element Nutrition, National Health and Family Planning Commission of China, Department of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
| | - Jing Chen
- Key Laboratory of Trace Element Nutrition, National Health and Family Planning Commission of China, Department of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
| | - Zhen Liu
- Key Laboratory of Trace Element Nutrition, National Health and Family Planning Commission of China, Department of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
| | - Chunfeng Yun
- Key Laboratory of Trace Element Nutrition, National Health and Family Planning Commission of China, Department of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
| | - Yajie Li
- Key Laboratory of Trace Element Nutrition, National Health and Family Planning Commission of China, Department of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
| | - Jianhua Piao
- Key Laboratory of Trace Element Nutrition, National Health and Family Planning Commission of China, Department of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
| | - Xiaoguang Yang
- Key Laboratory of Trace Element Nutrition, National Health and Family Planning Commission of China, Department of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
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Huang Y, Clements PR, Gibson RA. Robust measurement of vitamin A status in plasma and blood dried on paper. Prostaglandins Leukot Essent Fatty Acids 2015; 102-103:31-6. [PMID: 26489594 DOI: 10.1016/j.plefa.2015.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 08/31/2015] [Accepted: 10/01/2015] [Indexed: 10/22/2022]
Abstract
Vitamin A deficiency is the leading cause of preventable blindness in children and increases the risk of disease and death from severe infections. In addition, fat soluble vitamin A and associated retinoids directly regulate the expression of genes involved in fatty acid metabolism. Conventional methods for measuring vitamin A involve venipuncture, centrifugation and refrigeration all of which make measuring vitamin A in nutritional surveys expensive. We aimed to develop a simple and robust system for measurement of retinol (biomarker for vitamin A) using dried blood spot (DBS) samples. Low recoveries and inconsistent results reported by others were found to be due to poor extraction efficiency rather than retinol instability. Maintaining acid conditions during extraction resulted in recoveries >95% with <6.5% of coefficient of variation. Using isocratic high performance liquid chromatography, separation was achieved in <3.5 min. Detector response was linear (R(2)=0.9939) within a range of 0.05-2 μg/mL, with a limit of quantification of 0.05 μg/mL. Retinol in DBS was shown to be stable (>95%) at room temperature for up to 10 weeks. DBS values for retinol were highly correlated with venous blood samples from 24 healthy subjects (r=0.9724) and were consistent with results from a commercial laboratory. This simple and reliable method for the determination of vitamin A status should prove particularly valuable for population studies and large clinical trials.
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Affiliation(s)
- Yichao Huang
- FOODplus Research Centre, School of Agriculture, Food and Wine, the University of Adelaide, Adelaide, South Australia, Australia
| | - Peter Roy Clements
- FOODplus Research Centre, School of Agriculture, Food and Wine, the University of Adelaide, Adelaide, South Australia, Australia
| | - Robert Alan Gibson
- FOODplus Research Centre, School of Agriculture, Food and Wine, the University of Adelaide, Adelaide, South Australia, Australia.
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Talsma EF, Verhoef H, Brouwer ID, Mburu-de Wagt AS, Hulshof PJM, Melse-Boonstra A. Proxy markers of serum retinol concentration, used alone and in combination, to assess population vitamin A status in Kenyan children: a cross-sectional study. BMC Med 2015; 13:30. [PMID: 25856672 PMCID: PMC4324407 DOI: 10.1186/s12916-014-0256-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 12/12/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Serum retinol concentration determined by high-performance liquid chromatography (HPLC) is recommended by the World Health Organization to assess population vitamin A status. This assay is expensive, technically demanding and rarely available in developing countries. Our objective was a) to assess the diagnostic performance of proxy markers in detecting vitamin A deficiency and b) to derive decision rules based on these markers to estimate vitamin A deficiency prevalence. METHODS A survey was conducted in 15 rural primary schools in Eastern Province, Kenya, with 375 children aged 6 to 12 years (25 randomly selected per school). Serum retinol concentration <0.70 μmol/L by HPLC was used to define vitamin A deficiency. Proxy markers for vitamin A deficiency were serum concentrations of retinol binding protein (RBP), transthyretin, retinol measured by fluorometry and RBP:transthyretin molar ratio. RESULTS The prevalence of vitamin A deficiency (HPLC) was 18%. Transthyretin and RBP showed the best diagnostic performance individually, with area-under-the-curve (AUC) values of 0.96 and 0.93. When combined, and with C-reactive protein added, the AUC increased to 0.98. A simple decision rule {(-15.277 × [RBP, μmol/L] - 7.013 × [Transthyretin, μmol/L] + 0.367 × [C-reactive protein, mg/L] + 24.714) > 0.496} yielded prevalence estimates of vitamin A deficiency that is unbiased by diagnostic error. CONCLUSIONS The combination of transthyretin, RBP and C-reactive protein concentrations could eventually replace retinol concentration by HPLC in resource-poor settings as the preferred method to assess the population burden of vitamin A deficiency.
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Affiliation(s)
- Elise F Talsma
- />Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV Wageningen, the Netherlands
| | - Hans Verhoef
- />Cell Biology and Immunology Group, Wageningen University, Wageningen, The Netherlands
- />Medical Research Council (MRC) International Nutrition Group, London School of Hygiene & Tropical Medicine, London, UK
- />Medical Research Council (MRC), Keneba, The Gambia
| | - Inge D Brouwer
- />Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV Wageningen, the Netherlands
| | - Anne S Mburu-de Wagt
- />Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV Wageningen, the Netherlands
| | - Paul JM Hulshof
- />Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV Wageningen, the Netherlands
| | - Alida Melse-Boonstra
- />Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV Wageningen, the Netherlands
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Soares-Mota M, Silva TA, Gomes LM, Pinto MAS, Mendonça LMC, Farias MLF, Nunes T, Ramalho A, Zaltman C. High prevalence of vitamin A deficiency in Crohn's disease patients according to serum retinol levels and the relative dose-response test. World J Gastroenterol 2015; 21:1614-1620. [PMID: 25663781 PMCID: PMC4316104 DOI: 10.3748/wjg.v21.i5.1614] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 10/01/2014] [Accepted: 10/21/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the vitamin A status of patients with Crohn’s disease (CD) by evaluating serum retinol levels and the relative dose response (RDR) test (liver retinol stores).
METHODS: Vitamin A nutritional status was measured by serum retinol obtained by high performance liquid chromatography and the RDR test for evaluation of the hepatic stores. Body composition was performed by densitometry by dual-energy X-ray absorptiometry. Vitamin A dietary intake was assessed from a semi-quantitative food frequency questionnaire.
RESULTS: This study included 38 CD patients and 33 controls. Low serum retinol concentrations were detected in 29% of CD patients vs 15% in controls (P < 0.005). The RDR test was positive in 37% of CD patients vs 12% in controls, which indicated inadequate hepatic vitamin A stores (P < 0.005). Individuals with hypovitaminosis A had lower BMI and body fat compared with those without this deficiency. There was no association between vitamin A deficiency and its dietary intake, ileal location, presence of disease activity and prior bowel resections.
CONCLUSION: Patients with CD have higher prevalence of vitamin A deficiency, as assessed by two independent methods.
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Abstract
OBJECTIVE Inflammation may constitute an underlying mechanism for increased risk of developing chronic diseases in later years, but few prospective studies have assessed the influence of low-grade inflammation on body weight gain, particularly among children in low- to middle-income settings with lower prevalence of overweight and obesity. We aimed to investigate whether C-reactive protein (CRP), as a biomarker of low-grade inflammation, predicts changes in body mass index-for-age z scores (BAZ) during childhood. METHODS A population-based longitudinal study was conducted in the Brazilian Amazon among children aged ≤10 years in 2007, with follow-up visits in 2009 and 2012. Outcome was annual change in BAZ. As the main exposure of interest, CRP concentrations were divided into four categories, with values <1 mg/L divided in tertiles plus a fourth category with values ranging from 1 to 10 mg/L. Children were simultaneously screened for iron and vitamin A deficiencies, diarrhea, and wheezing. We used mixed-effect linear regression models to measure the effect of CRP concentrations on annual BAZ change and linear regression models to explore CRP predictors at baseline. RESULTS At baseline, 1007 children had CRP and anthropometric data [mean (SD) age: 5.3 (2.9) years; 50.9% male, 84.5% mulatto/mixed-race, 14.0% at risk for overweight or obesity, 4.8% stunted]; 737 were successfully followed up. Morbidities and nutritional deficiencies were widespread. Among participants aged >5 years, children in the highest tertile of CRP <1 mg/L at baseline, regarded as an indicator of low-grade inflammation, had a 0.04 z/y higher gain in BAZ (95% CI: 0.01, 0.09 z/y) during follow-up. CRP was positively associated with household poverty and worse nutritional indicators. CONCLUSIONS We found evidence of a role for low-grade inflammation in predicting annual BAZ gain among children aged >5 years.
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Affiliation(s)
- Barbara H. Lourenço
- Public Health Nutrition Program, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Marly A. Cardoso
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- * E-mail:
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Blanchard MS, Romero JM, Hoang MP. Case records of the Massachusetts General Hospital. Case 1-2014. A 32-year-old man with loss of vision and a rash. N Engl J Med 2014; 370:159-66. [PMID: 24401054 DOI: 10.1056/nejmcpc1214217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
PURPOSE To report a patient with autoimmune hepatitis and cirrhosis who was diagnosed with severe vitamin A deficiency based on the findings of xerophthalmic fundus. METHODS Retrospective chart review. PATIENT A 36-year-old African American woman who had a history of autoimmune hepatitis and cirrhosis presents with peripheral retinal white spots, which led to the diagnosis of vitamin A deficiency. RESULTS The patient presented to the eye clinic for intermittent blurry vision 3 months after the diagnosis of liver cirrhosis secondary to autoimmune hepatitis since age 15. She also underwent partial large and small intestine resection as an infant for Hirschsprung disease. Anterior segment examination was significant for severe punctate epithelial erosions and posterior segment examination was significant for extensive white spots in the peripheral retina in both eyes. Workup showed near nondetectable levels of vitamin A (<0.06 mg/L, normal 0.3-1.2 mg/L) and retinyl palmitate (<0.02 mg/L, normal > 0.2 mg/L). After treatment with 200,000 IU of vitamin A orally, the white spots slowly resolved in ∼6 months. She never developed nyctalopia and her dry eye symptoms completely resolved. CONCLUSION Although rare, vitamin A deficiency should be considered in patients with liver cirrhosis especially in those with a history of intestinal surgeries. Early diagnosis and treatment with vitamin A supplementation can reverse the signs and symptoms of xerophthalmia.
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Affiliation(s)
- Clement C Chow
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois
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Rushood AA, Azmat S, Shariq M, Khamis A, Lakho KA, Jadoon MZ, Sial N, Rushood AA, Kamil EA. Ocular disorders among schoolchildren in Khartoum State, Sudan. East Mediterr Health J 2013; 19:282-288. [PMID: 23879081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
From December 2005 to June 2007, a total screening of all 1418 government primary schools in Khartoum State, Sudan, was performed to estimate ocular problems among children aged 6-15 years. We screened 671,119 children (56.7% males) for significant refractive error and other eye ailments. Ocular problems were found in 20,321 (3.03%) children. The 3 localities with highest ocular pathology were Karary (26.2%), Ummbada (21.0%) and Jabal Awlia (15.7%). The overall prevalence of refractive error was 2.19%. Myopia was found in 10,064 (1.50%) children while 4661 (0.70%) were hyperopic. Other ocular problems included vernal keratoconjunctivitis, vitamin A deficiency, microbial conjunctivitis, strabismus and corneal opacity. Only 288 (0.04%) children were diagnosed with active trachoma: 86.5% of these were from Ummbada locality, on the periphery ofthe State, where transportation facilities are poor and poverty is widespread. Overall, 99% of the eye ailments identified are either treatable or preventable. To reduce these and to achieve the goals of Vision 2020, an effective and efficient school health programme is needed.
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Affiliation(s)
- A A Rushood
- Department of Ophthalmology, College of Medicine, Dammam University, Al-Khobar, Saudi Arabia.
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Khoramnia R, Auffarth GU, Mogler C, Cordeiro SA, Scheuerle AF. [Severe bilateral keratomalacia]. Ophthalmologe 2013; 110:61-4. [PMID: 23329120 DOI: 10.1007/s00347-012-2706-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In contrast to developing countries, xerophthalmia is rather rare in developed countries. Malnutrition (e.g. in mentally deficient or psychiatric patients), chronic liver diseases (e.g. due to alcoholism), or bowel surgery can be reasons for vitamin A deficiency in developed countries. The prodromal stage of hypovitaminosis A is characterized by nyctalopia, which often manifests subclinically. Longer lasting and severe cases of vitamin A deficiency may be complicated by the occurrence of keratinizing metaplasia in the cornea and conjunctiva, xerosis, keratomalacia or blindness.
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Affiliation(s)
- R Khoramnia
- Universitäts-Augenklinik Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg.
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Gebremedhin S, Enquselassie F, Umeta M. Independent and joint effects of prenatal Zinc and Vitamin A Deficiencies on birthweight in rural Sidama, Southern Ethiopia: prospective cohort study. PLoS One 2012; 7:e50213. [PMID: 23272058 PMCID: PMC3521768 DOI: 10.1371/journal.pone.0050213] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 10/22/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The effects of prenatal Zinc Deficiency (ZD) and Vitamin A Deficiency (VAD) on birthweight are controversial and their interaction has not been investigated. OBJECTIVE To assess the independent and interaction effects of prenatal zinc and vitamin A deficiencies on birthweight in rural Sidama, Southern Ethiopia. METHODOLOGY A community-based prospective cohort study design was employed. Six hundred fifty pregnant women in their second or third trimester were randomly selected and their serum zinc and retinol concentrations were determined. About 575 subjects were successfully followed until delivery and birthweight was measured within 72 hours after delivery. The association between the exposures and birthweight was examined using log-binomial and liner regression analyses. Potential interaction between ZD and VAD was examined using Synergy Index (SI). RESULTS The mean birthweight (± standard deviation) was 2896 g (±423). About 16.5% (95% CI: 13.5-19.6%) of the babies had Low Birthweight (LBW). Prenatal ZD and VAD were not significantly associated to LBW with Adjusted Relative Risk (ARR) of 1.25 (95 CI: 0.86-1.82) and 1.27 (95% CI: 0.86-1.87), respectively. Stratified analysis on the basis of gestational trimester showed that the occurrence of the deficiencies neither in the second nor third trimester were associated to LBW. The deficiencies did not show synergetic interaction in causing LBW [SI = 1.04 (95% CI: 0.17-6.28)]. Important risk factors of LBW were maternal illiteracy [RR = 1.80 (95% CI: 1.11-2.93)], female sex of the newborn [RR = 1.79 (95% CI: 1.19-2.67)], primiparity [RR = 1.16 (95% CI: 1.02-1.35)], short maternal stature [RR = 1.63 (95% CI: 1.06-2.51)] and maternal thinness [RR = 1.52 (95% CI: 1.03-2.25)]. In the linear regression model, elevated CRP was also negatively associated to birthweight. CONCLUSION LBW is of public health significance in the locality. The study did not witness any independent or interaction effect of prenatal ZD and VAD on birthweight.
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Chaparala P, Prayaga AK, Digumarti RR. Significance of acellular smears in conjunctival impression cytology. Acta Cytol 2012; 56:539-42. [PMID: 23075896 DOI: 10.1159/000342495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 07/19/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Conjunctival xerosis is a marker for vitamin A deficiency. Conjunctival impression cytology (CIC) is a widely used technique to detect xerosis in field studies. Inadequate and acellular samples are generally considered technical failures and are treated as uninterpretable. The purpose of this study is to determine the significance of acellular smears in the detection of vitamin A deficiency. STUDY DESIGN CIC with transfer (CICT) and blood samples were collected from freshly diagnosed cancer patients and healthy controls. CICT smears were classified as cellular or acellular. Serum vitamin A levels were tested by high-performance liquid chromatography. CICT results were compared with vitamin A levels. RESULTS CICT was collected from 1,694 subjects. There were 118 (7%) acellular smears, i.e. 99 in patients and 19 in controls. Serum vitamin A levels were available in 112 of these subjects. Levels <20 µg/dl were seen in 82.1% of the subjects with acellular smears and in 18.9% of the subjects with cellular smears (p < 0.001). Of the gastrointestinal and hepatobiliary and hematologic cancers, 15.6% and 10.5% showed acellular smears, respectively. CONCLUSIONS Acellular smears in conjunctival imprint cytology may indicate hypovitaminosis A, provided technical failure to obtain cellularity is ruled out.
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Affiliation(s)
- Padmini Chaparala
- Department of Pathology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, India
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