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Use of biomarkers of sub-clinical infection, nutrition and neonatal maturity to interpret plasma retinol in Nigerian neonates

Published online by Cambridge University Press:  09 March 2007

Delana A. Adelekan ,
Christine A. Northrop-Clewes ,
Joshua A. Owa ,
Adesola O. Oyedeji ,
Adedayo A. Owoeye  and
David I. Thurnham
Delana A. Adelekan
Affiliation:
Department of Community Health, Obafemi Awolowo, University Ile-Ife, Nigeria
Christine A. Northrop-Clewes
Affiliation:
Northern Ireland Centre for Diet and Health (NICHE), University of Ulster, Coleraine BT52 1SA, Northern Ireland, UK
Joshua A. Owa
Affiliation:
Department of Paediatrics and Child Health, Obafemi Awolowo, University Ile-Ife, Nigeria
Adesola O. Oyedeji
Affiliation:
Department of Paediatrics, Wesley Guild Hospital, Ilesa, Nigeria
Adedayo A. Owoeye
Affiliation:
Department of Paediatrics, Wesley Guild Hospital, Ilesa, Nigeria
David I. Thurnham*
Affiliation:
Northern Ireland Centre for Diet and Health (NICHE), University of Ulster, Coleraine BT52 1SA, Northern Ireland, UK
*
*Corresponding author: Professor David I. Thurnham, fax +44 2870 324965, email [email protected]
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Abstract

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Using the World Health Organization criterion, the prevalence of sub-clinical vitamin A deficiency can be assessed using plasma retinol concentrations <0·7 μmol/l. However, plasma retinol can be depressed by infection; thus, the use of this criterion alone may overestimate deficiency. In the present study, we investigated the usefulness of the acute-phase proteins (APP) α1-antichymotrypsin (ACT) and α1-acid glycoprotein (AGP), plasma carotenoids and anthropometric and gestational indices to interpret plasma retinol in the blood of 192 apparently healthy Nigerian neonates collected randomly during days 1–20 postpartum. The mean weight (2·64 kg) and length (0·458 m) of the neonates and plasma concentrations (geometric mean, μmol/l) of retinol (0·54), α-carotene (0·072), ß-carotene (0·076) and lutein (0·080) were low. The prevalence of vitamin A deficiency was 72 %, indicating a severe public health problem. Babies who were of low birth weight (P<0·003) or premature and low birth weight (P<0·023) had significantly lower retinol concentrations than full-term normal weight babies. Thirty-two neonates had abnormal ACT and forty-four abnormal AGP concentrations. Positive correlations between retinol and ACT (r 0·186, P=0·05) and AGP (r 0·31, P=0·0001) during days 1–5 may be due to the increasing plasma retinol from maternal milk and a coincidental increasing capacity to synthesise APP. Subsequently, negative correlations between retinol and ACT (r −0·28, P=0·02) and AGP (r −0·29, P=0·018) from day 6 onwards reflected the continuing increase in plasma retinol, but no further increase in the APP. Overall, weight, ACT, lutein and age explained 30 % of the variance in retinol, but lutein was the most significant (r2 0·18, P<0·0001). Hence, the distribution of plasma retinol concentrations in this group of neonates was more strongly linked with nutrition (via the surrogate marker lutein) than infection.

Keywords

RetinolLuteinAcute-phase proteinsα1-Antichymotrypsinα1-Acid glycoproteinNigeriaNeonate
Type
Research Article
Information
British Journal of Nutrition , Volume 90 , Issue 2 , August 2003 , pp. 353 - 361
Copyright
Copyright © The Nutrition Society 2003

References

Adelekan, DA, Fatusi, AO, Fakunle, JB, Olotu, CT, Olukoga, IA, Jinadu, MK & Ojofeitimi, EO (1997) Prevalence of malnutrition and vitamin A deficiency in Nigerian pre-school children subsisting on high intakes of carotenes. Nutr Health 12, 1724Google Scholar
Adelekan, DA, Owa, JA, Chan, W et al. (2002) Plasma retinol, carotenoids and acute phase proteins in Nigerian neonates. J Nutr 132, 2971SGoogle Scholar
Alt, R, Erny, P, Messer, J & Willard, D (1984) Neonatal bacterial infections. Kinetic study of C-reactive protein and orosomucoid. Presse Med 13, 1373–1376.Google Scholar
Basu, TK, Wein, EE, Gangopadhyay, KC, Wolever, TMS & Godel, JC (1994) Plasma vitamin A (retinol) and retinol binding protein in new-borns and their mothers. Nutr Res 14, 1297–1303.CrossRefGoogle Scholar
Bluhm, DP, Summers, RS & Ellis, JB (1994) Severe vitamin A deficiency in black neonates in a tertiary referral hospital in South Africa. J Trop Paediatr 40, 116–118.CrossRefGoogle Scholar
Calvin, J & Price, CP (1986) Measurement of serum α1-antichymotrypsin by immunoturbidometry. Ann Clin Biochem 23, 206–209.CrossRefGoogle Scholar
Cardonoparez, A, Valdesramos, R, Topetelezama, B, Mezacamacho, C & Udaetamora, E (1996) Cord blood retinol and retinol binding protein in preterm and term neonates. Nutr Res 16, 191–196.Google Scholar
Centres for Disease Control and Prevention (2000) Pediatric growth charts. http://www.cdc.gov/growthchartsGoogle Scholar
Chan, V, Greenough, A, Cheeseman, P & Gamsu, HR (1993) Vitamin A status in preterm and term infants at birth. J Perinat Med 21, 59–62.CrossRefGoogle ScholarPubMed
Coutsoudis, A, Adhikarim, M & Coovadia, HM (1995) Serum vitamin-A (retinol) concentrations and association with respiratory disease in premature infants. J Trop Pediatr 41, 230–233.CrossRefGoogle ScholarPubMed
Coutsoudis, A, Adhikarim, M, Pillay, K, Kuhn, L & Coovadia, HM (2000) Effect of vitamin A supplementation on morbidity of low-birth-weight neonates. S Afr Med J 90, 730–736.Google ScholarPubMed
Craft, NE, Brown, ED & Smith, J (1988) Effects of storage and handling conditions on concentrations of individual carotenoids, retinol and tocopherol in plasma. Clin Chem 34, 44–48.CrossRefGoogle ScholarPubMed
Fiteau, SM, Morris, SS, Abbott, RA et al. (1993) Influence of morbidity on serum retinol of children in a community-based study in northern Ghana. Am J Clin Nutr 58, 192–197.CrossRefGoogle Scholar
Filteau, SM, Morris, SS, Raynes, JG et al. (1995) Vitamin A supplementation, morbidity, and serum acute-phase proteins in young Ghanaian children. Am J Clin Nutr 62, 432–438.CrossRefGoogle ScholarPubMed
Fleck, A (1989) Clinical and nutritional aspects of changes in acute-phase proteins during inflammation. Proc Nutr Soc 48, 347–354.CrossRefGoogle ScholarPubMed
Fleck, A & Myers, MA (1985) Diagnostic and prognostic significance of the acute-phase proteins. In The Acute-Phase Response to Injury and Infection. pp. 249–271. [Gordon, AH and Koj, A, editors]. Amsterdam: Elsevier Science Publishers BV.Google Scholar
Freer, DE, Statland, BE, Johnson, M & Felton, H (1979) Reference values for selected enzyme activities and protein concentrations in serum and plasma derived from cord-blood specimens. Clin Chem 25, 565–569.Google Scholar
Godel, JC, Basu, TK, Pabst, HF, Hodges, RS, Hodges, PE & Ng, ML (1996) Perinatal vitamin A (retinol) status of Northern Canadian mothers and their infants. Biol Neonat 69, 133–139.CrossRefGoogle ScholarPubMed
Goodman, DW (1984) Vitamin A and retinoids in health and disease. New Eng J Med 310, 1023–1031.Google ScholarPubMed
Hussein, L & Ali, M (2000) Cord plasma retinol level and its impact on birth weight and growth velocity in infancy. Nutr Res 20, 1361–1366.Google Scholar
Jewell, VC, Sweet, D, Tubman, R, Northrop-Clewes, CA & Thurnham, DI (2000) Lutein and zeaxanthin levels in newborns and mothers. Proc Nutr Soc 59, 47A.Google Scholar
Kanai, M, Raz, A & Goodman, DW (1968) Retinol-binding protein: the transport protein for vitamin A in human plasma. J Clin Invest 47, 2025–2044.CrossRefGoogle ScholarPubMed
Khachik, F, Spangler, CJ, Smith, JCJ, Canfield, LM, Steck, A & Pfander, H (1997) Identification, quantification, and relative concentrations of carotenoids and their metabolites in human milk and serum. Ann Chem 69, 1873–1881.Google Scholar
King, JC (1982) Vitamin requirements during pregnancy. In Nutrition in Pregnancy. Proceedings of the Tenth Study Group of the Royal College of Obstetricians and Gynaecologists, pp. 33–45 [Campbell, DM and Gillmer, MDG, editors]. London: Royal College of Obstetricians and Gynaecologists.Google Scholar
Paracha, PI, Jamil, A, Northrop-Clewes, CA & Thurnham, DI (2000) Interpretation of vitamin A status in apparently healthy Pakistani children by using markers of subclinical infection. Am J Clin Nutr 72, 1164–1169.Google Scholar
Philip, AG & Hewitt, JR (1983) Alpha 1-acid glycoprotein in the neonate with and without infection. Biol Neonat 43, 118–124.CrossRefGoogle ScholarPubMed
Rondo, PHC, Abbott, R, Rodrigues, LC & Tomkins, AM (1995) Vitamin A, folate and iron concentrations in cord and maternal blood of intra-uterine growth retarded and appropriate birth weight babies. Eur J Clin Nutr 4, 9391–9399.Google Scholar
Ross, DA (2002) Recommendations for vitamin A supplementation. J Nutr 132, 2902S–2906S.Google Scholar
Rosso, P (1990) In Nutrition and Metabolism, Mother and Fetus. 1st ed., Oxford: Oxford University Press.Google Scholar
Sann, L, Bienvenu, J, Lahet, C, Divry, P, Cotte, J & Bethenod, M (1981) Serum orosomucoid concentration in newborn infants. Eur J Pediatr 136, 181–185.CrossRefGoogle ScholarPubMed
Shenai, JP (1989) Vitamin A metabolism in the preterm infant. In Textbook of Gastroenterology and Nutrition in Infancy. 2nd ed., pp. 367–375. [Lebenthal, E, editor]. New York: Raven Press.Google Scholar
Shenai, JP, Chytil, F, Jhaveri, A & Stahlman, MT (1981) Plasma vitamin A and retinol binding protein in premature and term neonates. J Pediatr 99, 302–305.Google Scholar
Smith, FR & Goodman, WS (1971) The effects of diseases of the liver, thyroid and kidneys on the transport of vitamin A in human plasma. J Clin Invest 50, 2426–2436.CrossRefGoogle ScholarPubMed
Surks, MI & Oppenheimer, JH (1964) Post operative changes in the concentration of thyroxine-binding prealbumin and serum free thyroxine. J Clin Endocrinol 24, 794–802.Google Scholar
Thompson, D, Milford-Ward, A & Whicher, JT (1992) The value of acute phase protein measurements in clinical practice. Ann Clin Biochem 29, 123–131.CrossRefGoogle ScholarPubMed
Thurnham, DI, McCabe, GP, Northrop-Clewes, CA & Nestel, P (2002) A meta-analysis of 15 studies to quantify the effects of sub-clinical infection on plasma retinol concentrations to assess the prevalence of vitamin A deficiency. Lancet (In the Press).CrossRefGoogle Scholar
Thurnham, DI, Northrop-Clewes, CA & Chopra, M (1998) Biomarkers in vegetable and fruit intakes. Am J Clin Nutr 68, 756–757.CrossRefGoogle ScholarPubMed
Thurnham, DI, Northrop-Clewes, CA, Paracha, PI & McLoone, UJ (1997) The possible significance of parallel changes in plasma lutein and retinol in Pakistani infants during the summer season. Br J Nutr 78, 775–784.CrossRefGoogle ScholarPubMed
Thurnham, DI & Singkamani, R (1991) The acute phase response and vitamin A status in malaria. Trans R Soc Trop Med Hyg 85, 194–199.CrossRefGoogle ScholarPubMed
Thurnham, DI, Smith, E & Flora, PS (1988) Concurrent liquid chromatographic assay of retinol, α-tocopherol, α-carotene, ß-carotene, lycopene and ß-cryptoxanthin in plasma, with tocopherol acetate as internal standard. Clin Chem 2, 377–381.Google Scholar
Tolba, AM, Hewedy, FM, Al Senaidy, AM & Al Othman, AA (1998) Neonates’ vitamin A status in relation to birth weight, gestational age and sex. J Trop Pediatr 44, 174–177.Google Scholar
United Nations International Children's Emergency Fund (1994) In The Nutritional Status of Women and Children in Nigeria. Lagos: UNICEF.Google Scholar
Uzoechina, ON & Okoro, BA (1994) Serum vitamin A status of pre-school children in Nigerian rural community. Ann Trop Paediatr 14, 157–161.CrossRefGoogle Scholar
Valquist, A, Rask, L, Peterson, PA & Berg, T (1975) The concentrations of retinol-binding protein, prealbumin and transferrin in the sera of newly delivered mothers and children of various ages. Scand J Clin Lab Invest 35, 569–575.CrossRefGoogle Scholar
Viani, A, Rizzo, G, Carrai, M & Pacfici, Gm (1992) Interindividual variability in the concentrations of albumin and alpha-1-acid glycoprotein in patients with renal disease, newborns and healthy subjects: implications for binding of drugs. Int J Clin Pharmacol Ther Toxicol 30, 128–133.Google Scholar
Wahid, MA & Shadia, AHF (1987) Nutrition and the unborn baby. Res Clin Lab 17, 199–206.Google Scholar
World Health Organization (1996) In Indicators for Assessing Vitamin A Deficiency and Their Application in Monitoring and Evaluating Intervention Programmes. pp. 1–77. Geneva: WHO. (NUT 96.10.)Google Scholar