Assessing the Role of Inflammation on Vitamin A Biomarkers in School-age children and Adolescents 公开

Abstract

 

OBJECTIVES: Recommended biomarkers for population vitamin A status are also negative acute phase proteins, thus may overestimate the prevalence of vitamin A deficiency (VAD) in settings with inflammation. This analysis expands prior research conducted by the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) working group to assess the relation between vitamin A biomarkers and inflammation in school-age children (SAC) and adolescents and investigate the use of the BRINDA inflammation adjustment to account for the role of inflammation.

 

METHODS: We analyzed nutrition surveys of 12,101 SAC (5-15 years) from six datasets and 7,099 adolescents (10-20 years) from ten datasets from the BRINDA project. We estimated the prevalence of inflammation (α-1-acid-glycoprotein [AGP] >1 g/L and C-reactive protein [CRP] > 5 mg/L) and the prevalence of VAD (using serum retinol < 0.7 µmol/L; retinol binding protein <0.7µmol/L), taking complex survey design into consideration. We calculated survey-weighted rank correlations to examine the relation between serum retinol or RBP and AGP or CRP. We used the BRINDA inflammation adjustment method to adjust serum retinol and RBP using AGP only, CRP only, and both AGP and CRP, and compared them with unadjusted values. 

 

RESULTS: The prevalence of elevated AGP or CRP varied by dataset from 10.7% to 33.0% and 2.1% to 23.4%, respectively. The prevalence of unadjusted VAD ranged from 0.6% to 23.3% in SAC and 0.2% to 17.1% in adolescents. Rank correlations between serum retinol or RBP and AGP or CRP were negative and statistically significant (p < 0.05) in all six SAC datasets but inconsistent in adolescents. Compared to the unadjusted value, VAD based on serum retinol was 0.2% to 6.2% lower in five SAC datasets and VAD based on RBP was 8.6% lower in one SAC dataset.

 

CONCLUSIONS: Inflammation adjustment of vitamin A biomarkers may prevent the overestimation of vitamin A deficiency among SAC. However, results were inconsistent among adolescents and further research is needed to inform decision making. 

Table of Contents

Introduction …………………………………………………………1

Literature Review …………………………………………………...3

Manuscript …………………………………………………………15

-      Abstract  ………………………………………..16

-      Introduction  ……………………………………17

-      Methods  ………………………………………. 18

-      Results …………………………………………. 20

-      Discussion ...………………………………….... 23

-      References  …………………………………….. 29

-      Tables and Figures .……………………………. 32

Discussion, Conclusions, and Recommendations ……...…………. 37

References …………………………………………….................... 45

Appendices …………………………………………………………49

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Nutrition
关键词	BRINDA Vitamin A Vitamin A deficiency Inflammation Retinol Retinol binding protein Adolescents School-age children
Committee Chair / Thesis Advisor	Dr. Melissa Young, Emory University
Committee Members	Dr. Hanqi Luo, Emory University Dr. Rochelle Werner, Emory University

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