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Use of the retinol-binding protein : transthyretin ratio for assessment of vitamin A status during the acute-phase response

Published online by Cambridge University Press:  09 March 2007

Suzanne M. Filteau ,
Juana F. Willumsen ,
Keith Sullivan ,
Karin Simmank  and
Mary Gamble
Suzanne M. Filteau*
Affiliation:
Centre for International Child Health, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
Juana F. Willumsen
Affiliation:
Centre for International Child Health, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
Keith Sullivan
Affiliation:
Centre for International Child Health, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
Karin Simmank
Affiliation:
Baragwanath Hospital, University of Witwatersrand, Soweto, South Africa
Mary Gamble
Affiliation:
Columbia University, New York, NY, USA
*
*Corresponding author: Dr Suzanne Filteau, fax +44 (0) 171 404 2062, email S.Filteau@ich.ucl.ac.uk
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Abstract

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The ratio plasma retinol-binding protein (RBP) : transthyretin (TTR) has been proposed as a means to improve the assessment of vitamin A status of individuals with concurrent infection or inflammation. We have measured RBP and TTR in stored sera from South African children who had accidentally ingested kerosene. Samples were collected from these children in hospital when suffering acute inflammation and respiratory distress, and from them and neighbourhood control children 3 months later. Vitamin A status was defined by modified relative dose response (MRDR) tests of liver retinol stores at 3 months and by serum retinol concentration both when children were ill and when they were well. Illness was defined as either being in hospital or, at follow-up, as having a raised plasma α1-acid glycoprotein (AGP) level. The RBP : TTR value was significantly decreased by both illness and low liver retinol stores. When the effects on RBP : TTR of illness and vitamin A stores were considered together for the 3-month follow-up samples, only vitamin A status significantly decreased the value. We calculated sensitivity and specificity of the RBP : TTR ratio against established measures of vitamin A status using a cut-off value of 0·3 for RBP : TTR and standard cut-off values for MRDR (0·06) and plasma retinol (0·7 μmol/l). Compared with MRDR, RBP : TTR had sensitivities of 76 % and 43 % and specificities of 22 % and 81 % to detect vitamin A deficiency in hospitalized and well children respectively. Compared with plasma retinol, sensitivities were 88 % and 44 % and specificities were 55 % and 64 % in hospitalized and well children respectively. Only for the case of clinically well children with biochemical evidence of subclinical inflammation did sensitivity (62 % and 100 % against MRDR and plasma retinol respectively) and specificity (100 % and 60 % against MRDR and retinol) approach useful levels for an assessment tool. Overall, although a trend supporting the theory behind the use of the RBP : TTR for assessment of vitamin A status in infection was observed in the current study, the ratio did not provide adequate sensitivity and specificity to be a useful assessment tool.

Keywords

Vitamin ARetinol-binding proteinTransthyretin
Type
Research Article
Information
British Journal of Nutrition , Volume 83 , Issue 5 , May 2000 , pp. 513 - 520
Copyright
Copyright © The Nutrition Society 2000

References

Ahluwalia, N, Lonnerdal, B, Lorenz, SG and Allen, LH (1998) Spot ferritin assay for serum samples dried on filter paper. American Journal of Clinical Nutrition 67, 88–92.CrossRefGoogle ScholarPubMed
Blaner, WS (1990) Radioimmunoassays for retinol-binding protein, cellular retinol-binding protein, and cellular retinoic acid-binding protein. Methods in Enzymology 189, 270–281.CrossRefGoogle ScholarPubMed
Cordon, SM, Elborn, JS, Hiller, EJ and Shale, DJ (1991) C-reactive protein measured in dried blood spots from patients with cystic fibrosis. Journal of Immunological Methods 143, 69–72.CrossRefGoogle ScholarPubMed
Coutsoudis, A, Coovadia, HM, Broughton, M, Salisbury, RT and Elson, I (1991) Micronutrient utilisation during measles treated with vitamin A or placebo. International Journal of Vitamin and Nutrition Research 61, 199–204.Google ScholarPubMed
Donnen, P, Dramaix, M, Brasseur, DBitwe, R, Vertongen, F & Hennart, P (1998) Usefulness of the molar ratio of serum retinol binding protein to transthyretin to assess vitamin A status during infection in hospitalized children. In 2nd European Congress on Tropical Medicine, p. 92. Liverpool: Liverpool School of Tropical Medicine.Google Scholar
Filteau, SM (1999) Vitamin A and the acute phase response. Nutrition 15, 326–328.Google ScholarPubMed
Filteau, SM, Morris, SS, Abbott, RA, Tomkins, AM, Kirkwood, BR, Arthur, P, Ross, DA, Gyapong, JO and Raynes, JG (1993) Influence of morbidity on serum retinol of children in a community-based study in northern Ghana. American Journal of Clinical Nutrition 58, 192–197.CrossRefGoogle Scholar
Filteau, SM, Morris, SS, Tomkins, AM, Arthur, P, Kirkwood, BR, Ross, DA, Abbott, RA and Gyapong, JO (1994) Lack of association between vitamin A status and measures of conjunctival epithelial integrity in young children in northern Ghana. European Journal of Clinical Nutrition 48, 669–677.Google ScholarPubMed
Filteau, SM, Raynes, JG, Simmank, K and Wagstaff, LA (1998) Vitamin A status does not influence neopterin production during illness or health in South African children. British Journal of Nutrition 80, 75–79.CrossRefGoogle Scholar
Filteau, S and Willumsen, J (1998) Response to the letter to the editor from Rosales (letter). Journal of Nutrition 128, 783.CrossRefGoogle Scholar
Friedman, GD, Blaner, WS, Goodman, DS, Vogelman, JH, Brind, JL, Hoover, R, Fireman, BH and Orentreich, N (1986) Serum retinol and retinol binding protein levels do not predict subsequent lung cancer. American Journal of Epidemiology 123, 781–789.CrossRefGoogle Scholar
Gamble, MV, Ramakrishnan, R, Berglund, L, Palafox, NA,Lima, AAM, Guerrant, RL & Blaner, WS (1999) Validation of RBP as a surrogate for serum retinol: a survey assessing the effects of acute phase response in children and HIV-infected adults living in northeastern Brazil. In Vitamin A and Other Micronutrients: Biologic Interactions and Integrated Interventions, p. 93. Washington, DC: International Vitamin A Consultative Group.Google Scholar
Gamble, MV, Ramakrishnan, S, Palafox, NA & Blaner, WS (1997) Correlation of serum RBP and retinol in vitamin A deficient children from the Marshall Islands; can RBP levels serve as a surrogate measure of retinol? In Sustainable Control of Vitamin A Deficiency, p. 90. Washington, DC: International Vitamin A Consultative Group.Google Scholar
Milland, J, Tsykin, A, Thomas, T, Aldred, AR, Cole, T and Schreiber, G (1990) Gene expression in regenerating and acute-phase rat liver. American Journal of Physiology 259, G340–G347.Google Scholar
Navab, M, Smith, JE and Goodman, DS (1977) Rat plasma prealbumin: metabolic studies of effects of vitamin A status and on tissue distribution. Journal of Biological Chemistry 252, 5107–5114.CrossRefGoogle ScholarPubMed
Ramsden, DB, Prince, HP, Burr, WA, Bradwell, AR, Black, EG, Evans, AE and Hoffenberg, R (1978) The inter-relationship of thyroid hormones, vitamin A and their binding proteins following acute stress. Clinical Endocrinology 8, 109–122.CrossRefGoogle ScholarPubMed
Rosales, FJ (1998) Comments on the paper by Willumsen. et al. (1997) (letter). Journal of Nutrition 128, 782.CrossRefGoogle Scholar
Rosales, FJ, Ritter, SJ, Zolfaghari, R, Smith, JE and Ross, AC (1996) Effects of acute inflammation on plasma retinol, retinol-binding protein, and its mRNA in the liver and kidneys of vitamin A-sufficient rats. Journal of Lipid Research 37, 962–971.CrossRefGoogle Scholar
Rosales, FJ and Ross, AC (1998) A low molar ratio of retinol binding protein to transthyretin indicates vitamin A deficiency during inflammation: studies in rats and a posteriori analysis of vitamin A-supplemented children with measles. Journal of Nutrition 128, 1681–1687.CrossRefGoogle Scholar
Simmank, K, Wagstaff, L, Sullivan, K, Filteau, S and Tomkins, A (1998) Prediction of illness severity and outcome of children symptomatic following kerosene ingestion. Annals of Tropical Paediatrics 18, 309–314.CrossRefGoogle ScholarPubMed
South African Vitamin A Consultative Group (1996), –. Anthropometric, vitamin A iron and immunisation coverage status in children aged 6–71 months in South Africa, 1994. South African Medical Journal 86, 354–357.Google Scholar
Stansfield, SKMuller, P-LLerebours, G and Augustin, A (1993) Vitamin A supplementation and increased prevalence of childhood diarrhoea and acute respiratory infections. Lancet 341, 578–582.CrossRefGoogle Scholar
Tanumihardjo, SACheng, J-C, Permaesih, D, Rustan, E, Karyadi, D and Olson, JA (1996) Refinement of the modified relative dose response test as a method for assessing vitamin A status in a field setting: experience with Indonesian children. American Journal of Clinical Nutrition 64, 966–971.CrossRefGoogle Scholar
Willumsen, JF, Simmank, K, Filteau, SM, Wagstaff, LA and Tomkins, AM (1997) Toxic damage to the respiratory epithelium induces acute phase changes in vitamin A metabolism without depleting retinol stores of South African children. Journal of Nutrition 127, 1339–1343.CrossRefGoogle Scholar
World Health Organization (1996) Indicators for Assessing Vitamin A Deficiency and Their Application in Monitoring and Evaluating Intervention Programmes. Geneva: WHO.Google Scholar
World Health Organization/United Nations Children's Fund/International Vitamin A Consultative Group (1988) Vitamin A Supplements: A Guide to Their Use in the Treatment and Prevention of Vitamin A Deficiency and Xerophthalmia. Geneva: WHO.Google Scholar