Accounting for the influence of inflammation on retinol-binding protein in a population survey of Liberian preschool-age children
Leila Margaret Larson, O Yaw Addo, Fanny Sandalinas, Katherine Faigao, Roland Kupka, Rafael Flores-Ayala, Parminder S Suchdev, Leila Margaret Larson, O Yaw Addo, Fanny Sandalinas, Katherine Faigao, Roland Kupka, Rafael Flores-Ayala, Parminder S Suchdev
Abstract
Vitamin A deficiency (VAD) is an important contributor to child morbidity and mortality. The prevalence of VAD, measured by retinol-binding protein (RBP) or retinol, is overestimated in populations with a high prevalence of inflammation. We aimed to quantify and adjust for the effect of inflammation on VAD prevalence in a nationally representative survey of Liberian children 6 to 35 months of age. We compared five approaches to adjust RBP for inflammation and estimate VAD prevalence (defined as RBP < 0.7 µmol/L): (1) ignoring inflammation; (2) excluding individuals with inflammation (C-reactive protein (CRP) >5 mg/L or alpha1-acid glycoprotein (AGP) >1 g/)L; (3) multiplying each individual's RBP by an internal correction factor; (4) by an external correction factor; and (5) using regression (corrected RBP = exp(InRBP - β1 (lnCRPobs -lnCRPref ) - β2 (lnAGPobs -lnAGPref )). Corrected RBP was based on a regression model where reference lnCRP and lnAGP were set to the maximum of the lowest decile. The unadjusted prevalence of VAD was 24.7%. Children with elevated CRP and/or AGP had significantly lower RBP concentrations than their apparently healthy peers (geometric mean RBP 0.79 µmol/L (95% CI: 0.76, 0.82) vs. 0.95 µmol/L (95% CI: 0.92, 0.97), P < 0.001). Using approaches 2-5 resulted in a prevalence of VAD of 11.6%, 14.3%, 13.5% and 7.3%, respectively. Depending on the approach, the VAD prevalence is reduced 10-17 percentage points when inflammation is taken into account. Further quantification of the influence of inflammation on biomarkers of vitamin A status from other national surveys is needed to compare and recommend the preferred adjustment approach across populations.
Keywords: C-reactive protein; alpha1-acid glycoprotein; inflammation; nutrition; retinol-binding protein; vitamin A deficiency.
Conflict of interest statement
The authors declare that they have no conflicts of interest.
© 2016 John Wiley & Sons Ltd.
Figures
![Figure 1](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/6866170/bin/MCN-13-e12298-g001.jpg)
Figure 2
Geometric mean retinol‐binding protein (RBP)…
Figure 2
Geometric mean retinol‐binding protein (RBP) and proportion of children with unadjusted RBP
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- Research Support, Non-U.S. Gov't
- Biomarkers / blood
- C-Reactive Protein / metabolism
- Child, Preschool
- Cross-Sectional Studies
- Hemoglobins / metabolism
- Humans
- Infant
- Inflammation / epidemiology*
- Liberia / epidemiology
- Morbidity
- Nutritional Status
- Orosomucoid / metabolism
- Prevalence
- Retinol-Binding Proteins / metabolism*
- Vitamin A / blood
- Vitamin A Deficiency / blood
- Vitamin A Deficiency / epidemiology*
- Biomarkers
- Hemoglobins
- Orosomucoid
- Retinol-Binding Proteins
- Vitamin A
- C-Reactive Protein
- Full Text Sources
- Other Literature Sources
- Medical
- Research Materials
- Miscellaneous
![Figure 2](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/6866170/bin/MCN-13-e12298-g002.jpg)
Source: PubMed