Nutritional rehabilitation of malnourished children detected by Screening Tool for Assessment of Malnutrition in Pediatric: Urban versus rural settings.

BACKGROUND: Malnutrition presents a major global health burden. In Egypt, it remains an important issue in children under 5 years especially in rural communities. AIM OF THE STUDY: The aim of the study was to screen 2-5 years old children enrolled from Egyptian hospitals in rural and urban areas for the risk of malnutrition using Screening Tool for Assessment of Malnutrition in Pediatric (STAMP) and to evaluate the effectiveness of nutritional intervention programs. SUBJECTS AND METHODS: This cross-sectional study was conducted on 90 patients recruited from two hospitals in urban and rural Cairo, Dietary history and anthropometric measurements were assessed. Patients at intermediate and severe risk of malnutrition according to STAMP were given tailored nutritional programs. RESULTS: In the rural hospital, 4.4% of the screened children were underweight, 22.2% were marginally underweight, and 73.3% had normal weight. Regarding the urban hospital, 15.6% were marginally underweight, 84.4% had normal weight and no underweight patients. Among the rural group 35.6% were at high risk according to STAMP score results compared to 20% in the urban group. Nevertheless, the only significant differences were the more stunting and higher BMI in rural hospital patients. After nutritional intervention, high-risk category patients decreased in both groups coupled by significant improvement in the anthropometric parameters and nutrition data with no significant differences between them. CONCLUSION: Nutritional education and prompt implementation of nutritional rehabilitation program for malnourished children detected by screening tools result in improvement in their nutritional status disregards their location whether urban or rural.

Arsenic and cadmium in food-chain in Bangladesh--an exploratory study.

Arsenic contamination of tubewell water is a major public-health problem in Bangladesh. In the recent years, the use of shallow and deep tubewell water for irrigation and the use of excess amount of cheap fertilizers and pesticides containing cadmium pose a serious threat of contamination of arsenic and cadmium in food. In an exploratory study, arsenic and cadmium were measured in foods from Matlab, a rural area in Bangladesh, that is extensively affected by arsenic and the economy is agriculture-based. Raw and cooked food samples were collected from village homes (households, n=13) and analyzed to quantify concentrations of arsenic and cadmium using atomic absorption spectrophotometry. Washing rice with water before cooking reduced the concentration of arsenic in raw rice by 13-15%. Rice, when cooked with excess water discarded, showed a significant decrease in arsenic concentration compared to that cooked without discarding the water (p<0.001). In contrast, concentration of cadmium did not decrease in cooked rice after discarding water. Cooked rice with discarded water had significantly lower concentration of arsenic compared to raw rice (p=0.002). Raw rice had higher concentration of arsenic compared to raw vegetables (p<0.001); however, no such difference was found for cadmium. Compared to raw vegetables (e.g. arum), concentration of arsenic increased significantly (p=0.024) when cooked with arsenic-contaminated water. Thus, the practice of discarding excess water while cooking rice reduces the concentration of arsenic but not of cadmium in cooked rice. However, water generally not discarded when cooking vegetables to avoid loss of micronutrients consequently retains arsenic. The results suggest that arsenic and cadmium have entered the food-chain of Bangladesh, and the cooking practices influence the concentration of arsenic but not of cadmium in cooked food.

Effect of dietary fat supplementation during late pregnancy and first six months of lactation on maternal and infant vitamin A status in rural Bangladesh.

Dietary fat intake is extremely low in most communities with vitamin A deficiency. However, its role in vitamin A status of pregnant and lactating women is poorly understood. The aim of the study was to examine the effect of supplementing women with fat from mid-/late pregnancy until six months postpartum on their vitamin A status and that of their infants. Women recruited at 5-7 months of gestation were supplemented daily with 20 mL of soybean-oil (n = 248) until six months postpartum or received no supplement (n = 251). Dietary fat intake was assessed by 24-hour dietary recall at enrollment and at 1, 3 and 6 months postpartum. Concentrations of maternal plasma retinol, beta-carotene, and lutein were measured at enrollment and at 1, 3 and 6 months postpartum, and those of infants at six months postpartum. Concentration of breastmilk retinol was measured at 1, 3 and 6 months postpartum. The change in concentration of plasma retinol at three months postpartum compared to pregnancy was significantly higher in the supplemented compared to the control women (+0.04 vs -0.07 micromol/L respectively; p < 0.05). Concentrations of plasma beta-carotene and lutein declined in both the groups during the postpartum period but the decline was significantly less in the supplemented than in the control women at one month (beta-carotene -0.07 vs -0.13 micromol/L, p < 0.05); lutein -0.26 vs -0.49 micromol/L, p < 0.05) and three months (beta-carotene -0.04 vs -0.08 micromol/L, p < 0.05; lutein -0.31 vs -0.47 micromol/L, p < 0.05). Concentration of breastmilk retinol was also significantly greater in the supplemented group at three months postpartum than in the controls (0.68 +/- 0.35 vs 0.55 +/- 0.34 micromol/L respectively, p < 0.03). Concentrations of infants' plasma retinol, beta-carotene, and lutein, measured at six months of age, did not differ between the groups. Fat supplementation during pregnancy and lactation in women with a very low intake of dietary fat has beneficial effects on maternal postpartum vitamin A status.

Low-dose beta-carotene supplementation and deworming improve serum vitamin A and beta-carotene concentrations in preschool children of Bangladesh.

Despite the national vitamin A and antihelminthic prophylaxis programmes, both intestinal geohelminths and subclinical vitamin A deficiency continue to be prevalent among children in developing countries. Studies on potential synergistic effects of vitamin A supplementation and deworming on retinol status have inconsistent results. The purpose of the present study was to investigate the impacts of low-dose beta-carotene supplementation and antihelminthic therapy on serum retinol and beta-carotene concentrations in preschool children of Bangladesh. Two hundred and forty-four children, known to be infected with Ascaris lumbricoides, were randomized into four treatment groups: I-IV. Group I and II received two oral doses of 400 mg of albendazole each, the first dose at baseline and the second dose after four months; Group III and IV received placebo in place of albendazole. In addition, Group I and III received 1.2 mg of beta-carotene powder in capsule daily for six months, and Group II and IV received placebo in place of beta-carotene. Serum retinol and beta-carotene levels were measured before and after six months of the interventions. Serum retinol and beta-carotene increased significantly in Group I where both antihelminthic therapy and daily beta-carotene supplementation were given (p<0.05 and p<0.001 respectively). Antihelminthic therapy alone only improved serum beta-carotene concentration (p<0.0001). Low-dose beta-carotene supplementation, along with an antihelminthic therapy, synergistically improved vitamin A status. This finding has public-health implications for improving vitamin A status of children in developing countries.

Effect of micronutrients on morbidity and duration of hospital stay in childhood pneumonia.

A cross-sectional and controlled clinical trial was conducted in under-5 children to compare the effects of supplementation of five micronutrients (vitamin-A, vitamin C, vitamin E, folic acid and zinc) on the morbidity and on the duration of hospital stay in pneumonia. Data were collected from 1150 children. Among them 350 children were excluded for various reasons and finally data from 800 children were analyzed. Among these 800 children 59.00% (475) were male and 41.00% (325) were female. The mean+/-SD age was 6.5+/-5.6 months and 56.25% (450) were infants. The children were divided into two groups-400 in control group and 400 in intervention (case) group. In both the groups, specific treatment was given by ampicillin and gentamycin. In intervention group, five micronutrients were given in 200 children from the day of admission and continued up to discharge. Another 200 children were again divided into 5 sub-groups (40 in each sub-group) and a single micronutrient was given in the same way in each sub-groups. All the subjects were suffering clinically from severe pneumonia and radiologically from bronchopneumonia. Cases and controls were matched by parents' occupation, education level, economic status and family members. All the children were fully vaccinated as per existing EPI schedule of the country, partially breastfed up to six months and after six months weaned by carbohydrate rich diet. All the children were in mild (grade I) PEM according to Gomez's classification. Venous blood was collected for estimation of serum level of five micronutrients from all the samples before starting treatment by standard procedures. The average blood level of all the micronutrients was low. The average duration of hospital staying was 6.75 days in intervention group and 7.75 days in control group (p<0.01). Chest indrawing and fast breathing disappeared earlier in the intervention group (p<0.01) suggesting that supplementation of micronutrients decrease the morbidity and duration of hospital stay of children suffering from pneumonia.

The epidemiology of visceral leishmaniasis and asymptomatic leishmanial infection in a highly endemic Bangladeshi village.

We examined the epidemiology of kala-azar and asymptomatic leishmanial infection measured by serologic and leishmanin skin test results in a Bangladeshi community. In a subset, we measured serum retinol, zinc and C-reactive protein (CRP). Kala-azar and seroconversion incidence were 15.6 and 63.1 per 1,000 person-years, respectively. Proximity to a previous kala-azar case increased the likelihood of both kala-azar and asymptomatic infection. Bed net use protected against kala-azar (rate ratio = 0.35, P < 0.01), but not subclinical infection (rate ratio = 1.1, P = 0.82). Kala-azar patients were younger (P < 0.001) and reported lower red meat consumption (P < 0.01) than asymptomatic seropositive individuals. Retinol and zinc levels were lower in current kala-azar patients and those who later developed kala-azar compared with uninfected and asymptomatically infected subjects. The CRP levels were higher in kala-azar patients compared with the other two groups. Low red meat intake and poor zinc and retinol status may characterize a group at higher risk of symptomatic disease.

Antioxidant vitamins E and C as adjunct therapy of severe acute lower-respiratory infection in infants and young children: a randomized controlled trial.

OBJECTIVE: To evaluate the effect of antioxidant Vitamins E and C as adjunct therapy of severe acute lower respiratory infection (ALRI) in children. DESIGN: Randomized double-blind placebo-controlled clinical trial. SETTING: A large childrens' hospital serving the urban poor in Kolkata, India. SUBJECTS: Children aged 2-35 months admitted with severe ALRI. INTERVENTION: In total, 174 children were randomly assigned to receive alpha-tocopherol 200 mg and ascorbic acid 100 mg twice daily or placebo for 5 days. All children received standard treatment for severe ALRI. Outcome measures were: time taken to recover from a very ill status, fever, tachypnoea, and feeding difficulty; and improvement in oxidative stress and immune response indicated by thiobarbituric acid reacting substances (TBARS) and response to skin antigens, respectively. RESULTS: Recovery rate ratios (95% CI) using proportional hazards model were 0.89 (0.64-1.25), 1.01 (0.72-1.41), 0.86 (0.57-1.29), and 1.12 (0.77-1.64) for very ill status, feeding difficulty, fever, and tachypnoea, respectively. TBARS values were high and similar in the two groups at admission, discharge, and at 2 weeks follow-up. Serum alpha-tocopherol significantly increased in treated group at discharge. Immune response to skin antigens were very poor at admission and after 2 weeks, in both groups. CONCLUSION: Infants with severe ALRI failed to benefit from two antioxidant nutrients as adjunct therapy. Severe ALRI in infants may cause cell-mediated immune dysfunction. We need a better understanding of oxidative processes in growing infants to help us better design interventions with antioxidant therapy.

A modified routine analysis of arsenic content in drinking-water in Bangladesh by hydride generation-atomic absorption spectrophotometry.

The high prevalence of elevated levels of arsenic in drinking-water in many countries, including Bangladesh, has necessitated the development of reliable and rapid methods for the determination of a wide range of arsenic concentrations in water. A simple hydride generation-atomic absorption spectrometry (HG-AAS) method for the determination of arsenic in the range of microg/L to mg/L concentrations in water is reported here. The method showed linearity over concentrations ranging from 1 to 30 microg/L, but requires dilution of samples with higher concentrations. The detection limit ranged from 0.3 to 0.5 microg/L. Evaluation of the method, using internal quality-control (QC) samples (pooled water samples) and spiked internal QC samples throughout the study, and Standard Reference Material in certain lots, showed good accuracy and precision. Analysis of duplicate water samples at another laboratory also showed good agreement. In total, 13,286 tubewell water samples from Matlab, a rural area in Bangladesh, were analyzed. Thirty-seven percent of the water samples had concentrations below 50 microg/L, 29% below the WHO guideline value of 10 microg/L, and 17% below 1 microg/L. The HG-AAS was found to be a precise, sensitive, and reasonably fast and simple method for analysis of arsenic concentrations in water samples.

Zinc for severe pneumonia in very young children: double-blind placebo-controlled trial.

BACKGROUND: Pneumonia is a leading cause of morbidity and mortality in young children. Early reversal of severity signs--chest indrawing, hypoxia, and tachypnoea--improves outcome. We postulated that zinc, an acute phase reactant, would shorten duration of severe pneumonia and time in hospital. METHODS: In a double-blind placebo-controlled clinical trial in Matlab Hospital, Bangladesh, 270 children aged 2-23 months were randomised to receive elemental zinc (20 mg per day) or placebo, plus the hospital's standard antimicrobial management, until discharge. The outcomes were time to cessation of severe pneumonia (no chest indrawing, respiratory rate 50 per min or less, oxygen saturation at least 95% on room air) and discharge from hospital. Discharge was allowed when respiratory rate was 40 per minute or less for 24 consecutive hours while patients were maintained only on oral antibiotics. FINDINGS: The group receiving zinc had reduced duration of severe pneumonia (relative hazard [RH]=0.70, 95% CI 0.51-0.98), including duration of chest indrawing (0.80, 0.61-1.05), respiratory rate more than 50 per min (0.74, 0.57-0.98), and hypoxia (0.79, 0.61-1.04), and overall hospital duration (0.75, 0.57-0.99). The mean reduction is equivalent to 1 hospital day for both severe pneumonia and time in hospital. All effects were greater when children with wheezing were omitted from the analysis. INTERPRETATION: Adjuvant treatment with 20 mg zinc per day accelerates recovery from severe pneumonia in children, and could help reduce antimicrobial resistance by decreasing multiple antibiotic exposures, and lessen complications and deaths where second line drugs are unavailable.

Increased food intake after the addition of amylase-rich flour to supplementary food for malnourished children in rural communities of Bangladesh.

BACKGROUND: In Bangladesh, as in other developing countries, protein-energy malnutrition is mostprevalent among children during weaning. After weaning, children are often fed cereal-based diluted low-calorie porridge, resulting in growth-faltering. OBJECTIVE: To assess the effect on food intake of adding amylase-rich flour (ARF) from germinated wheat to supplementary food among children in nine rural Community Nutrition Centers under the Bangladesh Integrated Nutrition Project (BINP). METHODS: A total of 166 malnourished children of either sex, aged 6 to 24 months, received one of three diets randomly allocated to the Community Nutrition Centers. The composition of the diets was the same; however, the consistency and calorie density were altered by adding either ARF or water. Thirty-five children received the standard supplementary food of the BINP (S-SF), 65 received supplementaryfood with added ARF (ARF-SF), and 66 received supplementary food with added water (W-SF). The children were studied for six weeks. Results. The mean +/- SD intake of supplementaryfood from a single meal by children completing six weeks on the diets was higher for children receiving ARF-SF (33.91 +/- 8.25 g) than for those receiving S-SF (25.66 +/- 6.73 g) or W-SF (30.26 +/- 8.39g) (p < .05 for both comparisons). The weight of vomited food was significantly higher for children receiving W-SF than for children in the other two groups. Weight gain and increments in length and weight-for-height were higher for children who received ARF-SF than for children in the other two groups, but the differences were not statistically significant. The acceptability ofARF-SF was higher than that of the two other diets. The additional cost of adding 2 g of ARF to the diet was about Taka 0.25 (U.S. dollar 1 = Taka 48). CONCLUSIONS: Addition of ARF to existing standard supplementary food, as used under the BINP program, is a simple and effective means to increase the intake of food by changing its consistency, thus making it easier for malnourished children to ingest.

Functional outcome of unstable pelvic ring injuries after iliosacral screw fixation: single versus two screw fixation.

INTRODUCTION: A clinical series of patients was studied to compare the functional score after the use of a single versus two percutaneous iliosacral screws for unstable posterior pelvic ring fractures with or without anterior fixation with the aim to explore if the addition of a second screw would provide better results regarding the functional outcome score. MATERIALS AND METHODS: This case series includes 77 patients with an average of 32.6 years who suffered unstable posterior pelvic ring fractures. Forty-six were Tile type C and 31 were Tile type B. Patients underwent closed reduction and were fixed using percutaneous fluoroscopic-guided iliosacral screws in the supine position with 1 screw in 50 fractures, 2 screws in 37 fractures, 2 fractures were fixed with plates after ORIF, and in 6 cases (out of the bilateral cases) the undisplaced side was unfixed. Postoperatively three patients were lost to follow up and 74 patients (84 posterior fractures fixed with screws) were followed up for a mean of 37.4 months (range 6-151 months) and were evaluated using the Majeed score (1989). RESULTS: Clinical union occurred in all the patients, although in two cases posterior fixation failed and was revised. Radiologically excellent reduction was achieved in 55 patients (71.4%), good in 16 (20.8%), fair in 6 (7.8%) and none had poor reduction. Statistically; among 62 cases that completed the Majeed score evaluation at the last follow-up session, there was no significant difference p value 0.051 between two groups. We also compared Majeed score in Tile B and C fractures fixed with one versus two screws. CONCLUSION: The addition of a second screw for posterior fixation did not show any statistically significant difference regarding functional outcome. LEVEL OF EVIDENCE: Level IV clinical trial.

Effect of early vitamin A supplementation on cell-mediated immunity in infants younger than 6 mo.

One hundred twenty infants were randomly assigned to receive either 15 mg vitamin A or placebo with each of three DPT/OPV (diphtheria, pertussis, tetanus/oral polio vaccine) immunizations at monthly intervals. Sixty-two received vitamin A and 58 received placebo. One month after the third supplementation dose, the response to the delayed cutaneous hypersensitivity test [multitest cell-mediated immunity (CMI) skin evaluation] for tetanus, diphtheria, and tuberculin (purified protein derivative, PPD) was the same in the vitamin A and placebo infants. The number of anergic infants was 17 (27%) and 19 (33%) in the vitamin A and placebo groups, respectively. The number of positive tests among well-nourished infants was significantly higher than that in malnourished infants irrespective of supplementation (P < 0.001). Among the infants with adequate serum retinol concentrations (> 0.7 mumol/L) after supplementation, the vitamin A-supplemented infants had a significantly higher proportion of positive CMI tests than the placebo infants (chi-square test: 8.99, P = 0.008). Among the infants with low serum retinol concentrations (< 0.7 mumol/L) after supplementation, vitamin A supplementation had no effect on CMI response. These results indicate that CMI in young infants was positively affected by vitamin A supplementation only in those infants whose vitamin A status was adequate (ie, serum retinol > 0.7 mumol/L) at the time of the CMI test. CMI was consistently better in well-nourished infants irrespective of supplementation.

Predictors of serum retinol in children with shigellosis.

BACKGROUND: Low serum retinol can be useful as an indicator of depleted liver vitamin A stores, particularly in population-based studies. However, serum retinol concentrations decrease transiently during infection, independent of any changes in liver stores. The magnitude of the decrease in serum retinol is often proportional to indicators of disease severity. OBJECTIVE: We examined the relation of serum retinol in children with culture-positive shigellosis with severity of illness, anthropometric indicators of nutritional status, urinary retinol excretion, and serum concentrations of C-reactive protein, alpha1-acid glycoprotein, retinol binding protein, and transthyretin. DESIGN: This was a prospective study assessing the clinical and laboratory measurements at admission and recovery of 90 children with dysentery (66 with shigellosis) hospitalized in Bangladesh. RESULTS: Serum retinol concentrations were low at admission but were significantly greater at discharge even though no vitamin A supplements were given during the illness (0.36 +/- 0.22 compared with 1.15 +/- 0.50 micromol/L, P < 0.001). Serum retinol concentrations were lower in children with Shigella dysenteriae type 1 infection than in children with shigellosis due to less virulent strains of Shigella. Low serum retinol was independently associated with S. dysenteriae type 1, high serum C-reactive protein concentrations, and low weight-forage in multiple regression analysis. CONCLUSIONS: This study showed that shigellosis was associated with a significant, transient decrease in serum retinol concentrations of approximately 0.8 micromol/L, and that this change was significantly associated with severity of disease and poor underlying nutritional status, particularly low weight-for-age.

Comparison of the modified relative dose response (MRDR) and the relative dose response (RDR) in the assessment of vitamin A status in malnourished children.

The modified-relative-dose-response (MRDR) test and the relative-dose-response (RDR) test were compared in 49 mildly to moderately malnourished Bangladeshi children. The MRDR test had a significantly lower sensitivity, detecting only 71% of children with very low serum retinol (< or = 0.35 mumol/L) and 33% of children with low serum retinol (0.355-0.70 mumol/L) compared with 100% and 80% for the RDR test, respectively. The MRDR test showed a very strong dependency on retinol-binding protein (RBP) saturation (ie, percent saturation of RBP with retinol) compared with the RDR test. Only 3 (23%) of 13 children with RBP saturation > or = 55% but low vitamin A stores were diagnosed as abnormal by the MRDR test. This suggests that when apo-RBP concentration is limiting, as it is in malnourished children, didehydroretinol, the analog used in the MRDR test cannot effectively compete with retinol for binding to apo-RBP. Under these circumstances, the MRDR test is rendered ineffective. The possibility of increasing the sensitivity of the test by using a high dose of didehydroretinol needs to be investigated.

Carbohydrate malabsorption in infants with rotavirus diarrhea.

We studied a group of patients with rotavirus diarrhea to determine the association of carbohydrate malabsorption during diarrhea with the degree of acidosis and severity of purging. Unlike enterotoxigenic diarrhea in which the metabolic acidosis is due to loss of bicarbonate in an alkaline stool, patients with rotavirus develop a metabolic acidosis while passing an acid stool with little detectable bicarbonate. Also unlike enterotoxigenic diarrhea, rotavirus stool contains large quantities of reducing substances suggesting significant carbohydrate malabsorption. Our findings are consistent with the hypothesis that carbohydrate malabsorption is an important secondary pathophysiological mechanism in the rotavirus diarrhea syndrome. This model for rotavirus diarrhea helps to explain the electrolyte and acid-base pattern of the rotavirus stool and stresses the importance of further nutrition balance studies to determine the optimal dietary management of patients with rotavirus diarrhea.

Effect of zinc supplementation between 1 and 6 mo of life on growth and morbidity of Bangladeshi infants in urban slums.

BACKGROUND: Evidence for an effect of zinc supplementation on growth and morbidity in very young infants in developing countries is scarce and inconsistent. OBJECTIVE: We assessed the effect of zinc supplementation on growth and morbidity in poor Bangladeshi infants aged 4-24 wk. DESIGN: Infants from Dhaka slums were enrolled at 4 wk of age and randomly assigned to receive 5 mg elemental Zn/d (n = 152) or placebo (n = 149) until 24 wk of age. They were followed weekly for information on compliance and morbidity; anthropometric measurements were performed monthly. Serum zinc was assessed at baseline and at 24 wk of age. RESULTS: At 24 wk of age, serum zinc concentrations were higher in the zinc than in the placebo group (13.3 +/- 3.8 and 10.7 +/- 2.9 micro mol/L, respectively; P < 0.001). Significantly greater weight gains were observed in the zinc than in the placebo group for 43 infants who were zinc deficient (< 9.18 micro mol/L) at baseline (3.15 +/- 0.77 and 2.66 +/- 0.80 kg, respectively; P < 0.04). In the other infants, no significant differences were observed in mean weight and length gains during the study period. Zinc-deficient infants showed a reduced risk of incidence of acute lower respiratory infection after zinc supplementation (relative risk: 0.30; 95% CI: 0.10, 0.92); among the non-zinc-deficient infants there were no significant differences between treatment groups. CONCLUSIONS: Zinc-deficient Bangladeshi infants showed improvements in growth rate and a reduced incidence of acute lower respiratory infection after zinc supplementation. In infants with serum zinc concentrations > 9.18 micro mol/L, supplementation improved only biochemical zinc status.

Urinary retinol excretion and kidney function in children with shigellosis.

BACKGROUND: Acute infections, including diarrhea, are associated with an increased risk of vitamin A deficiency. Urinary retinol excretion during such infections may contribute to this risk. The mechanism accounting for urinary retinol loss has not been clearly defined. OBJECTIVE: This study attempted to determine whether urinary retinol loss in children with acute infection is associated with impaired kidney function, particularly impaired tubular protein reabsorption. DESIGN: Urinary retinol excretion and kidney function were examined in 66 hospitalized children 5 mo to 5 y of age with acute Shigella dysentery. RESULTS: Urinary retinol loss occurred in 59% of children and was substantial (>0.1 micromol/d) in 8% of them. Children with more severe disease excreted higher concentrations of urinary retinol; those with a body temperature > or =40 degrees C excreted a mean of 0.10 +/- 0.18 micromol/d compared with 0.005 +/- 0.008 micromol/d for other children (P < 0.0001). Children with more severe disease also had impaired tubular reabsorption of low-molecular-weight proteins beta2-microglobulin and retinol binding protein (RBP)], although other measures of tubular and glomerular function were not similarly impaired. In multiple regression analysis, severity of disease indicators were the best predictors of tubular reabsorption of beta2-microglobulin (R2 = 0.53) whereas tubular reabsorption of beta2-microglobulin and RBP were found to be the best predictors of urinary retinol loss (R2 = 0.69). CONCLUSIONS: A significant amount of retinol was excreted in the urine in children with shigellosis: 8% excreted >0.10 micromol/d (15% of the daily metabolic requirement). Impaired tubular reabsorption of low-molecular-weight proteins, such as RBP transporting retinol, appeared to be the cause of this urinary retinol loss.

Use of the deuterated-retinol-dilution technique to assess total-body vitamin A stores of adult volunteers consuming different amounts of vitamin A.

BACKGROUND: The deuterated-retinol-dilution (DRD) technique provides a quantitative estimate of total body stores of vitamin A. However, it is not known whether the technique can detect changes in vitamin A pool size in response to different intakes of vitamin A. OBJECTIVE: Our objective was to determine the responsiveness of the DRD technique to 3 different daily supplemental vitamin A intakes during a period of 2.5-4 mo. DESIGN: Two oral doses of [(2)H(4)]retinyl acetate [52.4 micromol retinol equivalent (RE)] were administered on study days 1 and 91 to 26 men (18-32 y of age) who were consuming controlled, low-vitamin A diets, and receiving daily either 0, 5.2, or 10.5 micromol RE of unlabeled supplemental retinyl palmitate during a 75- or 129-d period. Plasma isotopic ratios of [(2)H(4)]retinol to retinol on day 115 were used to estimate final vitamin A body stores per Furr et al (Am J Clin Nutr 1989;49:713-6). RESULTS: Final ( +/- SD) estimated vitamin A pool sizes were 0.048 +/- 0.031, 0.252 +/- 0.045, and 0.489 +/- 0.066 mmol in the treatment groups receiving 0, 5.2, and 10.5 micromol RE/d, respectively (P < 0.001). Estimated mean changes in vitamin A pool sizes were similar to those expected for the vitamin A-supplemented groups [estimated:expected (95% CI of change in pool size): 1.08 (0.8, 1.2) and 1.17 (1.0, 1.3)]. CONCLUSIONS: The DRD technique can detect changes in total body stores of vitamin A in response to different daily vitamin A supplements. However, abrupt changes in dietary vitamin A intake can affect estimates of total-body vitamin A stores.

Plasma kinetics of an oral dose of [2H4]retinyl acetate in human subjects with estimated low or high total body stores of vitamin A.

The deuterated retinol dilution technique is an indirect method for quantitatively estimating total body stores of vitamin A by using the postequilibration plasma isotopic ratio [2H4]retinol:retinol and the prediction model described by Furr et al (Am J Clin Nutr 1989;49:713-6). Limited data are available on the time required for an oral dose of labeled vitamin A to mix with vitamin A body stores in human subjects. This article describes the plasma retinol kinetics of an oral dose of [2H4] retinyl acetate in 4 healthy adults (2 men and 2 women) and 1 healthy female child in the United States and in 4 Bangladeshi women. After an oral dose of [2H4]retinyl acetate was administered, plasma samples were collected at 6, 12, and 24 h postdose during the first day and at 15 time points during the subsequent 90-d period for measurement of plasma [2H4]retinol:retinol. The mean respective plasma isotopic ratios on day 20 for US and Bangladeshi subjects (0.02 +/- 0.02 and 0.17 +/- 0.12, P = 0.03) and estimated total body vitamin A reserves (1.03 +/- 0.45 and 0.10 +/- 0.11 mmol, P = 0.003) were significantly different. The fraction of dose in plasma was plotted against time, and biexponential equations were fit to the kinetic data by using the time points from 24 h through day 90. The mean equilibration time (time required for the fraction of dose in plasma to reach a plateau) for all subjects was 16.6 +/- 3.8 d (11-23 d). There was no difference in estimated equilibration time between the group of US and Bangladeshi adult subjects (17.5 +/- 4.4 and 16.3 +/- 3.9 d, respectively, P = 0.69). Thus, the size of hepatic vitamin A reserves does not appear to affect equilibration time within the range of values observed.

Assessment of vitamin A status by the deuterated-retinol-dilution technique and comparison with hepatic vitamin A concentration in Bangladeshi surgical patients.

Hepatic stores of vitamin A were estimated in 31 Bangladeshi surgical patients (15 males and 16 females) by the deuterated-retinol-dilution (DRD) technique and by analysis of the vitamin A concentration of a liver biopsy specimen obtained during previously scheduled abdominal surgery. Patients ranged in age from 21 to 65 y and had an average body mass index (BMI: in kg/m2) of 17.7 +/- 3.4. They received 0.753 mumol [2H4]retinyl acetate/kg body wt orally 9-11 d before surgery. Hepatic vitamin A reserves were estimated according to Furr et al (Am J Clin Nutr 1989;49:713-6) by using a single plasma isotopic-ratio measurement (18-25 d postdose). Estimated mean hepatic vitamin A stores were similar by both techniques, 0.110 +/- 0.072 mmol (by DRD) compared with 0.100 +/- 0.067 mmol (by biopsy). Regression analysis was used to compare results of the DRD and biopsy techniques. A significant linear relation was found between the two techniques (r = 0.75, P < 0.0001), and the least-squares regression line was not significantly different from y = x (P = 0.09). The results indicate that the DRD technique provided a very good estimate of hepatic vitamin A reserves for this population. However, a wide prediction interval was observed for estimates of hepatic vitamin A reserves for individual subjects. Thus, further refinement of the prediction model is necessary to improve estimates of hepatic vitamin A reserves for individual subjects.