Oral contraceptives: effect of long-term use on liver vitamin A storage assessed by the relative dose response test.

Vitamin A status measured by the relative dose response (RDR) test was determined among groups of Northern Thai women who had used estrogen-containing oral contraceptives (OCs) with or without multivitamin supplements through 13 cycles. Mean serum vitamin A values were elevated approximately 40% above those of control subjects (intrauterine contraceptive device (IUCD) users) during OC usage. Daily (one capsule) or periodic (two capsules 7 d/mo) multivitamin supplementation that included 1700 micrograms vitamin A per capsule did not significantly influence vitamin A serum values. The RDR test after 13 cycles was elevated in one individual who had taken OCs and the periodic multivitamin supplement. It reverted to normal after supplementation with vitamin A. A single high-dose vitamin A supplement (68,000 micrograms) did not change circulating levels of the vitamin. Among this population there is little evidence that use of estrogen-containing OCs for greater than 1 y resulted in a physiologically significant deterioration of vitamin A status.

PIP: Vitamin A status measured by the relative dose response (RDR) test was determined among groups of Northern Thai women who had used estrogen- containing oral contraceptives (OCs) with or without multivitamin supplements through 13 cycles. Mean serum vitamin A values were elevated approximately 40% above those of control subjects (IUD users) during OC usage. Daily (1 capsule) or periodic (2 capsules 7 days/month) multivitamin supplementation that included 1700 mcg vitamin A/capsule did not significantly influence vitamin A serum values. The RDR test after 13 cycles was elevated in 1 individual who had taken OCs and the periodic multivitamin supplement. It reverted to normal after supplementation with vitamin A. A single high-dose vitamin A supplement (68,000 mcg) did not change circulating levels of the vitamin. Among this population there is little evidence that use of estrogen-containing OCs for more than 1 year resulted in a physiologically significant deterioration of vitamin A status.

Plasma vitamin A, retinol-binding protein and prealbumin concentrations in protein-calorie malnutrition. III. Response to varying dietary treatments.

Plasma vitamin A, retinol-binding protein, and prealbumin concentrations have been studied in 38 northern Thai children with protein-calorie malnutrition (PCM). The 4-week study period consisted of 1 week of stabilization followed by 3 weeks of treatment with formula diets varying in their protein and calorie content. The stabilization period comprised 7 days of initial treatment with fluids, antibiotics, and a gradually increasing intake of protein and calories to a final level of 1 g protein and 100 kcal/kg of body weight. During this period vitamin A, retinol-binding protein and prealbumin levels all showed significant increases compared to admission values, whereas plasma albumin and total protein did not change. During the subsequent 3 weeks, the effects of four different dietary regimens, with daily calorie and protein intakes of 100 or 175 kcal/kg and 1 or 4 g/kg, respectively, were studied. Significant increases in plasma total protein concentration were seen in each of the four test groups, and increases in plasma albumin and prealbumin were also seen in three of the four test groups, and increases in plasma albumin and prealbumin were also seen in three of the four test groups (all but the 175 kcal-1 g protein group). Significant increases in plasma vitamin A levels were not seen in any of the groups. The higher protein regimens (4 g/kg per day) resulted in much greater increases in plasma albumin and total protein levels than did the lower protein regimens. No significant differences in the changes in retinol-binding protein or vitamin A levels were apparent between the test groups. Sixteen additional children with both clinical vitamin A deficiency and protein-calorie malnutrition showed significant increases in total plasma vitamin A concentrations 24 hours after the intramuscular injection of 100,000 IU water-miscible vitamin A palmitate, without a change in plasma retinol-binding protein concentrations. These studies demonstrate that plasma retinol-binding protein and prealbumin concentrations are more rapidly responsive and sensitive to dietary protein intake than is plasma albumin concentration. Furthermore, the absence of a 24-hour rise in plasma retinol-binding protein after parenteral vitamin A provides further evidence that hepatic retinol-binding protein synthesis is impaired in protein-calorie malnutrition.

Iron deficiency in a Northern Thai population: the effects of iron supplements studied by means of plasma ferritin estimations.

Iron deficiency is a common problem, particularly in developing countries, but traditional laboratory methods of detecting this condition are unreliable. The prevalence of iron deficiency in a Northern Thai population (pre-school, school children, adult women) has been assessed by means of plasma ferritin concentrations. The results were compared with prevalences based on blood haemoglobin concentrations. Estimations of prevalences based on plasma ferritin values were 10-24% in non-vegetarian and 49-71% in vegetarian groups, whilst those based on blood haemoglobin were 11-21% (non-vegetarian) and 24-50% (vegetarian). Dietary supplementation with iron produced dramatic rises in plasma ferritin in all of the groups studied. The effects on blood haemoglobin concentration and haematocrit were less marked. These results highlight the extent of iron deficiency in a Thai population and demonstrate the sensitivity of plasma ferritin as a test for detecting this condition and assessing the response to dietary supplementation.

A study of the mechanism of weight gain in medroxyprogesterone acetate users.

Twelve non-lactating Thai women using the injectable contraceptive medroxyprogesterone acetate (DMPA) were studied in order to elucidate the mechanism of weight gain frequently seen among DMPA users. The study design included repeated estimations of body fluid compartments (total, extracellular and intravascular) and of nitrogen metabolism, as well as anthropometric measurements. The mean weight remained constant in this group of women after one year of treatment. But 25% of them demonstrated a mean weight gain of 6.05 kilograms, while another 25% showed a mean weight loss of 3.50 kilograms. None of the subjects (including those who gained and lost weight) showed significant changes in her fluid compartmental size, creatinine excretion rate, or nitrogen metabolism. However, skin-fold thicknesses were positively correlated to body weight changes. It can be concluded that medroxyprogesterone acetate when used as injectable contraceptive does not appear to have significant anabolic or fluid retaining properties, and that weight gain appears to be associated mainly with fat deposition.

PIP: It is well known that medroxyprogesterone acetate (DMPA) can cause weight increases. 12 DMPA users were examined for 1 year in order to estimate distribution of body fluid and nitrogen metabolism. Although mean weight remained unchanged, 25% showed a mean weight loss of 3.50 kg. No subject showed significant changes in fluid compartment size, although skin-fold thickness was positively correlated to changes in body weight. These results show that weight gain during DMPA use is associated with fat deposit, and not with fluid retention.

Vitamin and trace mineral metabolism in medroxyprogesterone acetate users.

The effect of one year's continual use of medroxyprogesterone acetate as an injectable contraceptive (150 mg I.M. every 90 days) on vitamin (A, B-carotene, E, B-1, B-2, B-6, oral tryptophan load test, folate and B-12) and trace mineral metabolism (Na, K, Ca, Mg, Cu, Zn and phosphorus) were assessed before and at the 3rd week, 3rd, 6th, 9th and 12th months after initiation of daily treatment with a vitamin-mineral supplement, in 12 non-lactating helathy Thai women. Neither vitamin nor trace mineral metabolism changed significantly as a result of treatment when compared to the pre-treatment control, suggesting that this form of hormonal contraceptive did not interfere with any of the parameters studied.

alpha 2HS-glycoprotein serum levels in protein-energy malnutrition.

1. alpha 2HS-glycoprotein accumulates in bone and dentine and its plasma levels could vary in conditions in which the rate of bone formation is altered. 2. The plasma concentration of this protein was found to be lower in thirteen children suffering from protein-energy malnutrition compared with age-matched healthy preschool children. 3. This finding might be associated with the phenomenon of stunting in protein-energy malnutrition.

Plasma somatomedin and growth hormone values in children with protein-calorie malnutrition.

This study was undertaken to define the interrelationships of somatomedin, growth hormone, and an inhibitor of SM in protein-calorie malnutrition. Twenty-seven patients, eight to 60 months of age, were studied. Twenty-one well-nourished children acted as controls. SM was significantly depressed at Days 2 and 8 (p less than 0.01) but was not different from controls at Day 29 and 50. In ten out of 27 Day 2 samples and six out of 27 Day 8 samples an inhibitor was identified. When SM values were compared to simultaneous hGH levels, there was an inverse relationship. The low SM levels in the face of markedly elevated hGH levels suggests a functional block in the synthesis and/or release of SM.

The early changes in retinol-binding protein and prealbumin concentrations in plasma of protein-energy malnourished children after treatment with retinol and an improved diet.

1. Changes in total retinol-binding protein (RBP), the holoprotein (holoRBP) and prealbumin (PA) concentrations have been monitored in plasma of thirty protein- and vitamin A-deficient preschool children from within a few hours up to 7 weeks after treatment with retinol and a good-quality protein diet. 2. The children were classified into groups according to nutritional status as having either kwashiorkor, marasmus-kwashiorkor or marasmus, and given formula diets whose protein and energy contents increased stepwise from 1 g and 105 kJ/kg body-weight respectively up to 4 g and 733 kJ/kg body-weight after 4 weeks. Retinol was administered in the forms of retinyl palmitate either orally or intramuscularly. 3. PA and total RBP were determined by electroimmunoassay procedures and the holoRBP by its fluorescence after separation from other plasma proteins. 4. RBP in plasma of the vitamin A-deficient child is largely denatured and incapable of binding administered retinol, which must first be taken up by the liver before native holoRBP is released. An increased pool of native apoprotein accumulates in the liver during vitamin A deficiency which is released into plasma quickly after retinol uptake to form peak concentrations of total and holoRBP approximately 3 h after dosing intramuscularly and 6 h orally. 5. The accumulated pool of RBP was highest in livers from the marasmus group and lowest in those from the kwashiorkor group, reflecting their relative capacities to synthesize plasma proteins. 6. The mean plasma concentrations of total and holoRBP for the various groups were minimal 24-48 h after dosing with retinol and then improved almost linearly over the following week. 7. Mean plasma PA concentrations of the various groups on admission were also in order of the severity of their malnutrition. There was little or no change in this protein concentration over the first 24 h after dosing with retinol, but thereafter the mean values rose almost linearly over 2 weeks. Albumin on the other hand changed little during the first week. The results show that PA is the more sensitive measurement of protein nutritional status.