Proxy markers of serum retinol concentration, used alone and in combination, to assess population vitamin A status in Kenyan children: a cross-sectional study

BMC Medicine

Alida Melse-Boonstra²  Paul JM Hulshof²  Anne S Mburu-de Wagt²  Inge D Brouwer²  Hans Verhoef¹  Elise F Talsma² 

[1] Medical Research Council (MRC), Keneba, The Gambia;Division of Human Nutrition, Wageningen University, P.O. Box 8129, Wageningen, 6700 EV, the Netherlands

关键词: Diagnosis;    Inflammation;    Transthyretin;    Retinol binding protein;    Retinol;    Predictive value of tests;    Sensitivity and specificity;    ROC curve;    Discriminant analysis;    Vitamin A deficiency;   

Others  :  1122473
DOI  :  10.1186/s12916-014-0256-5

 received in 2014-10-13, accepted in 2014-12-12,  发布年份 2015

【 摘 要 】

Background

Serum retinol concentration determined by high-performance liquid chromatography (HPLC) is recommended by the World Health Organization to assess population vitamin A status. This assay is expensive, technically demanding and rarely available in developing countries. Our objective was a) to assess the diagnostic performance of proxy markers in detecting vitamin A deficiency and b) to derive decision rules based on these markers to estimate vitamin A deficiency prevalence.

Methods

A survey was conducted in 15 rural primary schools in Eastern Province, Kenya, with 375 children aged 6 to 12 years (25 randomly selected per school). Serum retinol concentration <0.70 μmol/L by HPLC was used to define vitamin A deficiency. Proxy markers for vitamin A deficiency were serum concentrations of retinol binding protein (RBP), transthyretin, retinol measured by fluorometry and RBP:transthyretin molar ratio.

Results

The prevalence of vitamin A deficiency (HPLC) was 18%. Transthyretin and RBP showed the best diagnostic performance individually, with area-under-the-curve (AUC) values of 0.96 and 0.93. When combined, and with C-reactive protein added, the AUC increased to 0.98. A simple decision rule {(−15.277 × [RBP, μmol/L] - 7.013 × [Transthyretin, μmol/L] + 0.367 × [C-reactive protein, mg/L] + 24.714) > 0.496} yielded prevalence estimates of vitamin A deficiency that is unbiased by diagnostic error.

Conclusions

The combination of transthyretin, RBP and C-reactive protein concentrations could eventually replace retinol concentration by HPLC in resource-poor settings as the preferred method to assess the population burden of vitamin A deficiency.

【 授权许可】

   
2015 Talsma et al.; licensee BioMed Central.

【 图 表 】

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