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Biochemical indicators of vitamin A depletion in children with cholestasis
Insights
Infants with severe cholestasis have critically low liver vitamin A reserves early in life. Plasma vitamin A levels are unreliable indicators of vitamin A status in these children, except when below 10 micrograms/dL.
Area of Science:
- Biochemistry
- Pediatric Nutrition
- Hepatology
Background:
- Severe cholestasis in infants can lead to early nutritional deficiencies.
- Vitamin A status is crucial for infant development and immune function.
- Assessing vitamin A levels in cholestatic infants presents diagnostic challenges.
Purpose of the Study:
- To evaluate vitamin A status in children with severe early-onset cholestasis.
- To compare liver and plasma vitamin A concentrations between cholestatic and non-cholestatic children.
- To determine the reliability of plasma vitamin A as an indicator in cholestatic infants.
Main Methods:
- Measurement of liver vitamin A concentrations (micrograms of retinol per gram of liver).
- Measurement of plasma vitamin A concentrations (micrograms of retinol per deciliter).
- Assessment of plasma retinol-binding protein levels.
Main Results:
- Cholestatic children had significantly lower mean liver vitamin A concentrations (6.3 +/- 7.1 µg/g) compared to non-cholestatic children (143 +/- 108 µg/g).
- In infants under 6 months, 14 of 17 cholestatic infants had liver vitamin A < 10 µg/g, versus none of 3 non-cholestatic infants.
- Plasma vitamin A levels < 10 µg/dL correlated with liver concentrations < 10 µg/g, but higher plasma levels were poor indicators.
Conclusions:
- Infants with chronic cholestasis exhibit precarious vitamin A nutritional status very early in life.
- Liver vitamin A reserves are severely depleted in early-onset cholestasis.
- Plasma vitamin A measurements are unreliable indicators of vitamin A status in cholestatic infants, except at very low concentrations.
Abstract:
Biochemical indicators of vitamin A status were measured in 24 children (1 month to 6 years old) with severe cholestasis starting early in life and in 21 children (3 months to 13 years old) with liver disease but without cholestasis. Liver vitamin A concentrations, expressed as micrograms of retinol per gram of liver (mean +/- S.D.), were 6.3 +/- 7.1 (range: 0.14 to 28) and 143 +/- 108 (range: 18 to 424), respectively, in cholestatic and non-cholestatic children. In infants less than 6 months of age, liver vitamin A values less than 10 micrograms per gm were found in 14 of 17 cholestatic children but in none of 3 non-cholestatic subjects. Plasma vitamin A values, expressed as micrograms of retinol per deciliter (mean +/- S.D.), were 23 +/- 18 (range: 3 to 62) and 46 +/- 33 (range: 14 to 125), respectively, for the two groups. Plasma retinol values less than 10 micrograms per dl were always associated with liver concentrations less than 10 micrograms per gm. Plasma retinol-binding protein was only reduced to 71% of control values in cholestatic children. The fatty acid composition of liver retinyl esters was unaffected by any condition studied. Infants with chronic cholestasis are in a precarious nutritional status very early in life relative to liver reserves of vitamin A. Plasma vitamin A values, unless less than 10 micrograms retinol per dl, are poor indicators of inadequate vitamin A status.