Relationship between vitamin A deficiency, malnutrition, and conjunctival impression cytology

One hundred seventy-eight children from three villages were studied in a cross-sectional fashion to evaluate the efficacy of conjunctival impression cytology (CIC) to characterize vitamin A status of individual children and populations of children and to examine the relationship of vitamin A status to nutritional status. Although children with abnormal CIC results had lower retinol concentrations than those with normal CIC results (P < 0.02), CIC exhibited poor sensitivity and specificity. Results of a CIC prevalence criterion were concordant with plasma retinol criteria in characterizing the vitamin A status of each community. Plasma retinol measurements, but not CIC, were associated with height (P < 0.003) and severe stunting (P < 0.001). We conclude that although CIC was a poor indicator of an individual child's vitamin A status, it accurately characterized the risk of vitamin A deficiency of communities. Furthermore, vitamin A deficiency defined by circulating retinol measurements but not CIC is associated with poor linear growth.