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Predictors of serum retinol in children with shigellosis
A K Mitra1, J O Alvarez, M A Wahed
1Department of International Health, The University of Alabama at Birmingham, USA.
Insights
Infections like shigellosis cause a temporary drop in serum retinol levels, independent of vitamin A stores. This decrease is linked to disease severity and poor nutritional status in children.
Area of Science:
- Nutritional Biochemistry
- Infectious Diseases
- Pediatrics
Background:
- Low serum retinol can indicate depleted vitamin A stores but also decreases transiently during infection.
- Infection-related serum retinol reduction is independent of liver vitamin A stores.
- The extent of serum retinol decrease often correlates with disease severity.
Purpose of the Study:
- To investigate the relationship between serum retinol in children with shigellosis and illness severity.
- To assess correlations with nutritional status, urinary retinol excretion, and inflammatory markers.
- To examine serum concentrations of C-reactive protein, alpha1-acid glycoprotein, retinol binding protein, and transthyretin.
Main Methods:
- Prospective study of 90 children with dysentery (66 with shigellosis) in Bangladesh.
- Clinical and laboratory measurements were taken at admission and recovery.
- Utilized multiple regression analysis to identify independent associations.
Main Results:
- Serum retinol levels were significantly lower at admission than at discharge (0.36 vs. 1.15 micromol/L).
- Children with Shigella dysenteriae type 1 had lower serum retinol than those with less virulent strains.
- Low serum retinol was independently associated with S. dysenteriae type 1, high C-reactive protein, and low weight-for-age.
Conclusions:
- Shigellosis causes a significant, transient decrease in serum retinol concentrations (approx. 0.8 micromol/L).
- This retinol decrease is significantly associated with disease severity.
- Poor underlying nutritional status, especially low weight-for-age, is linked to this retinol reduction.
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.