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Article

Re-Defining the Population-Specific Cut-Off Mark for Vitamin A Deficiency in Pre-School Children of Malawi

1
Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi
2
Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
*
Authors to whom correspondence should be addressed.
Academic Editor: Begoña Olmedilla-Alonso
Nutrients 2021, 13(3), 849; https://doi.org/10.3390/nu13030849
Received: 12 February 2021 / Revised: 23 February 2021 / Accepted: 2 March 2021 / Published: 5 March 2021
(This article belongs to the Special Issue Nutrition Assessment Methodology: Current Update and Practice)
Retinol Binding Protein (RBP) is responsible for the transport of serum retinol (SR) to target tissue in the body. Since RBP is relatively easy and cheap to measure, it is widely used in national Micronutrient Surveys (MNS) as a proxy for SR to determine vitamin A status. By regressing RBP concentration against SR concentration measured in a subset of the survey population, one can define a population-specific threshold concentration of RBP that indicates vitamin A deficiency (VAD). However, the relationship between RBP and SR concentrations is affected by various factors including inflammation. This study, therefore, aimed to re-define the population-specific cut-off for VAD by examining the influence of inflammation on RBP and SR, among pre-school children (PSC) from the 2015–16 Malawi MNS. The initial association between RBP and SR concentrations was poor, and this remained the case despite applying various methods to correct for inflammation. The World Health Organization (WHO) recommends the threshold of 0.7 µmol/L to define VAD for SR concentrations. Applying this threshold to the RBP concentrations gave a VAD prevalence of 24%, which reduced to 10% after inflammation adjustments following methods developed by the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA). Further research is required to identify why SR and RBP were poorly associated in this population. Future MNS will need to account for the effect of inflammation on RBP to measure the prevalence of VAD in Malawi. View Full-Text
Keywords: vitamin A; retinol binding protein; serum retinol; inflammation; c-reactive protein; alpha-1 acid glycoprotein vitamin A; retinol binding protein; serum retinol; inflammation; c-reactive protein; alpha-1 acid glycoprotein
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MDPI and ACS Style

Likoswe, B.H.; Joy, E.J.M.; Sandalinas, F.; Filteau, S.; Maleta, K.; Phuka, J.C. Re-Defining the Population-Specific Cut-Off Mark for Vitamin A Deficiency in Pre-School Children of Malawi. Nutrients 2021, 13, 849. https://doi.org/10.3390/nu13030849

AMA Style

Likoswe BH, Joy EJM, Sandalinas F, Filteau S, Maleta K, Phuka JC. Re-Defining the Population-Specific Cut-Off Mark for Vitamin A Deficiency in Pre-School Children of Malawi. Nutrients. 2021; 13(3):849. https://doi.org/10.3390/nu13030849

Chicago/Turabian Style

Likoswe, Blessings H., Edward J.M. Joy, Fanny Sandalinas, Suzanne Filteau, Kenneth Maleta, and John C. Phuka. 2021. "Re-Defining the Population-Specific Cut-Off Mark for Vitamin A Deficiency in Pre-School Children of Malawi" Nutrients 13, no. 3: 849. https://doi.org/10.3390/nu13030849

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