Serum retinol levels of persons aged 4-74 years from three Hispanic groups

Disproportionate Vitamin A Deficiency in Women of Specific Ethnicities Linked to Differences in Allele Frequencies of Vitamin A-Related Polymorphisms

Background: While the current national prevalence rate of vitamin A deficiency (VAD) is estimated to be less than 1%, it is suggested that it varies between different ethnic groups and races within the U.S. We assessed the prevalence of VAD in pregnant women of different ethnic groups and tested these prevalence rates for associations with the vitamin A-related single nucleotide polymorphism (SNP) allele frequencies in each ethnic group. Methods: We analyzed two independent datasets of serum retinol levels with self-reported ethnicities and the differences of allele frequencies of the SNPs associated with vitamin A metabolism between groups in publicly available datasets. Results: Non-Hispanic Black and Hispanic pregnant women showed high VAD prevalence in both datasets. Interestingly, the VAD prevalence for Hispanic pregnant women significantly differed between datasets (p = 1.973 × 10⁻¹⁰, 95%CI 0.04–0.22). Alleles known to confer the risk of low serum retinol (rs10882272 C and rs738409 G) showed higher frequencies in the race/ethnicity groups with more VAD. Moreover, minor allele frequencies of a set of 39 previously reported SNPs associated with vitamin A metabolism were significantly different between the populations of different ancestries than those of randomly selected SNPs (p = 0.030). Conclusions: Our analysis confirmed that VAD prevalence varies between different ethnic groups/races and may be causally associated with genetic variants conferring risk for low retinol levels. Assessing genetic variant information prior to performing an effective nutrient supplementation program will help us plan more effective food-based interventions.

Vitamin A is not associated with exacerbations in multiple sclerosis

BACKGROUND

Vitamin A is a multifunctional vitamin that can inhibit the formation of Th17 cells, which are probably involved in the development of relapses in MS. Furthermore, it promotes Treg formation. Therefore, vitamin A can be hypothesized to be lower in patients than in healthy controls, and to decrease relapse risk in relapsing-remitting MS (RRMS) patients.

OBJECTIVE

To compare vitamin A levels in MS patients and controls, and to investigate whether vitamin A levels are associated with relapse risk.

METHODS

In a case-control study all-trans-retinol levels were compared between 31 RRMS patients and 29 matched controls. In a prospective longitudinal study in 73 RRMS patients, serum samples for all-trans-retinol measurements were taken every eight weeks. Associations between all-trans-retinol concentrations and relapse rates were calculated using Poisson regression with the individual serum levels as time-dependent variable. Associations between vitamin A and vitamin D were calculated.

RESULTS

Mean vitamin A levels were lower in patients (2.16μmol/l) than in controls (2.44μmol/l) but with borderline significance (p=0.05). In the longitudinal study, during follow-up (mean 1.7 years), 58 patients experienced a total of 139 relapses. Monthly moving averages of all-trans retinol levels were categorized into tertiles: a low (<2.9μmol/l), medium (2.9-3.7μmol/l) and high level (>3.7μmol/l). Relapse rates were not associated with serum all-trans retinol levels (p>0.2), in univariate nor in multivariate analysis. Serum concentrations of all-trans-retinol and 25-OH-vitamin D were positively correlated, although this correlation was weak (r=0.15).

CONCLUSION

We did not find evidence for a role for vitamin A in the disease course of RRMS. We did find an association between vitamin A and D levels in the RRMS patients, possibly explained by dietary products that contain both fat-soluble vitamins.

Status of vitamins A and E in schoolchildren in the centre west of Tunisia: a population-based study

OBJECTIVE

The present study was undertaken to assess the status of vitamins A and E (VA and VE, respectively) and their main determinants in Tunisian children.

DESIGN

Cross-sectional population-based study.

SETTING

Kasserine Governorate in the centre west of Tunisia.

SUBJECTS

A total of 7407 children attending the first grade of elementary school were included. VA and VE were assessed by HPLC.

RESULTS

The prevalence of moderate VA deficiency (VAD; <0·70 μmol/l) was 2·3 % and VE deficiency (VED; <6·97 μmol/l) was 5·4 %. Low status in VA (0·70-1·05 μmol/l) and VE (6·97-11·61 μmol/l) was observed in 17 % and 20·2 % of children, respectively. No child exhibited severe VA or VE deficiency (<0·35 and <2·32 μmol/l, respectively). The main predictors of VAD were advanced age (OR = 1·65; 95 % CI 1·13, 2·41; P = 0·05) and sickness within the past 2 weeks (OR = 1·51; 95 % CI 1·09, 2·09; P = 0·01). Predictors of VED were living in the peri-urban region (OR = 1·60; 95 % CI 1·28, 2·01; P < 0·001) and sickness within the past 2 weeks (OR = 0·75; 95 % CI 0·60, 0·94; P = 0·01).

CONCLUSIONS

Moderate VAD and VED were uncommon in Tunisian children. However, low status in VA and/or VE remains frequent. A reinforcement of the national strategies for children's nutrition and health is needed, particularly in disadvantaged regions. Supplementation of VA and VE is not necessary in Tunisia, but food fortification may be beneficial.

Nutrition provided to Mexican-American preschool children on the Texas-Mexico border

The purpose of this study was to assess whether nutrients offered to border Mexican-American preschool children met the Recommended Dietary Allowances. Nutrient contents of two dietary patterns were examined in this study, one composed exclusively of home foods and one containing a combination of both home and school foods. The sample consisted of 198 Mexican-American preschoolers living on the Texas-Mexico border, who were recruited using a convenience sampling technique. A self-administered, precoded 24-hour recall questionnaire was used. Nutrient values of home foods were collected during a weekend day, and nutrient values containing a combination of both home and school foods were collected during a weekday. Fisher's exact test or chi2 test and t test were used for analyses. Mean nutrient contents of foods provided to the border Mexican-American children exceeded recommendations for total energy (P<0.001), total fat (P<0.001), saturated fat (P<0.001), carbohydrates (P<0.001), protein (P<0.001), sodium (P<0.001), and niacin (P<0.001). Foods offered were also significantly insufficient in fiber (P<0.001), vitamin A (P<0.001), and potassium (P<0.001). Nutrition interventions targeting low-income border Mexican-American families should emphasize the need and importance of providing children with diets that meet the Recommended Dietary Allowances.

Intraindividual variation in serum retinol concentrations among participants in the third National Health and Nutrition Examination Survey, 1988-1994

BACKGROUND

The biological variability in serum retinol concentrations has never been examined in a large sample, and its effect on population distribution estimates and the clinical assessment of vitamin A status is unknown.

OBJECTIVE

We evaluated the biological CV of serum retinol and examined the effect of the CV on both population distribution estimates and clinical assessments of vitamin A status by using data from the third National Health and Nutrition Examination Survey, 1988-1994.

DESIGN

We described the biological CV [(SD/x) x 100] and examined associations between the CV and other factors via multivariate analysis of variance and linear regression. We used linear regression to predict the mean retinol concentration from a single concentration and established 95% CIs for each participant. We estimated the adjusted prevalence of inadequate vitamin A status (retinol < 1.05 micromol/L) on the basis of the CIs. We estimated an uncertainty range for serum retinol concentrations for which the CIs included the established cutoff.

RESULTS

The mean biological CV across all strata was 6.45%. The biological CV varied significantly between racial-ethnic groups (P < 0.05). Prevalence estimates of inadequate serum retinol concentrations were reduced after adjustment for the total variation, with an adjusted overall prevalence of 0.62% compared with an unadjusted prevalence of 2.63%.

CONCLUSIONS

The actual population prevalence of inadequate vitamin A status may be 75% lower than the estimates previously reported. Confirmation of vitamin A status may be needed for persons in the United States with observed serum retinol concentrations near the recognized cutoff.

Alterations in cellular retinol metabolism contribute to differential retinoid responsiveness in normal human mammary epithelial cells versus breast cancer cells

The present study was undertaken to compare ROH growth responsiveness between normal human mammary epithelial cells (HMECs), estrogen receptor positive (MCF-7) and negative (MDA-MB-231) breast cancer cells, and assess whether this responsiveness is correlated with differences in ROH metabolism, particularly RA synthesis. HMECs were markedly more growth sensitive to a physiological dose of ROH than breast cancer cells, exhibiting a significant decrease in cell number by 48h and >70% decrease by 144h. In comparison, numbers of MCF-7s were only decreased 32% by 144h. MDA-MB-231 cells were not affected. However, HMECs and MCF-7 cells displayed similar growth responsiveness to 1 microM RA, while MDA-MB-231 cells were minimally affected. Although the initial rates and extent of ROH uptake were comparable among cell types, ROH levels in HMECs progressively decreased to 20% of the peak by 24h and < or = 10% by 72h. In contrast, ROH levels in the cancer cells remained relatively constant through 48 h. The decrease in HMEC ROH was attributable to greater metabolism as evidenced by rapid and predominant retinyl ester formation. HMECs also produced approximately 5 times more RA from ROH than MCF-7s and approximately 10 times more than MDA MB-231 cells. Our results demonstrate that normal HMECs are markedly more responsive to the growth inhibitory effects of ROH than breast cancer cells, and that this responsiveness is associated with greater ROH metabolism including greater RA synthesis. These data suggest that altered ROH metabolism may be a factor in breast cancer progression.

Plasma retinol and tocopherol levels in greek elderly population from an urban and a rural area: associations with the dietary habits

Data on plasma concentrations of retinol and alpha-tocopherol in elderly (over 65 years) living in the Mediterranean countries are sparse. In the current study, plasma retinol and alpha-tocopherol concentrations were determined in 200 healthy subjects (82 men and 112 women) residing in an urban and in a rural area in South Western Greece. High prevalence of low plasma retinol concentration was observed for both sexes in each area. The 16.7% of males in urban and 25.4% in rural area had plasma retinol levels below 0.3 mg/l. The corresponding values for female subjects were 26% and 20.3%. Plasma alpha-tocopherol was found to be within normal range in the rural area (only one male had plasma alpha-tocopherol below 5 mg/l) while in the urban area 68.3% of men and 62% of women had plasma alpha-tocopherol values below 5 mg/l. Differences in dietary habits between subjects living in the rural and in the urban area were revealed through a weekly food frequency questionnaire. This could partly explain the difference in alpha-tocopherol concentrations between the two areas. The results of this study revealed high risk of vitamin A and E deficiency and suggests that the health care system in Greece should pay more attention on the social and health status of its elderly population.

Serum concentrations of retinol, alpha-tocopherol and the carotenoids are influenced by diet, race and obesity in a sample of healthy adolescents

An important part of understanding the functions of vitamin A, vitamin E and the carotenoids in nutritional status assessment, health promotion and disease prevention is knowledge of factors that influence their distribution in human tissues. Our objective was to examine serum concentrations of these nutrients and compounds in a sample of 285 healthy participants, 12-17 y old, from three U. S. cities. Pearson correlations between diet measured with a food frequency questionnaire and serum nutrient concentrations among these adolescents (adjusted for total serum cholesterol, age, sex, race and body mass index) were as follows: retinol, 0.23; alpha-tocopherol, 0.16; alpha-carotene, 0.31; beta-carotene, 0.15; beta-cryptoxanthin, 0.38; lycopene, 0.08; and lutein + zeaxanthin, 0.25. Multivariate linear regression modeled associations of demographic, dietary and physiologic variables with serum concentrations of these nutrients. African-American participants had significantly lower concentrations of serum retinol (P < 0.001), alpha-tocopherol (P < 0.01) and alpha-carotene (P < 0.02), but higher concentrations of lutein + zeaxanthin (P = 0.001) compared with Caucasians. Obese participants had serum nutrient concentrations that were 2-10% (P < 0.05) lower than normal weight participants. Dietary intake was a significant predictor of all serum analytes (P < 0.01) except lycopene. These models explained 20% of the variability in serum retinol, 28% of the variability in serum alpha-tocopherol, and 14-24% of the variability in serum carotenoids.

Metabolic conversion of retinol to retinoic acid mediates the biological responsiveness of human mammary epithelial cells to retinol

The biological effects of vitamin A are mediated in part by retinoic acid (RA) modulation of gene transcription. In this study, we examined whether normal human mammary epithelial cells (HMECs) are biologically responsive to retinol (ROH), the metabolic precursor of RA. While both ROH and tRA resulted in time- and dose-dependent decreases in total cell number, tRA was markedly more potent. Metabolically, treatment of HMECs with physiological doses of ROH resulted in rapid uptake and subsequent production of both retinyl esters and tRA. Although a comparatively minor metabolite, tRA levels peaked at 6 h and remained above endogenous levels for up to 72 h in proportion to cellular ROH concentrations. In HMECs transfected with an RA-responsive luciferase reporter gene, treatment with 3 microM ROH resulted in an increase in luciferase activity to a level intermediate between that observed with 0.001 and 0.01 microM tRA. Citral, an RA-synthesis inhibitor, was also used to examine the biological activity of ROH. Compared to ROH alone, ROH plus citral treatment resulted in three-fold less tRA synthesis and a > 65% attentuation of RA-responsive reporter gene activity which persisted through 72 h. Citral also significantly attenuated the extent of ROH-mediated reductions in total HMEC number. Thus, treatment with physiological concentrations of ROH results in fewer total numbers of HMECs and this response is a consequence of cellular tRA synthesis which can induce RA-responsive gene expression.

Serum retinol distributions in residents of the United States: third National Health and Nutrition Examination Survey, 1988-1994

BACKGROUND

Inadequate vitamin A status has been a potential nutritional problem for some segments of the US population, particularly children and the poor.

OBJECTIVE

We evaluated serum retinol concentration by using population-representative data from 16058 participants aged 4 to >/=90 y in the third National Health and Nutrition Examination Survey, 1988-1994.

DESIGN

We used multivariate regression to examine the simultaneous associations of sociodemographic, biologic, and behavioral factors with serum retinol concentration.

RESULTS

In children, serum retinol concentrations were greater with greater age, body mass index, serum lipids, and the use of supplements containing vitamin A. In adults, male sex, serum lipids, alcohol consumption, and age were positively associated with serum retinol concentration in most racial/ethnic strata. Household income was not associated with serum retinol concentration in children; associations were inconsistent in adults. The prevalence of serum retinol <0.70 micromol/L was very low in all strata; the prevalence of serum retinol <1.05 micromol/L was 16.7-33.9% in children aged 4-8 y and 3.6-14.2% in children aged 9-13 y, depending on sex and racial/ethnic group. The prevalence of serum retinol<1.05 micromol/L was higher in non-Hispanic black and Mexican American children than in non-Hispanic white children; these differences remained significant (P < 0.0001) after covariates were controlled for. Among adults, nonwhite women were significantly (P < 0.0001) more likely than white women to have serum retinol <1.05 micromol/L after covariates were controlled for.

CONCLUSIONS

Clinically low serum retinol concentration is uncommon in US residents aged > or = 4 y, although racial/ethnic and socioeconomic differences in serum retinol concentration still exist.

Serum retinol, the acute phase response, and the apparent misclassification of vitamin A status in the third National Health and Nutrition Examination Survey

BACKGROUND

Serum retinol decreases transiently during the acute phase response and can thus result in misclassification of vitamin A status.

OBJECTIVE

Our objective was to determine the prevalence of acute phase response activation in a representative sample of the US population, identify the factors associated with this activation, and determine whether persons with an active acute phase response have lower serum retinol concentrations.

DESIGN

Data from the third National Health and Nutrition Examination Survey (NHANES III) were analyzed. A serum C-reactive protein (CRP) concentration >/=10 mg/L indicated an active acute phase response.

RESULTS

Mean serum retinol was lowest in subjects aged <10 y and increased with age. Concentrations were higher in males than in females aged 20-59 y. The prevalence of a CRP concentration >/=10 mg/L was lowest in subjects aged <20 y (</=4%) and increased with age to a maximum of nearly 15%. An elevated CRP concentration was 2.4-fold greater in females than in males aged 20-59 y. Serum retinol was lower in subjects with elevated CRP concentrations.

CONCLUSIONS

Serum retinol increases with age and males have higher mean values than do females aged 20-59 y. The prevalence of a CRP concentration >/=10 mg/L also increases with age, is 2-fold greater in females than in males aged 20-69 y, and is associated with common inflammatory conditions. Thus, inflammation appeared to contribute to the misclassification of vitamin A status in the NHANES III population, and serum CRP is useful in identifying subjects who may be misclassified.

Reference values for plasma concentrations of vitamin E and A and carotenoids in a Swiss population from infancy to adulthood, adjusted for seasonal influences

In a cross-sectional survey, plasma concentrations of α- and γ-tocopherol, α- and β-carotene (cis and trans isomers), lycopene, and retinol were determined by reversed-phase HPLC, and ratios of plasma α-tocopherol to cholesterol were calculated in 208 Swiss individuals ages 0.4–38.7 years. The influence of age, sex, and season of sampling was studied. Age was a significant predictor of all plasma concentrations except α-carotene. No sex-related differences were observed. Season of sampling affected α-tocopherol and retinol (higher in winter) and γ-tocopherol and cholesterol concentrations (higher in winter and spring than in the other seasons). After correction for seasonal influences, age differences were 0.24 μmol/L per year for α-tocopherol, 0.04 μmol/L per year for retinol, and 0.04 μmol/L per year for cholesterol concentrations; ratios of plasma α-tocopherol to cholesterol were not affected by age. We constructed age-specific reference intervals from the regression line and a multiple of the standard deviation. Separate regression equations are presented for seasons with low and high values.

Epidemiologic studies utilizing surveys: accounting for the sampling design

BACKGROUND

Since large-scale health surveys usually have complicated sampling schemes, there is often a question as to whether the sampling design must be considered in the analysis of the data. A recent disagreement concerning the analysis of a body iron stores-cancer association found in the first National Health and Nutrition Examination Survey and its follow-up is used to highlight the issues.

METHODS

We explain and illustrate the importance of two aspects of the sampling design: clustering and weighting of observations. The body iron stores-cancer data are reanalyzed by utilizing or ignoring various aspects of the sampling design. Simple formulas are given to describe how using the sampling design of a survey in the analysis will affect the conclusions of that analysis.

RESULTS

The different analyses of the body iron stores-cancer data lead to very different conclusions. Application of the simple formulas suggests that utilization of the sample clustering in the analysis is appropriate, but that a standard utilization of the sample weights leads to an uninformative analysis. The recommended analysis incorporates the sampling weights in a nonstandard way and the sample clustering in the standard way.

CONCLUSIONS

Which particular aspects of the sampling design to use in the analysis of complex survey data and how to use them depend on certain features of the design. We give some guidelines for when to use the sample clustering and sample weights in the analysis.

Serum concentrations of carotenoids, retinol, and alpha-tocopherol in healthy persons determined by high-performance liquid chromatography

Serum concentrations of alpha-carotene (AC), beta-carotene (BC), lycopene (LY), beta-cryptoxanthin (CR), zeaxanthin (including lutein. ZX), canthaxanthin (CX), retinol (RE), and alpha-tocopherol (TO) in healthy persons (618 males and 1,196 females) aged 7-86 years were determined by HPLC. Serum concentrations of BC among persons aged 20-49 years were higher with increasing age in females, but not in males. Serum CR concentrations decreased with age ranging from 7 to 39 years, while ZX concentrations rose in the age group of 20 to 59 years for both sexes. In contrast, serum RE concentrations and ratios of RE/BC and RE/CR, especially in males aged 20-49, were higher with age. Serum TO values in both sexes rose with age and were similar.