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. 2013 Sep;16(9):1540-7.
doi: 10.1017/S1368980012004351. Epub 2012 Oct 1.

The importance of controlling for the acute-phase response in the population-based assessment of vitamin A status: a study in children of pre-school age in Uganda

Rhona Baingana  1 , Dennis Matovu-Kasozi, Dean Garrett
Affiliations

The importance of controlling for the acute-phase response in the population-based assessment of vitamin A status: a study in children of pre-school age in Uganda

Rhona Baingana et al. Public Health Nutr. 2013 Sep.

Abstract

Objective: To improve estimates of vitamin A deficiency in children of pre-school age in the 2006 Uganda Demographic and Health Survey (UDHS 2006).

Design: A cross-sectional study in which dried blood spot samples were analysed for C-reactive protein (CRP). Retinol-binding protein (RBP) had previously been analysed using a commercial enzyme immunoassay.

Setting: A population-based study in Uganda.

Subjects: A systematically selected subset of the dried blood spot samples collected from children aged 6–59 months for UDHS 2006. Children were categorized into ‘normal CRP’ (Group A) and ‘raised CRP’ (Group B) using a CRP cut-off of 5mg/l. A correction factor was calculated to adjust the Group B RBP values for the influence of the acute-phase response.

Results: Geometric mean CRP was 6.2 (95% CI 5.5, 7.0) mg/l, 1.6 (95% CI 1.5, 1.8) mg/l and 17.9 (95% CI 16.4, 19.6) mg/l in all children, in Group A and in Group B, respectively. Geometric mean RBP in all children, in Group A and in Group B was 1.18 (95% CI 1.14, 1.22)mmol/l, 1.26 (95% CI 1.20, 1.33)mmol/l and 1.12 (95% CI 1.07, 1.17)mmol/l, respectively, before correction. Correction increased mean RBP in Group B to 1.26 (95% CI 1.21, 1.31)mmol/l. The prevalence of vitamin A deficiency (RBP,0.825mmol/l) reduced from 18.4% (95% CI 17.2, 23.0%) to 13.9% (95% CI 11.3, 16.5%).

Conclusions: Correcting for the acute-phase response significantly reduced the prevalence of vitamin A deficiency; thus, the acute-phase response should be considered when vitamin A status is assessed using RBP in order to improve population-level estimates of vitamin A deficiency.

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Figures

Fig. 1
Fig. 1
Retinol-binding protein (RBP) in children (aged 6–59 months, n 661) before (formula image) and after correction (formula image) for the influence of the acute-phase response, 2006 Uganda Demographic and Health Survey. Values are geometric means, with 95 % confidence intervals represented by vertical bars. The difference in mean RBP of Group A (n 293) and Group B (n 368) before correction was significant: *P < 0·0001
See this image and copyright information in PMC

References

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