Association Between Retinol-binding Protein and Sarcopenia in General Inpatient Older Adults: a Cross Sectional Study

Objective: This study aims to evaluate the relationship between serum retinol binding protein levels and sarcopenia in elderly general hospitalized patients. Methods: This cross-sectional study included 682 elderly patients with Barthel-index ≥100 on admission. Sarcopenia was defined according to the recently updated Asian Sarcopenia Working Group 2019 criteria. The skeletal muscle mass index was measured by dual-energy X-ray absorptiometry. Serum prealbumin, albumin, hemoglobin, blood creatinine, alanine aminotransferase, aspartate aminotransferase, and retinol binding protein are also detected. Multivariate logistic regression analysis was used to evaluate the association between serum RBP levels and sarcopenia, and to adjust for potential confounding factors.Results:There are 105 cases of sarcopenia, 56 males and 49 females. The total prevalence of sarcopenia is 15.40% in general inpatients, of which 16.47% are males and 14.33% are females.For men and women, it was observed that the serum retinol binding protein in sarcopenia patients was significantly lower than that without sarcopenia (24.43±8.12 vs 29.98±9.91, P<0.001) and(23.27±5.13 vs 28.35±6.63, P < 0.001),The fully adjusted model showed that male and female low retinol binding protein participants had a 2.341(1.176,4.660) and 2.911(1.324-6.400) times higher risk of sarcopenia than normal retinol binding protein respectively.Conclusion: Low levels of retinol binding protein are associated with an increased risk of sarcopenia in elderly general hospitalized patients.

Effect of HIV status and retinol on immunogenicity to oral cholera vaccine in adult population living in an endemic area of Lukanga Swamps, Zambia

Background We set out to assess the impact of human immunodeficiency virus (HIV) and micronutrient deficiency as indicated by serum retinol levels on the immune responses to Oral Cholera Vaccine (Shanchol™) in a cohort of participants in Lukanga Swamps, Zambia. Cholera remains endemic in Zambia with vaccines being the only effective preventive measures. However, the effect of these vaccines on populations living with HIV has not been widely documented. Methods HIV testing and confirmation was done using the Alere Determine™ HIV-1/2 and Uni-Gold™ kits while vibriocidal antibody assay was applied for vaccine immunogenicity. Serum retinol analysis was assessed by Shimadzu Prominence HCT-2010 High Performance Liquid Chromatography (HPLC). The primary outcome was log transformed geometric mean titre. Results From 47 participants screened for HIV, 51% (24) tested positive. There was a statistically significant reduction in Ogawa geometric mean ratio (GMR) by 67% (GMR = 0.33; 95% CI: -0.15, 0.76; p-value = 0.009) attributable to HIV positivity with a non-significant reduction in Inaba GMR by about 50% due to HIV positivity. When doubling of retinol levels modelled, GMR reduction against Ogawa were non-significant but that against Inaba resulted in a significant reduction in geometric mean titer (GMT) (GMT-0.33, C.I 0.16–0.66, p-value 0.002). At 1000copies/ml viral load cut off and 350 cells/μl CD4 counts, Ogawa GMT was two times higher 11.16 (95%CI: 8.20–15.19) versus 6.06 (95%CI: 4.04–9.10) in low viremia participants, and three times higher in above threshold CD4 count participants; 24.81 (95%CI: 18.94–32.50) versus 7.07 (95%CI: 5.22–9.58). Conclusion Our results show that while Shanchol™ is immunogenic in both HIV+/- individuals, HIV + participants responded poorly. Viral load and CD4 count affected vaccine immunogenicity. More research is required for detailed understanding of this in order to appropriately inform policy and practice.

Association between serum retinol and overall and cause-specific mortality in a 30-year prospective cohort study

How retinol as a clinical indicator of vitamin A status is related to long-term mortality is unknown. Here we report the results of a prospective analysis examining associations between serum retinol and risk of overall and cause-specific mortality. During a 30-year cohort follow-up, 23,797 deaths were identified among 29,104 men. Participants with higher serum retinol experienced significantly lower overall, CVD, heart disease, and respiratory disease mortality compared to men with the lowest retinol concentrations, reflecting 17–32% lower mortality risk (Ptrend < 0.0001). The retinol-overall mortality association is similar across subgroups of smoking intensity, alcohol consumption, body mass index, trial supplementation, serum alpha-tocopherol and beta-carotene concentrations, and follow-up time. Mediation analysis indicated that <3% of the effects of smoking duration and diabetes mellitus on mortality were mediated through retinol concentration. These findings indicate higher serum retinol is associated with lower overall mortality, including death from cardiovascular, heart, and respiratory diseases.

Development, validity and reproducibility of a dish-based semi-quantitative food frequency questionnaire in Iran

BACKGROUND: The food frequency questionnaire (FFQ) is the method of choice for dietary assessment in epidemiological studies. FFQs focusing on mixed-dishes and simple food items are useful where mixed-dishes are an essential part of food consumption. OBJECTIVE: Regarding the fact that the nature of the Iranian diet is mixed-dish, the present study aimed to design and assess the validity and reproducibility of a dish-based semi-quantitative FFQ in the Iranian adult population. METHODS: A list of 302 food items was collected from four geographical areas around Iran. The validation study was conducted on 97 healthy adults. The FFQ was introduced at the beginning of the study and 10 months after; two three-day food records were collected during the study. Also, biomarkers including 24-hour urinary potassium and nitrogen, serum retinol, and alpha-tocopherol were measured. RESULTS: A 142-food-item FFQ was concluded. The correlation coefficient between the second FFQ and the second three-day food record ranged from 0.225 to 0.323 for macronutrients and 0.128 to 0.476 for micronutrients. The percentile agreements (same or adjacent quartile) between the two methods were more than 60%for all nutrients. The intraclass correlation coefficient between FFQs (except for vitamin E) ranged from 0.363 to 0.578. The correlation coefficient between the second FFQ and the second biomarker assessment was 0.241 for protein.

Serum Levels of Vitamin D, Retinol, Zinc and CRP in Relation To Obesity Among Children and Adolescents

Background: The aim of this study was to examine the possible association between serum micronutrients (vitamin D, retinol, Zinc ), C-reactive protein (CRP) and obesity among children and adolescents. Methods: Weight and height were measured and serum 25-hydroxy vitamin D, serum retinol, serum Zinc and CRP were measured in 2818 children and adolescents(6-17 years of age), using the data of 10 investigation sites in Zhejiang Province. The difference of micronutrients (vitamin D, retinol, zinc), CRP among different BMI status were explored by ANOVA and chi-square test. The associated factors of micronutrients and CRP of overweight and obesity were explored by multifactor analysis.Results: There were significant differences between male students and female students on BMI, 25(OH)D3, CRP, and there were significant differences between children and adolescents and between students living in urban area and rural area on BMI, 25(OH)D3, retinol, zinc(p < 0.05). There were significant differences on 25(OH)D3 and CRP level, and on retinol level among children and adolescents with different nutritional conditions (p < 0.05). In multifactor analysis, we found that gender(OR=0.626, 95%CI:0.486-0.806), living area (OR=0.666, 95%CI:0.515-0.860), age group(OR=0.894, 95%CI:0.856-0.934), high CRP concentration (OR=1.084,95%CI:1.046-1.122) and appropriate retinol level (OR=1.536, 95%CI:1.185-1.991) were associated with students with obesity. Conclusion: Gender, living area, age group, CRP concentration and vitamin A status were associated with children and adolescents with overweight and obesity. More attention in the intervention of overweight and obesity should be paid to boys living in urban areas, and high serum CRP and retinol level should also be concerned.

Vitamin A Levels Among Pre-School Children of Central and Western China

Objective: To investigate vitamin A deficiency of pre-school children in central and western China for developing strategies to prevent and control vitamin A deficiency (VAD) among children.Design: From November 2018 to September 2019, a total of 2,194 healthy children aged 2–6 years were enrolled. Serum retinol levels in the children were detected by liquid-phase tandem mass spectrometry. In addition, social demographic and dietary questionnaires were collected through interviews with children's caregivers.Setting: The participants were enrolled in 12 cities or their subordinate jurisdictions in the central and western regions of China.Participants: Two thousand one hundred and ninety four healthy children aged 2–6 years old.Results: Overall, 35.51% (779/2,194) of the children were found to be vitamin A insufficient (VAI, serum retinol &lt; 1.05 μmol/L). Elder children had a higher risk to suffer from VAI, with proportions of 25.00% (87/348), 28.92% (142/491), 38.38% (256/667), and 42.73% (294/688) among children aged 2, 3, 4, and 5 years, respectively. Vitamin A levels were also positively correlated with per capita income (AOR = 1.18) and regional economic level (0.71), and the frequency of milk intake (0.91).Conclusions: The incidence of VAI was higher among children aged 2–6 years, and the incidence of VAI increases with age. VA levels were positively correlated with levels of economic development in the family and region. So prevention strategies for VAD need to focus on pre-school children, especially dairy intake and developing regions.

Vitamins A and D and Zinc Affect the Leshmanicidal Activity of Canine Spleen Leukocytes

Canine leishmaniasis (CanL) is a chronic disease caused by Leishmania infantum, and the limitations of the current treatments have encouraged new alternatives, such as the use of immunomodulatory nutrients. The objective of this study was to determine the serum levels of vitamin A (retinol), vitamin D (25(OH)VD3), and zinc (Zn) in dogs with CanL and the effect of in vitro supplementation with the respective active forms ATRA, 1,25(OH)2VD3, and SZn on spleen leukocyte cultures. Serum retinol, 25(OH)VD3, and Zn were determined by HPLC, ELISA, and ICP-MS, respectively. Spleen leukocyte cultures were used for the detection of NO and ROS by flow cytometry; the IFN-γ, TNF-α, and IL-10 levels were determined by ELISA; and the parasite load was determined by microscopy. We detected low serum levels of retinol and Zn and high levels of 25(OH)VD3 in the CanL group. The in vitro supplementation of CanL spleen leukocytes with ATRA, 1,25(OH)2VD3, and SZn, in addition to a soluble leishmania antigen (SLA) treatment, increased the NO and ROS levels, while the treatments with only ATRA and SZn increased the TNF-a levels. Increased IL-10 and IFN-g levels were observed with the addition of SLA to the medium, although the addition of the three nutrients led to a reduction of the IL-10 levels, and the addition of 1,25(OH)2VD3 and SZn led to a reduction of IFN-g. A supplementation with 1,25(OH)2VD3 and SZn reduced the parasite load but only in the absence of SLA. We suggest that the nutrients we tested are involved in the leishmanicidal mechanism, showing a potential for investigation in future studies.

Vitamin A deficiency - experience from a tertiary referral UK hospital; not just a low- and middle-income country issue

Objective: Vitamin A (VA) deficiency, more common in low- and middle-income countries (LMIC) secondary to malnutrition, is associated with increased morbidity and mortality. The prevalence and impact of VA deficiency in high-income countries (HIC) where chronic conditions may predispose is less well understood. Setting: We examined the scale of low and deficient VA status in our tertiary University Teaching Hospital (HIC). Participants: Patients undergoing serum retinol concentrations 2012-2016 were identified from laboratory records, and records examined. Design: Interpretation of serum retinol may be affected by inflammation, so C-reactive protein (CRP) levels were sought. Binary logistic regression and generalised estimating equations were performed to review the relationship between CRP and VA. Results: 628 assays were requested, with 82 patients VA low (0.7-0.99umol/L) or deficient (<0.7umol/L). 16 patients were symptomatic (15 deficient), predominantly visual. Only one symptomatic patient’s VA deficiency was secondary to poor intake. Other symptomatic patients had chronic illnesses resulting in malabsorption. The incidence of a low VA level increases significantly with a raised CRP. Conclusion: The majority of patients tested either were replete or likely to have abnormal VA levels due to concomitant inflammation. A minority of patients had signs and symptoms of VA deficiency and was a cause of significant morbidity, but aetiology differs from LMIC, overwhelmingly malabsorption, most commonly secondary to surgery or hepatobiliary disease. A correlation between inflammation and low VA levels exists, which raises the possibility that requesting a VA level in an asymptomatic patient with active inflammation may be of questionable benefit.