Hyporetinolemia and acute phase proteins in children with and without xerophthalmia

BACKGROUND: The relations among hyporetinolemia, acute phase proteins, and vitamin A status in children are unclear. OBJECTIVE: The objective was to examine the relations between acute phase proteins and plasma retinol concentrations in children with and without clinical vitamin A deficiency (Bitot spots and night blindness). DESIGN: The study was a nonconcurrent analysis of acute phase protein concentrations and other data from a previous clinical trial. Preschool children, 3-6 y of age, with (n = 118) and without (n = 118) xerophthalmia were assigned to receive oral vitamin A (60 mg retinol equivalent) or placebo and were seen at 5 wk. All children received oral vitamin A (60 mg retinol equivalent) at 5 wk. RESULTS: At baseline, alpha(1)-acid glycoprotein (AGP) was elevated in 42.9% and 23.5% (P < 0.003) and C-reactive protein (CRP) was elevated in 17.7% and 13.7% (NS) of children with and without xerophthalmia, respectively. Hyporetinolemia (retinol < 0.7 micromol/L) occurred in 61.0% and 47.4% (P < 0.04) of children with and without xerophthalmia, respectively. A history of fever, a history of cough, and nasal discharge noted on examination were each associated with elevated acute phase proteins. Vitamin A supplementation increased plasma retinol at 5 wk but had no significant effect on concentrations of acute phase proteins. CONCLUSIONS: Elevated acute phase protein concentrations and infectious disease morbidity are closely associated during vitamin A deficiency.     

Reproducibility of determining vitamin A status by impression cytology

Impression cytology is a simple technique for detecting vitamin A deficiency. Methods of specimen collection, fixation, and staining are amenable to use in developing countries. Routine use of the technique requires good interobserver agreement. We compared the impression cytology results of 206 patient examinations analyzed by an experienced observer with those obtained by a newly trained observer. Percent agreement measured 96% (197/206) with a kappa of 0.90, indicating excellent agreement. Further improvement in interobserver agreement may be obtainable by simplification of the staining process to highlight the presence or absence of goblet cells, and by simplification of the staging criteria.     

Depression and its link to other symptoms in menopausal transition

Background: Menopausal transition may occur between 45 and 55 years old and take 3–9 years. During this transition, the hormonal changes may contribute to the physical and psychological complaints in women. One of the psychological complaints is a sign of depression. However, not all of the women will experience those complaints.Objective: To assess the relationship between depression in menopause transition and other menopausal symptoms and factors contribute to depression among Indonesian people.Methods: Cross-sectional study on 133 female subjects between 45 and 55 years old. Depression measured using Beck Depression Inventory-II (BDI-II), and menopausal symptoms were collected using Menopause Rating Scale (MRS). The comparison and relation were assessed for every aspect regarding depression and menopausal symptoms.Results: Out of 133 subjects, depression was found in 17 subjects (12.8%). Somato-vegetative symptoms were complained by 50.4% and urogenital symptoms by 75.9% subjects. There was significant correlation between depression and somato-vegetative (p = 0.008) as well as urogenital complaints among women who underwent menopause transition (p = 0.016). These findings were consistent with previous studies.Conclusion: Depression on menopausal transition significantly correlated with somato-vegetative and urogenital symptoms among women. Future investigations should be conducted with a cohort design to observe mood alterations during the menopause transition.     

The decline of admissions for xerophthalmia at Cicendo Eye Hospital,Indonesia, 1981–1992

Xerophthalmia due to vitamin A deficiency is a leading cause of blindness in children and has been a serious problem in Indonesia. To determine whether progress has been made in the eradication of xerophthalmia, we assessed hospital admissions for xerophthalmia at Cicendo Eye Hospital, Bandung, Indonesia. The hospital admission registry from 1981 to 1992 was reviewed. Between January 1981 and December 1992, there were 117 admissions for xerophthalmia, and of these, 63 were boys and 54 were girls, with an average age of 3.9 ± 0.3 years. Hospital admissions for xerophthalmia declined steeply from 1981 to 1985, with a few rare cases from 1985 through 1992. During the same period from 1981 through 1992, there were no overall changes in total hospital admissions or total pediatric admissions. These results suggest that xerophthalmia is becoming less common in Indonesia.     

Effect of vitamin A supplementation on immunoglobulin G subclass responses to tetanus toxoid in children.

Previously, we demonstrated that administering vitamin A supplements to children resulted in a significant increase in the immunoglobulin G (IgG) response generated against a vaccine dose of tetanus toxoid (TT) (R. D. Semba et al., J. Nutr. 122:101-107, 1991). However, from these analyses we could not determine whether there was an increase in levels of IgG of the subclass presumed to be important for protection against challenge by the toxin or whether there was simply a general increase in the levels of all the IgG subclasses expressing anti-TT activity. The goal of this study was to determine the profile of the anti-TT IgG subclasses in children receiving vitamin A supplementation or a placebo in order to assess the potential utility of the enhanced anti-TT response. In a randomized, double-masked, placebo-controlled clinical trial, the levels of the different anti-TT IgG subclasses were measured in 139 Indonesian preschool children (3 to 6 years of age) 2 weeks before and 3 weeks after immunization. Baseline anti-TT levels and immunization histories were used to separate those children who were responding to TT for the first time from those who responded in a secondary fashion because of previous exposure to TT. Children who were given vitamin A prior to immunization had significant increases in IgG1 levels regardless of whether they were undergoing primary or memory reactions. In the group of individuals who underwent a secondary response to TT, vitamin A supplementation was also associated with a modest but significant change in the levels of anti-TT IgG3. There were only minor changes in the levels of anti-TT IgG2 and IgG4. Since IgG1 is the subclass associated with a protective response to TT immunization, these results suggest that vitamin A supplementation may be a safe and effective intervention to enhance the relevant humoral response to TT and other vaccine antigens.     

Depressed immune response to tetanus in children with vitamin A deficiency.

A randomized, double-masked, placebo-controlled clinical trial was conducted with 236 preschool children, age 3-6 y, in Indonesia to assess immune status in mild vitamin A deficiency. The immune response to tetanus immunization was used as a measure of immune competence. Clinically normal children (n = 118) and children with mild xerophthalmia (n = 118) were randomly assigned to receive oral vitamin A (60,000 micrograms retinol equivalent) or placebo treatment for a total of four study groups. Two weeks after treatment, children were immunized with diphtheria-pertussis-tetanus vaccine. The immunoglobulin G (IgG) responses to tetanus at baseline and 3 wk following immunization were measured by ELISA. After adjusting for previous tetanus immunization, clinically normal and xerophthalmic children receiving vitamin A had a significantly greater IgG response to tetanus than clinically normal and xerophthalmic children receiving placebo (P less than 0.05). These results suggest that children with mild vitamin A deficiency have a relative immune depression compared with children who have been supplemented to normal vitamin A levels.     

Impression cytology: a practical index of vitamin A status

Impression cytology was performed on 148 Indonesian preschool children of whom half had mild xerophthalmia and half were age-matched control subjects. Subjects were divided into subgroups that reflected the degree of confidence in their true vitamin A status as determined by serum vitamin A levels, clinical examination, and response to therapy. Impression cytology was considered normal if goblet cells were present and abnormal if they were absent. Thirteen of 14 (93%) children with vitamin A-responsive Bitot's spots and night blindness with base-line serum vitamin A less than 20 micrograms/dL (0.70 mumol/L) (group 1, definite deficiency) had abnormal cytology. In contrast, 17 of 18 (94%) children with normal ocular exam and serum vitamin A greater than 25 micrograms/dL (0.87 mumol/L) (group 7, least likely deficient) had normal cytology. Importantly, 12 of 26 (46%) clinically normal children with serum vitamin A levels less than 20 micrograms/dL (0.70 mumol/L) had abnormal impression cytology.     

24-hour history is more closely associated with vitamin A status and provides a better estimate of dietary vitamin A intake of deficient Indonesian preschool children than a food frequency method

Objectives To determine if the Simplified Dietary Assessment to Identify Groups at Risk of Inadequate Intake of Vitamin A developed by the International Vitamin A Consultative Group (IVACG) correctly classified a group of vitamin A-deficient children as being at risk, and to see if a food frequency questionnaire (FFQ) or 24-hour history (24HH) yielded estimated dietary vitamin A intakes most closely associated with vitamin A status.

Design Forty-seven foods were identified as contributing most of the vitamin A to the diet of the study population. For each food, usual portion sizes were determined during a pilot study. Intake was calculated from data collected by FFQ and 24HH. Four modifications of the 24HH analysis were made to determine if this method of analysis could be simplified.

Subjects/setting Subjects were 265 Indonesian children with or at high risk of developing xerophthalmia.

Results Mean and median intakes of vitamin A based on the 24HH analysis were 50% and 27% of the US Recommended Dietary Allowance, respectively, which accurately identified the study sample as being at risk. Dietary intake based on the 24HH was significantly associated with serum retinol concentration (P=.01, trend test). Eliciting portion sizes during the 24HH was not necessary once the usual portion sizes consumed by the population were estimated in the pilot study. Mean and median intakes of vitamin A based on the FFQ were 150% and 118% of the Recommended Dietary Allowance, respectively, which suggests that the FFQ overestimated intake. Intake based on the FFQ was not correlated with serum retinol concentration.

Conclusions Our findings do not support the IVACG recommendation that the FFQ be regarded as more reliable than the 24HH when the 2 methods produce different conclusions, nor the recommendation of some users of the method that the 24HH be dropped from the assessment method. J Am Diet Assoc. 2000;100:1501-1507.     

Chronological age vs biological age: an age-related normogram for antral follicle count, FSH and anti-Mullerian hormone

Objective

To evaluate the correlation between chronological and biological age by comparing the normograms of AFC, AMH, and FSH.

Design

Retrospective study

Setting

Data were taken from patients who visited the Infertility Clinic at Dr. Cipto Mangunkusumo General Hospital Jakarta, Indonesia, between January 2008 and December 2010.

Patient(s)

Infertile women who visited the Infertility Clinic.

Intervention(s)

None.

Main Outcome Measure(s)

Normogram of AFC (n = 366), AMH (n = 1616) and FSH (n = 415).

Result(s)

The correlations among AFC, AMH, FSH, and age are statistically significant. Normograms of AFC and AMH with 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles showed a decrease in age where FSH increased. A cut-off value of AFC, AMH, and FSH for poor responders was plotted at the 50th percentile of each normogram. Serum AMH and AFC started to decline in women between 34 and 35 years old. We found a relatively lower slope increase of FSH in older patients compared to that of AFC and AMH. FSH was observed to be a later predictor of biological age than AMH and AFC.

Conclusion(s)

AMH predicted biological age earlier than FSH or AFC. Normograms can provide a reference guide for physicians to counsel infertile women. However, future validation with longitudinal data is still needed.