title: Low serum retinol levels are associated with hepatocellular carcinoma in patients with chronic liver disease.
abstract: BACKGROUND
  Retinol and other vitamin A derivatives affect the differentiation and growth of many tissues and have anti-tumour properties.
  
  
  OBJECTIVE
  To investigate serum retinol levels in patients with liver disease and hepatocellular carcinoma (HCC) and to assess its importance as a risk factor for the development of HCC.
  
  
  METHODS
  Serum retinol levels were measured in healthy volunteers and 175 patients (34 with chronic hepatitis C, 117 with cirrhosis, and 24 with HCC.
  
  
  RESULTS
  The serum retinol levels (mean +/- s.e.) in ng/mL, were 972.1 +/- 37.7 in the control group and 647 +/- 41.1 in patients with chronic hepatitis C. Serum retinol levels in patients with cirrhosis and HCC were lower than in patients with cirrhosis alone (365.8 +/- 43.1 vs. 438.9 +/- 22.1, P < 0.04). In particular, there was a more significant difference in serum retinol levels between Child-Pugh grade A patients with cirrhosis and Child-Pugh grade A patients with cirrhosis/HCC (serum retinol levels 532.4 +/- 26.7 vs. 366.1 +/- 86.4, P < 0.03). There was a significant difference in serum retinol levels between normal controls and all patients' groups (P < 0.001). There were significantly lower serum retinol levels in cholestatic Child-Pugh grade A patients with cirrhosis compared with noncholestatic Child-Pugh grade A patients with cirrhosis/HCC (411.5 +/- 30.3 vs. 579.7 +/- 32.7, P < 0.0004). Sixty percent of patients with Child-Pugh grade A cirrhosis/HCC had serum retinol levels below 350 ng/mL compared with only 18.4% of cirrhotics without HCC (chi 2-test, P=0.01). No correlation was found between serum retinol levels and alpha FP or any other liver function tests, apart from serum albumin, which showed a positive correlation (r=0.61 P < 0.018).
  
  
  CONCLUSIONS
  There was a progressive reduction in serum retinol levels from controls to patients with liver cirrhosis. Those patients with cirrhosis and HCC had significantly lower values than patients with cirrhosis alone. Serum retinol levels may be a risk factor for the development of HCC.
authors.affiliation: Department of Medicine, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK. p.Newsome@ed.ac.uk
authors.forename: P N
authors.initials: PN
authors.lastname: Newsome
authors.forename: I
authors.initials: I
authors.lastname: Beldon
authors.forename: Y
authors.initials: Y
authors.lastname: Moussa
authors.forename: T E
authors.initials: TE
authors.lastname: Delahooke
authors.forename: G
authors.initials: G
authors.lastname: Poulopoulos
authors.forename: P C
authors.initials: PC
authors.lastname: Hayes
authors.forename: J N
authors.initials: JN
authors.lastname: Plevris
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000150:complications; D002780:Cholestasis, Intrahepatic / Q000097:blood; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood; D008107:Liver Diseases / Q000097:blood* / Q000150:complications; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000097:blood* / Q000150:complications; D008297:Male; D014801:Vitamin A / Q000097:blood*; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000509:alpha-Fetoproteins; D014801:Vitamin A