title: Vitamin A deficiency and inflammatory markers among preschool children in the Republic of the Marshall Islands.
abstract: BACKGROUND
  The exclusion of individuals with elevated acute phase proteins has been advocated in order to improve prevalence estimates of vitamin A deficiency in surveys, but it is unclear whether this will lead to sampling bias. The purpose of the study was to determine whether the exclusion of individuals with elevated acute phase proteins is associated with sampling bias and to characterize inflammation in children with night blindness.
  
  
  METHODS
  In a survey in the Republic of the Marshall Islands involving 281 children, aged 1-5 years, serum retinol, C-reactive protein (CRP), and alpha1-acid glycoprotein (AGP) were measured.
  
  
  RESULTS
  Of 281 children, 24 (8.5%) had night blindness and 165 (58.7%) had serum retinol < 0.70 micromol/L. Of 248 children with AGP and CRP measurements, 123 (49.6%) had elevated acute phase proteins (CRP > mg/L and/or AGP > 1000 mg/L). Among children with and without night blindness, the proportion with serum retinol < 0.70 micromol/L was 79.2% and 56.8% (P = 0.03) and with anemia was 58.3% and 35.7% (P = 0.029), respectively. The proportion of children with serum retinol < 0.70 micromol/L was 52.0% after excluding children with elevated acute phase proteins. Among children with and without elevated acute phase proteins, mean age was 2.8 vs 3.2 years (P = 0.016), the proportion of boys was 43.1% vs. 54.3% (P = 0.075), with no hospitalizations in the last year was 11.0% vs 23.6% (P = 0.024), and with anemia was 43.8% vs 31.7% (P = 0.05), respectively.
  
  
  CONCLUSIONS
  Exclusion of children with inflammation in this survey of vitamin A deficiency does not improve prevalence estimates for vitamin A deficiency and instead leads to sampling bias for variables such as age, gender, anemia, and hospitalization history.
authors.affiliation: Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. maria_maqsood@yahoo.com
authors.forename: Maria
authors.initials: M
authors.lastname: Maqsood
authors.forename: Barbara
authors.initials: B
authors.lastname: Dancheck
authors.forename: Mary V
authors.initials: MV
authors.lastname: Gamble
authors.forename: Neal A
authors.initials: NA
authors.lastname: Palafox
authors.forename: Michelle O
authors.initials: MO
authors.lastname: Ricks
authors.forename: Kennar
authors.initials: K
authors.lastname: Briand
authors.forename: Richard D
authors.initials: RD
authors.lastname: Semba