Comparison of indices of vitamin A status in children with chronic liver disease.
Malabsorption of fat-soluble vitamins is a major complication of chronic cholestatic liver disease. The most accurate way to assess vitamin A status in children who have cholestasis is unknown. The goal of this study was to assess the accuracy of noninvasive tests to detect vitamin A deficiency. Children with chronic cholestatic liver disease (n = 23) and noncholestatic liver disease (n = 10) were studied. Ten cholestatic patients were identified as vitamin A-deficient based on the relative dose response (RDR). Compared with the RDR, the sensitivity and specificity to detect vitamin A deficiency for each test was, respectively: serum retinol, 90% and 78%; retinol-binding protein (RBP), 40% and 91%; retinol/RBP molar ratio, 60% and 74%; conjunctival impression cytology, 44% and 48%; slit-lamp examination, 20% and 66%; tear film break-up time, 40% and 69%; and Schirmer's test, 20% and 78%. We developed a modified oral RDR via oral coadministration of d-alpha tocopheryl polyethylene glycol-1000 succinate and retinyl palmitate. This test had a sensitivity of 80% and a specificity of 100% to detect vitamin A deficiency. In conclusion, vitamin A deficiency is relatively common in children who have chronic cholestatic liver disease. Our data suggest that serum retinol level as an initial screen followed by confirmation with a modified oral RDR test is the most effective means of identifying vitamin A deficiency in these subjects.
Feranchak
Andrew P
AP
Pediatric Liver Center and Liver Transplantation Program, Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, The Children's Hospital, Denver, CO, USA. drew.feranchak@utsouthwestern.edu
Gralla
Jane
J
King
Robert
R
Ramirez
Rebecca O
RO
Corkill
Mary
M
Narkewicz
Michael R
MR
Sokol
Ronald J
RJ
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002779:Cholestasis / Q000097:blood / Q000150:complications; D002908:Chronic Disease; D004224:Diterpenes; D015352:Dry Eye Syndromes / Q000175:diagnosis; D005260:Female; D006801:Humans; D007223:Infant; D008107:Liver Diseases / Q000097:blood / Q000150:complications*; D008297:Male; D011092:Polyethylene Glycols / Q000008:administration & dosage; D012177:Retinol-Binding Proteins / Q000378:metabolism; D000084562:Retinyl Esters; D012680:Sensitivity and Specificity; D014801:Vitamin A / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000097:blood; D014802:Vitamin A Deficiency / Q000097:blood / Q000175:diagnosis* / Q000209:etiology*; D014810:Vitamin E / Q000008:administration & dosage / Q000031:analogs & derivatives
D004224:Diterpenes; D012177:Retinol-Binding Proteins; D000084562:Retinyl Esters; D014801:Vitamin A; D014810:Vitamin E; C014794:retinol palmitate; D011092:Polyethylene Glycols; C014225:tocophersolan