Proxy markers of serum retinol concentration, used alone and in combination, to assess population vitamin A status in Kenyan children: a cross-sectional study

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dc.creatorTalsma, E.F.
dc.creatorVerhoef, H.
dc.creatorBrouwer, Inge D.
dc.creatorMburu-de Wagt, A.S.
dc.creatorHulshof, P.J.M.
dc.creatorMelse-Boonstra, A.
dc.date2015-02-20
dc.date2024-08-01T02:50:32Z
dc.date2024-08-01T02:50:32Z
dc.date.accessioned2026-06-27T15:21:19Z
dc.descriptionBackground: Serum retinol concentration determined by high-performance liquid chromatography (HPLC) is recommended by the World Health Organization to assess population vitamin A status. This assay is expensive, technically demanding and rarely available in developing countries. Our objective was a) to assess the diagnostic performance of proxy markers in detecting vitamin A deficiency and b) to derive decision rules based on these markers to estimate vitamin A deficiency prevalence. Methods: A survey was conducted in 15 rural primary schools in Eastern Province, Kenya, with 375 children aged 6 to 12 years (25 randomly selected per school). Serum retinol concentration <0.70 μmol/L by HPLC was used to define vitamin A deficiency. Proxy markers for vitamin A deficiency were serum concentrations of retinol binding protein (RBP), transthyretin, retinol measured by fluorometry and RBP:transthyretin molar ratio. Results: The prevalence of vitamin A deficiency (HPLC) was 18%. Transthyretin and RBP showed the best diagnostic performance individually, with area-under-the-curve (AUC) values of 0.96 and 0.93. When combined, and with C-reactive protein added, the AUC increased to 0.98. A simple decision rule {(−15.277 × [RBP, μmol/L] - 7.013 × [Transthyretin, μmol/L] + 0.367 × [C-reactive protein, mg/L] + 24.714) > 0.496} yielded prevalence estimates of vitamin A deficiency that is unbiased by diagnostic error. Conclusions: The combination of transthyretin, RBP and C-reactive protein concentrations could eventually replace retinol concentration by HPLC in resource-poor settings as the preferred method to assess the population burden of vitamin A deficiency.
dc.identifierhttps://hdl.handle.net/10568/150041
dc.identifier.urihttp://hdl.handle.net/123456789/101962
dc.languageen
dc.publisherSpringer
dc.rightsOpen Access
dc.sourceTalsma, E.F.; Verhoef, H.; Brouwer, I.D.; Mburu-de Wagt, A.S.; Hulshof, P.J.M.; and Melse-Boonstra, A. 2015. Proxy markers of serum retinol concentration, used alone and in combination, to assess population vitamin A status in Kenyan children: a cross-sectional study. BMC Medicine 13(30) https://doi.org/10.1186/s12916-014-0256-5
dc.subjectdiscriminant analysis
dc.subjectsenses
dc.subjectdiagnosis
dc.subjectmicronutrient deficiencies
dc.subjectretinol
dc.subjectinflammation
dc.subjectretinols
dc.titleProxy markers of serum retinol concentration, used alone and in combination, to assess population vitamin A status in Kenyan children: a cross-sectional study
dc.typeJournal Article

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