Comparison of Indices of Vitamin A Status in Children With Chronic Liver Disease *

Abstract

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%; retinolbinding 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. (HEPATOLOGY 2005;42:782-792.)

Nutritional status of patients with biliary atresia and autoimmune hepatitis related to serum levels of vitamins A, D and E

“…This result may be due to the sample being reduced or due to the rigid control for use of vitamins in patients with cholestasis. However, in the study conducted by FERANCHAK et al (12) , there were no significant differences in the serum levels of vitamins A, D and E when comparing the CLD patients with cholestasis and without cholestasis.…”

“…In another study conducted by FERANCHAK et al (12) , it was verified that the vitamin A deficiency is relatively frequent in children with CLD and cholestasis, being proposed that the serum retinol could be used as an initial parameter to monitor the vitamin A deficiency in children with CLD. The authors BASTOS and SILVEIRA (5) verified that the plasmatic levels of vitamin D presented significant difference between patients with cholestasis and the control patients.…”

“…There are several studies in the literature that relate the presence of low blood levels of vitamins A, E and D in patients with CLD and cholestasis (5,12,13,17) . According to the study conducted by FLOREANI et al (13) , the plasmatic levels of retinol, α-tocopherol and carotenoids were significantly lower in the CLD group with cholestasis (primary biliary cirrhosis and primary sclerosing cholangitis) than in the control group.…”

Low retinol levels differentially modulate bile salt–induced expression of human and mouse hepatic bile salt transporters†

“…Because cholestatic liver disease is associated with vitamin A deficiency, [13][14][15] it is crucial to understand the molecular mechanisms involved. This may lead to novel treatment strategies aimed at optimizing transporter function in the liver.…”

“…[13][14][15] Moreover, in these disorders hepatic stellate cells become activated, transdifferentiate into (myo)fibroblasts, and lose their retinoid content. 3 So far, most studies reporting on FXR/ RXR␣-dependent regulation of target genes have been focused on the ligands for FXR, either natural or synthetic.…”