Inflammation Adjustments to Serum Retinol and Retinol-Binding Protein Improve Specificity but Reduce Sensitivity when Estimating Vitamin A Deficiency Compared with the Modified Relative Dose-Response Test in Ghanaian Children

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dc.contributor.authorSuri, D.J.
dc.contributor.authorWirth, J.P.
dc.contributor.authorAdu-Afarwuah, S.
dc.contributor.authorPetry, N.
dc.contributor.authorRohner, F.
dc.contributor.authorSheftel, J.
dc.contributor.authorTanumihardjo, S.A.
dc.date.accessioned2021-11-15T12:24:40Z
dc.date.available2021-11-15T12:24:40Z
dc.date.issued2021
dc.descriptionResearch Articleen_US
dc.description.abstractBackground: Serum retinol and retinol-binding protein (RBP) concentrations are commonly used biomarkers of vitamin A deficiency (VAD); however, evidence indicates that they are not always accurate, especially in populations with high exposure to inflammation. Objective: The aim was to assess sensitivity and specificity of serum retinol and RBP concentrations to predict VAD, with and without adjustment for inflammation (using categorical and regression-adjusted approaches), using the modified relative dose-response (MRDR) as the reference standard for liver reserves. Methods: This secondary analysis of diagnostic accuracy used inflammation and RBP data and analyzed serum retinol and MRDR from a subsample of women of reproductive age (n = 178) and preschool children (n = 166) in the cross-sectional 2017 Ghana Micronutrient Survey. Results: Inflammation (elevated C-reactive protein and/or α1-acid glycoprotein) was present in 41% of children and 16% of women. Among children, estimates of VAD prevalence were as follows: 7% (MRDR), 40% (serum retinol), 29% (categorical-adjusted serum retinol), 24% (RBP), 13% (categorical-adjusted RBP), and 7% (regression-adjusted RBP). Sensitivity (95% CI) ranged from 22.2% (2.81%, 60.0%; both adjusted RBPs) to 80.0% (44.4%, 97.5%; serum retinol), whereas specificity ranged from 63.3% (54.7%, 71.3%; serum retinol) to 93.5% (88.0%, 97.0%; regression-adjusted RBP). Among women, VAD prevalence ranged from 1% (RBP) to 4% (all others); sensitivity was 0% and specificity was >96% for all indicators. Conclusions: Serum retinol and RBP had varying accuracy in estimating VAD, especially in children; adjustment for inflammation increased accuracy by increasing specificity at the expense of sensitivity. Effects of inflammation adjustment in the context of high inflammation and VAD prevalence need to be further explored. Especially in populations with high inflammation, the MRDR test should accompany serum retinol or RBP measurements in a subsample of subjects in population-based surveys. This trial was registered with the Open Science Framework registry (doi: 10.17605/OSF.IO/J7BP9 ). Curr Dev Nutr 2021;5:nzab098.en_US
dc.identifier.otherhttp://creativecommons.org/licenses/by-nc/4.0/)
dc.identifier.urihttp://ugspace.ug.edu.gh/handle/123456789/37117
dc.language.isoenen_US
dc.publisherOxford University Press on behalf of the American Society for Nutrition.en_US
dc.subjectbiomarkersen_US
dc.subjectmodified relative dose-responseen_US
dc.subjectRBP4en_US
dc.subjectsensitivityen_US
dc.subjectsensitivity and specificityen_US
dc.subjectserum retinolen_US
dc.subjectvitamin A deficiencyen_US
dc.subjectchildrenen_US
dc.subjectwomen of reproductive ageen_US
dc.titleInflammation Adjustments to Serum Retinol and Retinol-Binding Protein Improve Specificity but Reduce Sensitivity when Estimating Vitamin A Deficiency Compared with the Modified Relative Dose-Response Test in Ghanaian Childrenen_US
dc.typeArticleen_US

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