The relationship between serum retinol concentrations and subclinical infection in rural Brazilian children

TELES, Laísla França da Silva; PAIVA, Adriana de Azevedo; LUZIA, Liania Alves; LIMA-FERREIRA, Flávia Emília Leite de; CARVALHO, Cecilia Maria Resende Gonçalves de; RONDÓ, Patrícia Helen de Carvalho

doi:10.1590/1678-98652018000300004

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ORIGINAL ARTICLE • Rev Nutr 31 (3) • May-Jun 2018 • https://doi.org/10.1590/1678-98652018000300004 copy

The relationship between serum retinol concentrations and subclinical infection in rural Brazilian children

Relação entre as concentrações séricas de retinol e a infecção subclínica em crianças rurais brasileiras

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To evaluate the relationship between serum retinol concentrations and subclinical infection in children from rural settlements.

Methods

A cross-sectional population-based study was carried out in nine rural settlements in the northeastern region of Brazil, involving 118 children aged 6 to 59 months. The relationship between serum retinol and C-Reactive Protein levels, an important marker of infectious and inflammatory processes, was investigated by multiple linear regression, controlling for demographic, socioeconomic and nutritional variables. Serum retinol and C-Reactive Protein were measured, respectively, by High Performance Liquid Chromatography and immunoturbidimetric assay in automated equipment.

Results

Vitamin A deficiency (retinol <0.70μmol/L) was identified in 9.3% of the children. C-Reactive Protein was the only predictor of retinol concentrations in the final regression model, causing a 0.728μmol/L reduction in retinol concentrations in the studied children (p=0.008).

Conclusion

Vitamin A deficiency is a problem of mild/moderate severity and measures to control infectious diseases in this population are fundamental to prevent and/or combat this problem.

Keywords
Child; preschool; Infant; Infection; Rural area; Vitamin A

Variables		n	%	Mean	SD
Child age (months)				30.37	16.68
Child’s gender
	Female	70	59.3	-
	Male	48	40.7	-
Socioeconomic class
	C and D	10	08.5	-
	E	108	91.5	-
Government assistance
	Yes	86	72.8	-
	No	32	27.2	-
Access to health services
	Local health center	3	02.5	-
	Municipal health center	98	83.1	-
	Municipal hospital	15	12.7	-
	Other	2	01.7	-
Type of dwelling
	Mud/unfinished masonry	58	49.2	-
	Finished masonry	60	50.8	-
Presence of piped water
	Yes	100	84.7	-
	No	18	15.3	-
Waste destination
	Septic tank	90	76.3	-
	Open sky	28	23.7	-
Public garbage collection
	Yes	53	44.9	-
	No	65	55.1	-
Use of vitamin complexes (last 3 months)
	Yes	18	15.3	-
	No	100	84.7	-
Vitamin A supplementation (last 6 months) ^* * Interviewee could not answer.
	Yes	70	61.9	-
	No	43	38.1	-
Exclusive breast-feeing ^† † The child had not health booklet.
	<1 month or never	23	20.0	-
	1 to 5 months	38	33.0	-
	6 months	37	32.2	-
	>6 months	17	14.8	-
Health complications (in the last 15 days)
	Diarrhea	7	05.7	-
	Vomiting	5	04.1	-
	Parasitosis	5	04.1	-
	Respiratory diseases	65	52.8	-
Presence of subclinical infection ^‡ ‡ Assessed by C-Reactive Protein concentrations >5mg/L. BMI: Body Mass Index; SD: Standard Deviation.
	Yes	14	11.9	-
	No	104	88.1	-
Maternal age (years)		-		026.30	005.62
Maternal education level (years of schooling)		-		006.81	003.10
Paternal education level (years of schooling)		-		006.57	003.60
Number of household members		-		004.83	001.79
Household income (R$)		-		859.36	437.00
Per capita household income (R$)		-		190.95	109.66
Number of rooms		-		005.00	001.37
Number of persons per room		-		001.04	000.43
Anthropometry (Z-score)
	Weight for height	-		000.20	000.93
	Weight for age	-		00-0.10-	000.99
	Height for age	-		00-0.44-	001.15
	BMI for age	-		000.24	000.94
Nutrient intake
	Proteins (g)	-		057.10	25.2
	Lipids (g)	-		035.80	09.7
	Vitamin A (µg)	-		286.80	99.9
	Iron (mg)	-		008.00	02.5
	Zinc (mg)	-		005.50	02.2

Nutrients		EAR/ IA	Mean	SD	Percentiles of nutrient intake			Prevalence of inadequacy %
Nutrients		EAR/ IA	Mean	SD	25th	50th	75th	Prevalence of inadequacy %
6 months
	Proteins (g)^* * IA: Inadequate intake as reference value.	009.10	013.5	01.5	012.3	013.3	014.7	-
	Lipids (g)^* * IA: Inadequate intake as reference value.	31	027.6	06.6	023.7	030.0	031.5	-
	Vitamin A (µg)^* * IA: Inadequate intake as reference value.	400	671.9	97.9	609.7	701.9	734.1	-
	Iron (mg)^* * IA: Inadequate intake as reference value.	000.27	004.4	00.8	003.9	004.1	005.0	-
	Zinc (mg)^* * IA: Inadequate intake as reference value.	2	001.6	00.1	001.5	001.5	001.7	-
7-11 months
	Proteins (g)	9	025.9	07.4	019.8	023.7	029.4	01.13
	Lipids (g)^* * IA: Inadequate intake as reference value.	30.0	026.2	08.8	022.0	026.3	032.8	-
	Vitamin A (µg)^* * IA: Inadequate intake as reference value.	500	381.5	56.7	322.2	404.8	430.4	-
	Iron (mg)	06.9	003.1	01.4	001.9	002.6	004.3	99.66
	Zinc (mg)	02.5	002.5	00.8	002.1	002.3	003.0	0
12-47 months
	Proteins (g)	11	058.9	19.9	042.9	056.4	069.6	00.80
	Lipids (g)^† † Dietary reference intake not determined. Other nutrients = EAR: Estimated Average Requirement. BMI: Body Mass Index; SD: Standard Deviation.	-	036.0	05.0	032.6	036.2	038.6	-
	Vitamin A (µg)	210	280.4	75.7	218.2	274.9	330.4	17.62
	Iron (mg)	03.0	008.1	02.0	006.6	007.9	0v9.3	00.54
	Zinc (mg)	02.5	005.7	01.2	004.9	005.5	006.4	00.40
48-59 months
	Proteins (g)	13	071.0	27.8	055.9	071.0	084.8	01.88
	Lipids (g)^† † Dietary reference intake not determined. Other nutrients = EAR: Estimated Average Requirement. BMI: Body Mass Index; SD: Standard Deviation.	-	042.3	14.5	031.7	041.2	049.7	-
	Vitamin A (µg)	275	213.3	16.2	201.3	211.6	224.3	99.98
	Iron (mg)	04.1	009.8	02.5	008.1	009.6	010.9	01.13
	Zinc (mg)	4	007.0	02.7	005.4	006.5	008.4	13.35

Variables		Mean^* * Student t-test and analysis of variance for comparison between serum retinol concentrations and variables with two or more categories, respectively.	SD	r^† † Pearson’s correlation coefficient.	p
Child age (months)		-		-0.125	0.178
	Child’s gender
	Female	1.31	0.61	-	0.511
	Male	1.35	0.52	-	0.511
Socioeconomic class
	C and D	1.47	0.71	-	0.622
	E	1.32	0.56	-	0.622
Government assistance
	Yes	1.32	0.57	-	0.778
	No	1.36	0.57	-	0.778
Access to health services
	Local health center	2.09	0.53	-	0.140
	Municipal health center	1.32	0.54
	Municipal hospital	1.32	0.68
	Other	1.08	0.75
Type of dwelling
	Mud/unfinished masonry	1.21	0.52	-	0.025
	Finished masonry	1.44	0.60	-	0.025
Presence of piped water
	Yes	1.34	0.56	-	0.614
	No	1.29	0.61	-	0.614
Waste destination
	Septic tank	1.39	0.59	-	0.063
	Open sky	1.16	0.48	-	0.063
Public garbage collection
	Yes	1.33	0.58	-	0.794
	No	1.34	0.56	-	0.794
Use of vitamin complexes (last 3 months)
	Yes	1.27	0.35	-	0.955
	No	1.34	0.60	-	0.955
Vitamin A supplementation (last 6 months)
	Yes	1.02	0.55	-	0.189
	No	1.38	0.56	-	0.189
Exclusive breast-feeing
	< 1 month or never	1.30	0.46	-	0.170
	1 to 5 months	1.40	0.60
	6 months	1.37	0.62
	> 6 months	1.06	0.45
Health complications
	Diarrhea	1.50	0.81	-	0.503
	Vomiting	1.52	0.77
	Parasitosis	1.52	0.50
	Respiratory diseases	1.29	0.54
Presence of subclinical infection
	Yes	1.02	0.55	-	0.008
	No	1.38	0.56	-	0.008
Maternal age (years)		-		0.009	0.921
Maternal education level (years of schooling)		-		0.053	0.574
Paternal education level (years of schooling)		-		-0.002	0.987
Number of household members		-		-0.062	0.508
Household income (R$)		-		0.070	0.450
Per capita household income (R$)		-		0.098	0.290
Number of rooms		-		0.088	0.345
Number of persons per room		-		-0.111	0.232
Anthropometry (Z-score)		-
	Weight for height	-		0.117	0.206
	Weight for age	-		0.064	0.490
	Height for age	-		-0.018	0.851
	BMI for age	-		0.116	0.211
Nutrients
	Proteins (g)	-		0.044	0.667
	Lipids (g)	-		0.005	0.960
	Vitamin A (µg)	-		0.118	0.049
	Iron (mg)	-		-0.064	0.488
	Zinc (mg)	-		-0.008	0.934

Variables	Coefficients		T	p	Exp(B)^* * Data converted to their original values by exponential transformation.	95%CI for Exp(B)
Variables	B	Standard error	T	p		Lower limit	Upper limit
(Constant)	0.238	0.040	5.906	0.000	1.269	1.171	1.374
Presence of subclinical infection^† † Assessed by C-Reactive Protein concentrations >5mg/L. ANOVA (p=0.008), normality (p=0.946), homogeneity (p=0.723), R2=51.1%.	-0.317	0.117	-2.708	0.008	0.728	0.578	0.919

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[1] Correspondência para/Correspondence to: AA PAIVA. E-mail: <aapaiva@ufpi.edu.br>.