A comparative study on indicators of vitamin A status and risk factors for sensitivity and specificity of the methods to detect vitamin A deficiency

Olivier O Sombié; Augustin N Zeba; Jérome W Somé; Adama Kazienga; Michael Grahn; Sherry A Tanumihardjo; Stefaan De Henauw; Souheila Abbeddou

doi:10.1186/s12986-023-00768-7

A comparative study on indicators of vitamin A status and risk factors for sensitivity and specificity of the methods to detect vitamin A deficiency

Nutr Metab (Lond). 2023 Nov 16;20(1):49. doi: 10.1186/s12986-023-00768-7.

Authors

Olivier O Sombié^{1

2}, Augustin N Zeba³, Jérome W Somé⁴, Adama Kazienga⁵, Michael Grahn⁶, Sherry A Tanumihardjo⁶, Stefaan De Henauw⁷, Souheila Abbeddou⁷

Affiliations

¹ Unité Nutrition et Maladies Métaboliques, Institut de Recherche en Sciences de la Santé/Direction Régionale de l'Ouest, Bobo-Dioulasso, Burkina Faso. ouahaminolivier.sombie@ugent.be.
² Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. ouahaminolivier.sombie@ugent.be.
³ Unité Nutrition et Maladies Métaboliques, Institut de Recherche en Sciences de la Santé/Direction Régionale de l'Ouest, Bobo-Dioulasso, Burkina Faso.
⁴ Unité Nutrition et Maladies Métaboliques, Institut de Recherche en Sciences de la Santé/Direction Générale, Ouagadougou, Burkina Faso.
⁵ Department of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium.
⁶ Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, USA.
⁷ Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.

Abstract

Background: Serum retinol (SR) and retinol-binding protein (RBP) are commonly used indicators, but they are affected by infections and inflammation. This study aimed to assess the sensitivity and specificity of VA indicators to detect vitamin A deficiency (VAD) in 36-59-month-old children living in a rural area in Burkina Faso.

Methods: In a community-based study, two cross-sectional surveys were carried out from November 2016 to September 2017 in the health district of Dandé in Burkina Faso. The surveys included 115 children 36-59 months old. Indicators of VA and inflammation assessed in all children included SR, RBP and total liver VA reserves (TLR) estimated by retinol isotope dilution, and inflammation markers (C-reactive protein (CRP) and alpha 1-acid glycoprotein (AGP)). We calculated the sensitivity, specificity, positive and negative predictive values. In addition, the effects of inflammation, helminth infection, and season on sensitivity and specificity were assessed.

Results: The prevalence of VAD assessed by SR (< 0.7 µmol/L), RBP (< 0.7 µmol/L), and TLR (< 0.1 µmol/g liver) were, respectively, 30.9%, 33.3%, and 0%. Compared to TLR, the specificity, positive predictive value, and negative predictive value of SR were 71.1%, 0%, and 100%, and of RBP, were 68.9%, 0%, and 100%, respectively. The sensitivity was indeterminable for SR and RBP. The specificity of SR and RBP was lower during the dry season. Elevated CRP (> 5.0 mg/L) and AGP (> 1.0 g/L) were detected in 1.9% and 28.6% of children, respectively. The adjustment of VA indicators for inflammation improved SR's specificity to 75.9% and decreased RBP's specificity to 67.8%.

Conclusion: No cases of VAD were identified by TLR. However, (inflammation-adjusted) SR and RBP had varying accuracy in the estimation of VAD.

Trial registration: The study was registered, retrospectively, on 22 March 2018 as a clinical trial with the Pan African Clinical Trials Registry under the number Cochrane South Africa; PACTR201803002999356.

Keywords: Burkina Faso; Children; Retinol-binding protein; Sensitivity; Serum retinol; Specificity; Total liver reserve; Vitamin A deficiency.