Association between vitamin A status, inflammations, and infections in children 36-59 months of age in rural Burkina Faso: A cross - sectional study.

Abstract

Background: Assessing vitamin A (VA) status using retinol and retinol-binding protein (RBP) in the presence of infection and inflammation remains challenging, as both markers prove to be unreliable during such physiological disturbances.

Objective: This study aimed to assess the association between common infections and inflammation and VA status of children in rural Burkina Faso.

Methods: Two community-based cross-sectional studies were conducted in the villages of Sourkoudougou and Banakeledaga, in Southwestern Burkina Faso, one during the dry season (November 2016- January 2017) and the second during the rainy season (August- September 2017). In total, 115 children, 36-59 months of age, were included. The ¹³C-retinol isotope dilution test (RID) was used to assess total body VA stores (TBS) and VA total liver reserves (TLR). Malaria infection and intestinal parasites were evaluated at enrollment. Serum C-reactive protein (CRP) and alpha-1-acid glycoprotein (AGP) were measured. Univariable and multivariable linear regressions were used to test the associations between VA status and infection and inflammation status.

Results: No VA deficiency (TLR ≤ 0.1 µmol/g liver) was detected using RID method. Geometric means (95% confidence interval) of TBS and TLR were respectively 473 (412; 543) µmol and 0.86 (0.75; 0.99) µmol/g liver. One-third of study participants were found to have hypervitaminosis A (TLR > 1.0 µmol/g liver). Elevated CRP (> 5.0 mg/L) and AGP (> 1.0 g/L) were respectively detected in 1.9% and 28.6% of children. Positive malaria was diagnosed in 5 children. Intestinal parasites were found in one out of two (47.6%) participants, and other morbidities were detected in 2 participants. In a multivariable adjusted regression, significant positive weak associations were found between Log TLR and CRP concentrations (N = 79, β = 0.058, p = 0.004) and between Log TBS and CRP concentrations (N = 79, β = 0.054, p = 0.005).

Conclusion: Study children were apparently healthy with high prevalence of asymptomatic intestinal parasites and chronic inflammation. TLR and TBS were positively associated with the acute phase protein CRP warranting further investigation.

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