N. Usha, A. Sankaranarayanan, B. N. S. Walia, N. K. Ganguly

Assessment of Preclinical Vitamin A Deficiency in Children with Persistent Diarrhea

  • Gastroenterology
  • Pediatrics, Perinatology and Child Health

To explore the relationship between vitamin A deficiency and persistent diarrhea among young children, we studied the vitamin A status of 23 children < 5 years of age with persistent diarrhea by performing conjunctival impression cytology (CIC) and the relative dose–response test (RDR) as a measure of liver reserve of vitamin A. The control group consisted of 23 age‐ and sex‐matched children who were otherwise healthy in whom CIC was performed and fasting plasma retinol values were determined. The criteria for vitamin A deficiency in CIC were paucity of goblet cells and scanty, abnormal epithelial cells. None of these children had ocular manifestations of vitamin A deficiency. Among the children with persistent diarrhea, CIC characteristic of vitamin A deficiency was found in 17 (group 1) and CIC results were normal in six (group 2). In group 1, the serum retinol levels were 1 ± 1 μg/dl, and RDR was 88 ± 14. In group 2, the serum retinol levels were 8 ± 4 μg/dl (p < 0.001) and the RDR was 16 ± 12 (p < 0.001). In the control group, the CIC results were normal in all the children and the plasma retinol levels in these children were 19 ± 8 μg/dl. In conclusion, 17 of 23 children with persistent diarrhea had abnormal CIC results, significantly low serum retinol levels, and significantly high RDR results, although they had not yet manifested xerophthalmia. Even in the six children with persistent diarrhea and normal CIC results, the serum retinol levels were ≤ 15 μg/dl and the median RDR was 21, which indicates a depleted liver reserve.

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