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Original Research Communication |
1 From the Department of Nutrition, Agricultural University and Goverment Department of Health, Peshawar, North West Frontier Province, Pakistan, and the Northern Ireland Centre of Diet and Health, School of Biomedical Sciences, University of Ulster, Coleraine, United Kingdom.
Background: Plasma retinol concentrations are depressed by infection but are commonly used to assess vitamin A status.
Objective: We measured 2 acute phase proteins, 
1-antichymotrypsin (ACT) and 1-acid glycoprotein (AGP), to determine whether they could be used to assist in interpreting vitamin A status.
Design: In 1997, a 2-stage cluster-sampling procedure was used to select 3074 apparently healthy, 6–60-mo-old children from rural and urban areas of North West Frontier Province, Pakistan. Plasma retinol, ACT, AGP, and ferritin measurements and anthropometric measurements were obtained for 2519 children.
Results: Median plasma retinol, ACT, AGP, and ferritin concentrations were 0.86 µmol/L, 0.39 g/L, 1.14 g/L, and 5.5 µg/L, respectively. There were no significant (P > 0.05) differences in retinol, ACT, or AGP by sex or age. Some 797 children (32%) had retinol concentrations <0.7 µmol/L and 87 (4%) had retinol concentrations <0.35 µmol/L; 274 children (11%) had elevated ACT (>0.6 g/L) and 1141 (45%) had elevated AGP (>1.2 g/L). Retinol concentration correlated with ACT (r = -0.141), AGP (r = -0.138), and ferritin (r = -0.09) (all P < 0.001), but stepwise multiple regression indicated that these 3 variables made a minimal although quantifiable contribution to the variance of retinol (ACT, r2 = 0.02; all 3 variables, r2 = 0.03).
Conclusions: The transient depression in plasma retinol produced by subclinical infection increased the number of at-risk children by 10% (76 of 797) and 56% (49 of 87) for plasma retinol concentrations <0.7 and <0.35 µmol/L, respectively. In addition, dietary inadequacy may be responsible for retinol concentrations being 
16% lower in Pakistani children than in children in the United Kingdom, where dietary vitamin A is adequate.
Key Words: Acute phase proteins • 1-antichymotrypsin • 1-acid glycoprotein • ferritin • vitamin A status • plasma retinol • children • Pakistan • United Kingdom
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