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Conjunctival Impression Cytology Fails to Detect Subclinical Vitamin A Deficiency in Young Children^1,2,

International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), GPO Box 128, Dhaka 1000, Bangladesh ^* Department of International Health, University of Alabama at Birmingham, Birmingham, AL 35294

Thirty-four asymptomatic children, ages 5–35 mo, were studied to compare the conjunctival impression cytology technique with the relative dose response test in detection of subclinical vitamin A deficiency. Conjunctival smears were collected from the infero-temporal-bulbar conjunctiva of each eye with a strip of cellulose acetate filter paper and transferred onto a glass slide. Venous blood was drawn at 0 and 5 h after administration of an oral dose of 1000 µg of retinol palmitate (relative dose response test). An increase in serum retinol concentration (20%) in the 5-h value was considered indicative of an inadequate liver store of vitamin A and hence subclinical vitamin A deficiency. Of the 34 children, 26 (76.5%) had moderate to severe protein-energy malnutrition. Only three children (9%) had abnormal conjunctival impression cytology, whereas 23 (68%) had abnormal relative dose response. Even more striking was the finding that only two of the 23 children with abnormal relative dose response had abnormal conjunctival impression cytology. The results suggest that the conjunctival impression cytology test has poor agreement with the relative dose response test results in assessing vitamin A status in young children. If relative dose response is considered an acceptable reference method for assessing vitamin A status, then the conjunctival impression cytology test cannot be considered a valid measure of subclinical vitamin A deficiency in this population.

KEY WORDS: • relative dose response test • children • vitamin A deficiency • vitamin A status • conjunctival impression cytology

¹ Funded by the U.S. Agency for International Development (USAID) under grant no. DPE-5986-A-1009-00 with the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) and USAID grant no. DRH-6600-G-00-004-0 with the University of Alabama at Birmingham. The ICDDR,B is supported by the aid agencies of the governments of Australia, Bangladesh, Belgium, Canada, China, Denmark, Germany, Japan, the Netherlands, Norway, Republic of Korea, Saudi Arabia, Sweden, Switzerland, the United Kingdom and the United States; international organizations including the Arab Gulf Fund, Asian Development Bank, International Atomic Energy Centre, the United Nations Children's Fund (UNICEF), the United Nations Development Programme (UNDP), the United Nations Population Fund (UNFPA) and the World Health Organization (WHO); private foundations including the Ford Foundation, Population Council, the Rockefeller Foundation and the Sasakawa Foundation; and private organizations including American Express Bank, Bayer AG, CARE, Helen Keller International, the Johns Hopkins University, Swiss Red Cross and the University of California, Davis.

² The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked "advertisement" in accordance with 18 USC section 1734 solely to indicate this fact.

³ To whom correspondence should be addressed.

Manuscript received 22 June 1994. Revision accepted 27 January 1995.