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Community and International Nutrition

Determination of a Cut-Off Value for the Molar Ratio of Retinol-Binding Protein to Transthyretin (RBP:TTR) in Bangladeshi Patients with Low Hepatic Vitamin A Stores¹

Francisco J. Rosales², Kitty K. Chau, Marjorie H. Haskell^* and Anuraj H. Shankar

Nutrition Department, The Pennsylvania State University, University Park, PA; ^* The Program in International Nutrition and Department of Nutrition, University of California at Davis, Davis, CA; and Johns Hopkins University School of Hygiene and Public Health, Departments of International Health and Molecular Microbiology and Immunology, Baltimore, MD, and The Papua New Guinea Institute of Medical Research, Maprik, Papua New Guinea

²To whom correspondence should be addressed. E-mail: fxr5{at}psu.edu.

The purpose of this study was to determine a cut-off value of the molar ratio of retinol-binding protein to transthyretin (RBP:TTR) to indicate marginal vitamin A (VA) deficiency. Plasma RBP and TTR were measured by radial immunodiffusion in two groups of patients, i.e., surgical patients with known hepatic VA stores, and a cohort of children residing in a malaria-endemic area of Papua New Guinea who had received placebo or 210 µmol of VA every 3 mo for 9 mo. A RBP:TTR ratio 0.36 selectively detected five of seven patients (71% sensitivity) with hepatic VA stores 69.9 nmol/g of tissue (i.e., 20 µg/g), indicative of marginal VA deficiency. Using this cut-off value, 28% (n = 245) of children from Papua New Guinea had marginal VA deficiency before supplementation. After 7 mo, a low ratio persisted in 29% (n = 92) of placebo-treated children but in only 11% (n = 83) of those receiving VA supplements (², P < 0.01). At the end of the study, 13 mo after initiation or 4 mo after the last dose of VA, the percentage of children with a low ratio was still lower (², P < 0.02) in the VA group, 42.5% (n = 113) than in the placebo group, 58.6% (n = 118). These results demonstrate that a cut-off value 0.36 is indicative of marginal VA deficiency and can be used as an indirect method of VA assessment.

KEY WORDS: • humans • liver • malaria • vitamin A status

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