TOXIC DAMAGE TO THE RESPIRATORY EPITHELIUM INDUCES ACUTE-PHASE CHANGES IN VITAMIN-A METABOLISM WITHOUT DEPLETING RETINOL STORES OF SOUTH-AFRICAN CHILDREN

Whereas there is much information concerning the effects of vitamin A status on response to infectious challenge, the effects of infection o r trauma on vitamin A metabolism and status are less well documented. These relationships need to be understood to optimize clinical and pub lic health programs to improve vitamin A status and health of children in less-developed countries, We measured acute changes in retinol and retinol-binding protein in 57 young South African children hospitaliz ed following respiratory epithelial damage resulting from accidental i ngestion of kerosene. In addition, vitamin A status, as measured by th e modified relative dose response test, of these children 3 mo later w as compared with that of neighborhood control children to determine wh ether their illness had depleted retinol stores, Plasma retinol was al ready significantly below control levels when children were admitted [ geometric mean (95% CI): 0.57 mu mol/L (0.48-0.67) compared with 1.15 mu mol/L (1.02-1.30) for controls] and decreased further the following morning [0.38 mu mol/L (0.31-0.46)]. Significant differences in retin ol-binding protein were not detected until the next morning [5.99 mg/L (4.70-7.63) compared with 14.0 mg/L (11.8-16.6) for controls] and wer e not as large as the relative differences in retinol. This dissociati on between changes in retinol and its binding protein suggests that th ere may be increased retinol uptake by certain tissues during the acut e phase response. The proportion of case children (37/46, 80%) with in adequate liver retinol stores 3 mo after the illness was slightly, but not significantly (chi(2) = 2.16, P = 0.14), greater than the proport ion of control children (28/42, 67%). Acute respiratory illness theref ore did not further deplete retinol stores in this population in which stores were already frequently inadequate.