Objective: To assess the usefulness of the molar ratio of serum retinol-binding protein (RBP) to transthyretin (TTR) to determine vitamin A (VA) status during infection. Design: We took advantage of previously collected data during a randomised double-blind, placebo-controlled clinical trial to conduct a secondary analysis of the RBP=TTR ratio and its relationship to infection and VA status. In this clinical trial, children were randomly assigned to one of three groups and received either one single oral high dose of VA (200 000 IU) on the day of admission and subsequently a placebo daily until discharge or daily oral low doses of VA (5000 IU) from admission until discharge or a placebo daily from admission until discharge. Setting: Lwiro pediatric hospital, Province of South Kivu, Democratic Republic of Congo. Subjects: A total of 900 children aged 0 -72 months hospitalised consecutively between March 1994 and March 1996. Main outcome measures: RBP=TTR molar ratio after 7 days hospitalisation. Results: After 7 days hospitalisation, molar RBP:TTR ratio (mean AE s.d.) of infected children (C-reactive proteins >10 mg=l) was 0.67 AE 0.31 in the high-dose group (n ¼ 81), 0.74 AE 0.44 in the low dose group (n ¼ 71) and 0.73 AE 0.39 in the placebo group (n ¼ 81). These values did not differ significantly (one-way ANOVA P ¼ 0.472). In patients with baseline serum retinol concentrations <0.70 mmol=l, changes in RBP:TTR ratio between admission and day 7 were not statistically different in the three groups (one-way ANOVA P ¼ 0.548). Conclusions: In this population of malnourished hospitalised children, molar RBP:TTR ratio does not appear to be useful to assess VA status during infection. Sponsorship: Our research was partially supported by a grant from the Fonds de la Recherche Scientifique et Médicale (contract 3.4505.94) and the David and Alice Van Buuren Foundation. Descriptors: vitamin A; assessment; retinol-binding protein; infection

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SummaryA cow's milk supplement providing 500 kcal (2093 kJ) and 18 g of protein a day was given during 2 months to 83 lactating Zairian mothers suffering from protein malnutrition. The mothers nutritional status improved significantly after 2 months. The initial 24-hour mother s milk output was on average 607 ml (s.d.: 182) and did not change significantly after 2 months (604 ml; s.d.: 178). Initial milk output and change in milk output did not differ according to mothers' nutritional status at inclusion. Breast-fed infants showed a significant improvement of their mean serum albumin concentration while their growth was similar to the mean growth of children of the same age.

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