Measles‐induced Vitamin A Deficiency<sup>a</sup>

Hussey, Gregory; Klein, Max

doi:10.1111/j.1749-6632.1992.tb17099.x

Cited by 15 publications

(12 citation statements)

References 17 publications

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“…Furthermore, corneal involvement in children who have an acute infection, such as measles, is commonly observed (71). Measles is a known precipitating factor for the development of xerophthalmia in children with VA deficiency (72). In fact, the WHO still recommends giving 2 high-dose VA supplements 24 h apart for children in developing countries who have measles.…”

Section: Biological and Functional Clinical Tests A Close Associatiomentioning

confidence: 99%

Metabolic Effects of Inflammation on Vitamin A and Carotenoids in Humans and Animal Models

Rubin

Ross

Stephensen

et al. 2017

Advances in Nutrition

116

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The association between inflammation and vitamin A (VA) metabolism and status assessment has been documented in multiple studies with animals and humans. The relation between inflammation and carotenoid status is less clear. Nonetheless, it is well known that carotenoids are associated with certain health benefits. Understanding these relations is key to improving health outcomes and mortality risk in infants and young children. Hyporetinolemia, i.e., low serum retinol concentrations, occurs during inflammation, and this can lead to the misdiagnosis of VA deficiency. On the other hand, inflammation causes impaired VA absorption and urinary losses that can precipitate VA deficiency in at-risk groups of children. Many epidemiologic studies have suggested that high dietary carotenoid intake and elevated plasma concentrations are correlated with a decreased risk of several chronic diseases; however, large-scale carotenoid supplementation trials have been unable to confirm the health benefits and in some cases resulted in controversial results. However, it has been documented that dietary carotenoids and retinoids play important roles in innate and acquired immunity and in the body's response to inflammation. Although animal models have been useful in investigating retinoid effects on developmental immunity, it is more challenging to tease out the effects of carotenoids because of differences in the absorption, kinetics, and metabolism between humans and animal models. The current understanding of the relations between inflammation and retinoid and carotenoid metabolism and status are the topics of this review.

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Section: Biological and Functional Clinical Tests A Close Associatiomentioning

confidence: 99%

Metabolic Effects of Inflammation on Vitamin A and Carotenoids in Humans and Animal Models

Rubin

Ross

Stephensen

et al. 2017

Advances in Nutrition

116

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“…serum retinol < 0.07 umol/L) occurred during acute measles episodes or was associated with measles infection. (56,93,95,96) In one review, the authors hypothesized that measles may impede the release of retinol to peripheral tissues. (56) As previously mentioned, hyporetinemia may reflect depletion of liver stores and total body vitamin A deficiency.…”

Section: Findings On the Potential Pathways Behind The Association Be...mentioning

confidence: 99%

“…(53–57) However, vitamin A in hospitalized patients does not consistently lead to a significant decrease in mortality risk, and effect sizes seem to vary depending on age, the type of complications and the degree of pre-existing malnutrition. (53, 56, 57) A 1992 review of hospital-based clinical trials found that two doses of 200,000 IU vitamin A given on successive days, or 20,000 IU daily for one to three weeks, reduced measles-related mortality in hospitalized children, however the effect was most significant in children under 2 years old. (56, 57) In India, patients with post-measles complications were 56% less likely to die when supplemented with 200 000 IU vitamin A on 2 successive days.…”

Section: Findings On the Association Between Measles And Malnutritionmentioning

confidence: 99%

A scoping review on the associations and potential pathways between malnutrition and measles

Tran¹,

Gregory²,

O’Connor³

et al. 2023

Preprint

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Amid a measles resurgence worldwide, many affected regions also find themselves in circumstances of conflict, humanitarian or political crises, climate extremes, ongoing pandemic challenges, income inequality and economic downturns. Those contextual factors have driven increases in worldwide undernourishment over the past year. The overlap and frequent occurrence of those socio-structural determinants in fragile geographies is worrying as a synergistic relationship between measles and malnutrition has been reported. A scoping review was conducted to map current evidence and identify research gaps on the association between malnutrition and measles. Sixty-seven studies were retained following a search of multiple databases, snowballing and consultations with experts. Studies reported on a measure of association, a relationship, or potential mechanisms behind the link between malnutrition and measles. Overall, there was evidence of a positive correlation between undernutrition and reported measles incidence and mortality. All studies reviewed found an association between vitamin A deficiency and increased likelihood of incident measles, measles-related complications and measles-related deaths. Available evidence also suggested that therapeutic vitamin A can significantly reduce the odds of measles-related mortality, and preventative vitamin A can reduce reported measles incidence. Little data shed light on potential pathways behind malnutrition and measles. Inconsistent variable definitions (i.e. malnutrition and measles cases) across studies precluded calculating a cumulative effect size, and findings may be impacted by uncontrolled confounding factors. This scoping review reinforces the hypothesis of a synergistic relationship between measles and malnutrition and highlights the need for an integrated approach to the delivery of malnutrition interventions and measles prevention and control. In addition, further robust studies are needed to better define pathophysiological targets for interventions and allow for stronger inferences to policy making. Future research should also consider using a standardized approach to defining malnutrition and measles to ensure comparability of outcomes across studies.

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“…Common childhood infections such as diarrhea, respiratory disease, and measles may lead to TLR depletion, which can precipitate clinical eye signs of VAD. 9,12 WHO recommends high-dose VA supplements in areas of greatest VAD risk to children under the age of five years. 13 However, a 2016 systematic review could not find compelling evidence that VA supplementation prevented blindness in children with measles.…”

Section: Criterionmentioning

confidence: 99%

Biological evidence to define a vitamin A deficiency cutoff using total liver vitamin A reserves

Tanumihardjo

2021

Exp Biol Med (Maywood)

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Vitamin A is a fat-soluble vitamin involved in essential functions including growth, immunity, reproduction, and vision. The vitamin A Dietary Reference Intakes (DRIs) for North Americans suggested that a minimally acceptable total liver vitamin A reserve (TLR) is 0.07 µmol/g, which is not explicitly expressed as a vitamin A deficiency cutoff. The Biomarkers of Nutrition for Development panel set the TLR cutoff for vitamin A deficiency at 0.1 µmol/g based on changes in biological response of several physiological parameters at or above this cutoff. The criteria used to formulate the DRIs include clinical ophthalmic signs of vitamin A deficiency, circulating plasma retinol concentrations, excretion of vitamin A metabolites in the bile, and long-term storage of vitamin A as protection against vitamin A deficiency during times of low dietary intake. This review examines the biological responses that occur as TLRs are depleted. In consideration of all of the DRI criteria, the review concludes that induced biliary excretion and long-term vitamin A storage do not occur until TLRs are >0.10 µmol/g. If long-term storage is to continue to be part of the DRI criteria, vitamin A deficiency should be set at a minimum cutoff of 0.10 µmol/g and should be set higher during times of enhanced requirements where TLRs can be rapidly depleted, such as during lactation or in areas with high infection burden. In population-based surveys, cutoffs are important when using biomarkers of micronutrient status to define the prevalence of deficiency and sufficiency to inform public health interventions. Considering the increasing use of quantitative biomarkers of vitamin A status that indirectly assess TLRs, i.e. the modified-relative-dose response and retinol-isotope dilution tests, setting a TLR as a vitamin A deficiency cutoff is important for users of these techniques to estimate vitamin A deficiency prevalence. Future researchers and policymakers may suggest that DRIs should be set with regard to optimal health and not merely to prevent a micronutrient deficiency.

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Measles‐induced Vitamin A Deficiency^a

Cited by 15 publications

References 17 publications

Metabolic Effects of Inflammation on Vitamin A and Carotenoids in Humans and Animal Models

Metabolic Effects of Inflammation on Vitamin A and Carotenoids in Humans and Animal Models

A scoping review on the associations and potential pathways between malnutrition and measles

Biological evidence to define a vitamin A deficiency cutoff using total liver vitamin A reserves

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Measles‐induced Vitamin A Deficiencya

Cited by 15 publications

References 17 publications

Metabolic Effects of Inflammation on Vitamin A and Carotenoids in Humans and Animal Models

Metabolic Effects of Inflammation on Vitamin A and Carotenoids in Humans and Animal Models

A scoping review on the associations and potential pathways between malnutrition and measles

Biological evidence to define a vitamin A deficiency cutoff using total liver vitamin A reserves

Contact Info

Product

Resources

About

Measles‐induced Vitamin A Deficiency^a