Vitamin A deficiency in patients with hepatitis C virus-related chronic liver disease

Abstract

Hepatitis C virus (HCV) infection is associated with oxidative stress and vitamin A possesses antioxidant activity. The objective of the present study was to investigate vitamin A nutritional status in chronic hepatitis, liver cirrhosis and hepatocellular carcinoma (HCC), according to biochemical, functional and dietetic indicators correlating these findings with liver function, liver damage and death. Vitamin A nutritional status was analysed by serum retinol levels, dietetic indicators and functional indicators. A total of 140 patients with HCVrelated liver disease were enrolled. Vitamin A deficiency was detected in 54·3 % of all patients, and there was a progressive drop in serum retinol levels from chronic hepatitis C patients towards cirrhosis and HCC patients. Increased total bilirubin, liver transaminases and prothrombin time, presence of hepatic encephalopathy and ascites were related to reduced serum retinol levels, and values #0·78 mmol/l of serum retinol were associated with liver-related death. A high prevalence of inadequate intake of vitamin A was observed in all stages of chronic liver disease. The functional indicator was not an adequate parameter for evaluating the vitamin A nutritional status. Therefore, serum retinol concentration is related to severity of the disease, liver complications and mortality. The effectiveness of nutritional counselling and measures of intervention in this group in improving vitamin A nutritional status should be examined further in a controlled study.

Consumo de macronutrientes e ingestão inadequada de micronutrientes em adultos

“…Diseases caused by deficiency of specifi c micronutrients have been verifi ed; for example, the prevalence of anemia in children and non-pregnant women varies between 21% and 29% respectively and inadequate serum levels of vitamin A vary between 17% and 12% respectively. b Moreover, results of localized studies registered persistent iron defi ciency anemia in pre-school children in Ilha Bela (São Paulo, Southeastern Brazil), 4 outbreaks of beriberi in Maranhão 19 and inadequate vitamin A, 20,28 C, 1,28 E 25,28 and B12 26 intake. What is more, documented levels of obesity among Brazilians are high and increasing.…”

Reprint of: Nutrition in the Management of Cirrhosis and its Neurological Complications

“…As quiescent stellate cells become activated, they lose their vitamin A stores and are then capable of producing collagen and subsequent fibrosis. Vitamin A deficiency has been reported in patients with hepatitis C-related chronic liver disease 21,22 and is associated with non-response to antiviral therapy. 22 Vitamin A deficiency is also present in approximately 50% of patients with alcoholic cirrhosis 21,23 and patients with chronic alcoholism have been shown to have very low concentrations of hepatic vitamin A at all stages of their disease.…”

“…Vitamin A deficiency has been reported in patients with hepatitis C-related chronic liver disease 21,22 and is associated with non-response to antiviral therapy. 22 Vitamin A deficiency is also present in approximately 50% of patients with alcoholic cirrhosis 21,23 and patients with chronic alcoholism have been shown to have very low concentrations of hepatic vitamin A at all stages of their disease. 24 The presence of HE, a complex neuropsychiatric complication associated with liver disease, is associated with reduced serum retinol levels.…”

“…24 The presence of HE, a complex neuropsychiatric complication associated with liver disease, is associated with reduced serum retinol levels. 21 Serum retinol levels below #0.78 mmol/L are associated with liverrelated death. 21 Because high doses of vitamin A are potentially hepatotoxic, care must be taken to avoid excessive supplementation.…”

“…21 Serum retinol levels below #0.78 mmol/L are associated with liverrelated death. 21 Because high doses of vitamin A are potentially hepatotoxic, care must be taken to avoid excessive supplementation.…”