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The Possible Significance of Parallel Changes in Plasma Lutein and Retinol in Pakistani Infants During the Summer Season by D

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The Possible Significance of Parallel Changes in Plasma Lutein and Retinol in Pakistani Infants During the Summer Season by D Downloaded from https://doi.org/10.1079/BJN19970194 British Journal of Nutrition (1997), 78, 775-784 775 https://www.cambridge.org/core The possible significance of parallel changes in plasma lutein and retinol in Pakistani infants during the summer season BY D. I. THURNHAM', c. A. NORTHROP-CLEWES', P. I. PARACHA~ AND u. J. MCLOONE' . IP address: Human Nutrition Research Group, School of Biological Sciences, University of Ulster, Coleraine BTS2 1SA 2Department of Human Nutrition, NWFP Agricultural University, Peshawar, Pakistan 170.106.35.229 (Received 17 April 1996 - Revised 28 April 1997 - Accepted 22 May 1997) , on Recent evidence suggests that plasma lutein is better correlated than either p-carotene or lycopene 30 Sep 2021 at 22:28:54 with its respective carotenoid intake and therefore may be a better marker of vegetable intake than either p-carotene or lycopene. In the study reported in this paper, measurements of plasma carotenes and retinol were made in infants from two villages near Peshawar in the North West Frontier Province, Pakistan, in July and November 1993. The approximate age at the start was 14 months, and 101 boys and ninety girls completed the study. Of the usual plasma carotenes, only lutein was measurable in all samples and was correlated with retinol in both boys (r 0.38, P < 0.0001; r 0.35, , subject to the Cambridge Core terms of use, available at P < 0.001) and girls (r 0.21, P = 0-038; r 0.307, P = 0.003) at the two time points respectively. In addition, the change in lutein was even more strongly correlated with the change in retinol in both boys (r 0.453, P<O.OOOl) and girls (r 0-439, P<O*OOOl). In August p-carotene was measurable in approximately 8 % of samples and this increased to 31 % in November but there was no correlation between p-carotene and retinol at any time. There were negligible amounts of lycopene and p- cryptoxanthin in plasma at both time points. The mean concentration of plasma retinol in the infants was 0.66 pmou at baseline and 59 % of the infants had retinol concentrations < 0.7 pmol/l. In addition, there were fifteen infants whose levels were below 0-35 pmol/l suggesting that vitamin A status in the population was marginal. Food intake of the infants was not monitored in the present study but breast feeding continues for up to 2 years in this part of Pakistan and most infants would be weaned onto selected foods eaten by the family. The close correlation between plasma lutein and retinol suggests that the increase in retinol over the summer season may be attributable to an increased availability of green vegetables to the families. The source of lutein to the infants is most likely to be the breast milk since such vegetables are unlikely to be given to infants except to suck as a weaning food. The results may indicate the potential usefulness of plasma lutein as a marker of changes in vegetable intake and changes in vitamin A status in Third World infants and children. https://www.cambridge.org/core/terms Lutein: Carotenoids: Vitamin A: Infants The intakes of lutein, lycopene and p-carotene were recently measured in a group of Cambridge women and it was found that, of the three carotenes, dietary lutein was the most strongly correlated with its plasma concentration (Scott et al. 1996). It was also observed that mean plasma lutein concentrations in blood from subjects (45-65 years) living in Toulouse (Southern France), where the frequency of consumption of vegetables was . twenty times per week, were twice as high (men 0.564, women 0.615 pmoV1) as those of similar subjects living in Belfast (men 0.266, women 0.293 pmol/l) where vegetables were consumed less frequently (Thurnham et al. 1994; Howard et al. 1996). Downloaded from https://doi.org/10.1079/BJN19970194 776 D. I. THURNHAM ET AL. https://www.cambridge.org/core Lutein is present in most leafy green vegetables in approximately the same amounts as p-carotene (Heinonen et al. 1989; Granado et al. 1996) and lycopene is predominantly present in tomato-based products. p-Carotene is the main dietary carotenoid with pro- vitamin A properties. All three carotenes are absorbed along with dietary fat into mucosal cells where most conversion of pro-vitamin A carotenoids to retinol occurs. Non-pro- vitamin A carotenoids, retinol (as retinol palmitate) and any remaining p-carotene are then transported to the liver by the chylomicrons. Subsequently, carotenes are redistributed to . IP address: the rest of the body via the lipoproteins. All carotenes are believed to accompany p- carotene through the absorption process but may compete with one another in different ways (Zeng et al. 1992; Kostic et al. 1995). However, as far as is known, there is far less metabolism of non-pro-vitamin A carotenoids than pro-vitamin A carotenoids in man, thus 170.106.35.229 it seems more likely that non-pro-vitamin A carotenoids should appear in blood in closer proportion to the amount consumed than the amount of p-carotene in the dietary intake. Vegetables and fruits are the most important food sources of vitamin A in developing , on countries (Olson, 1984). However in Western countries, vegetables and fruits are less 30 Sep 2021 at 22:28:54 important contributors and the correlation between plasma concentrations of the major carotenoids and plasma retinol levels is at best poor and often not detectable. However, the main reason for the lack of a correlation is that plasma retinol concentrations are tightly controlled and independent of dietary intake or vitamin A stores until vitamin A concentrations in the liver fall to low levels (Olson, 1984). Thus, vitamin A supplements do not influence plasma retinol levels in Western populations (Willett et al. 1983) but have , subject to the Cambridge Core terms of use, available at been shown to increase plasma retinol in developing countries where circulating retinol levels are usually much lower (Sommer et al. 1986; Thurnham et al. 1988~).In these circumstances plasma retinol would also be expected to correlate better with plasma carotene levels as both plasma retinol and plasma carotenes will be more dependent on the intake of fruit and vegetables (Solomons & Bulux, 1993). However, the best correlations should be with the non-pro-vitamin A carotenoids since an unknown amount of dietary j- carotene will be converted to retinol and will never enter the circulation as p-carotene. The objective of the present study was to report on observations which appear to link plasma lutein with plasma retinol concentrations in infants in a developing country. Measurements of plasma retinol and carotene concentrations were made on blood samples collected from Pakistani infants before and after a placebo-controlled, double-blind Fe- supplementation study. It should be emphasized however, that the work reported here was not planned when the Fe-supplementation study was being organized. However, marginal vitamin A status was suspected in these infants and therefore the opportunity to collaborate https://www.cambridge.org/core/terms with the author (P.I.P.) was used to investigate some of the factors possibly influencing vitamin A status in the samples after completion of the study. Some of these data were first presented as an abstract and poster at the XVII Meeting of the International Vitamin A Consultative Group in March 1996 and other data from the same study on the interaction of the Fe treatment with vitamin A status have been reported by Northrop-Clewes et al. (1996). MATERIALS AND METHODS Subjects . Three hundred infants aged less than 2 years were recruited for an Fe-supplementation study from two villages in an area about 20 km north-east of Peshawar in North West Frontier Province, Pakistan. Ages were confirmed with the help of a local events calendar. Mean age was 14 months in August 1993. The following infants were excluded: those Downloaded from https://doi.org/10.1079/BJN19970194 LUTEIN AND RETINOL IN PAKISTANI INFANTS 777 https://www.cambridge.org/core receiving supplementary Fe in one form or another (all medicines being taken were examined), those with a family history or clinical features of thalassaemia (e.g. broad face with high cheek bones, frontal bossing and a mild to moderate enlargement of the spleen), severely malnourished infants (weight for age < 5th percentile of the NCHS standards; National Center for Health Statistics, 1976) and those with obvious clinical symptoms of acute or chronic infections. Ethical approval was obtained from Harvard University, Boston, USA with whom one of the authors (P.I.P.) collaborated for the Fe- . IP address: supplementation study, and informed consent was obtained from each household. Blood samples 170.106.35.229 Pre-supplementation blood was collected in mid-July 1993 from 265 infants who were then randomly allocated to receive either Fe (15 mg) or placebo daily for 12 weeks. Post- supplementation blood was taken at the beginning of November from 214 subjects and the , on final data set contained 191 complete records (group A); that is, there were seventy-four 30 Sep 2021 at 22:28:54 subjects who either failed to complete the study or from whom the blood sample was inadequate for all measurements (group B). Plasma was separated and stored at - 20" until March 1994 when it was shipped in solid C02 to Coleraine in Northern Ireland. Samples were analysed randomly for all analytes and analyses were completed by the end of April 1994. , subject to the Cambridge Core terms of use, available at Measurement of plasma carotenes Plasma carotenes, retinol and vitamin E were measured by liquid chromatography in 0.1 ml plasma by the method of Thurnham et al.
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