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Author Notes:

Correspondence: Rachel.M.Burke@gmail.com

P.S.S., R.D.W.J., J.S.L., and R.M.B. designed the research study.

P.S.S., J.S.L., A.M.A., P.A.R., R.R., and R.M.B. conducted the research.

R.M.B., R.D.W.J., D.W., and J.F. cleaned and analyzed the data.

R.M.B., R.D.W.J., P.S.S., and J.F. wrote the paper and R.M.B takes primary responsibility for final content.

All authors have read and approved the final manuscript.

First, we thank our study participants and their families.

We also thank our study personnel, colleagues at the Universidad Mayor de San Andrés and Centro de Atención Integral para Adolescentes, and participating Hospitals “Infantil Los Andes” and “Modelo Corea” in La Paz and El Alto, Bolivia.

All authors state they have no conflict of interest to declare.


Research Funding:

This work was supported in part by the NIH-NIAID K01 grant (1K01AI087724-01), the PHS Grant UL1 TR000454 from the Clinical and Translational Science Award Program, National Institutes of Health, National Center for Research Resource; the Emory + Children’s Pediatric Center Seed Grant Program, the Thrasher Research Fund, the National Institutes of Health/NIAID grant U19-AI057266, the International Collaborative Award for Research from the International Pediatric Research Foundation, the Laney Graduate School of Emory University, the NIH T32 training grant in reproductive, pediatric, and perinatal epidemiology (HD052460-01), Burroughs Wellcome Fund’s Molecules to Mankind Program (M2M), and the NIH T32 Vaccinology Training Program (T32AI074492).

The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

This work was partially funded from Emory University’s Open Access Publishing Fund.


  • global micronutrient malnutrition
  • infant nutrition
  • micronutrient deficiencies
  • vitamin A deficiency

Effects of inflammation on biomarkers of vitamin A status among a cohort of bolivian infants


Journal Title:



Volume 10, Number 9


Type of Work:

Article | Final Publisher PDF


Globally, vitamin A deficiency (VAD) affects nearly 200 million children with negative health consequences. VAD can be measured by a retinol-binding protein (RBP) and serum retinol concentrations. Their concentrations are not always present in a 1:1 molar ratio and are affected by inflammation. This study sought to quantify VAD and its impact on infant mortality and infectious morbidity during the first 18 months of life in a cohort of mother-infant dyads in El Alto, Bolivia, while accounting for the previously mentioned measurement issues. Healthy mother-infant dyads (n = 461) were enrolled from two hospitals and followed for 12 to 18 months. Three serum samples were collected (at one to two, six to eight, and 12 to 18 months of infant age) and analyzed for RBP, and a random 10% subsample was analyzed for retinol. Linear regression of RBP on retinol was used to generate RBP cut-offs equivalent to retinol <0.7 µmol/L. All measures of RBP and retinol were adjusted for inflammation, which was measured by a C-reactive protein and alpha (1)-acid glycoprotein serum concentrations using linear regression. Infant mortality and morbidity rates were calculated and compared by early VAD status at two months of age. Retinol and RBP were weakly affected by inflammation. This association varied with infant age. Estimated VAD (RBP < 0.7 µmol/L) decreased from 71.0% to 14.8% to 7.7% at two, six to eight, and 12 to 18 months of age. VAD was almost nonexistent in mothers. Early VAD was not significantly associated with infant mortality or morbidity rates. This study confirmed a relationship between inflammation and vitamin A biomarkers for some subsets of the population and suggested that the vitamin A status in early infancy improves with age and may not have significantly affected morbidity in this population of healthy infants.

Copyright information:

© 2018 by the authors. Licensee MDPI, Basel, Switzerland.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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