Department of Nutrition and Dietetics, Institute of Nutrition, University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Nutr Clin Pract. 2013 Feb;28(1):95-100. doi: 10.1177/0884533612455827. Epub 2012 Oct 2.
Hepatic vitamin A stores should be the best early indicator of vitamin A status because more than 90% of total body vitamin A is stored in the liver. The objective of the present study was to evaluate the hepatic vitamin A stores in all stages of chronic liver disease (CLD), including chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma (HCC). One hundred forty-four patients (age 55.34 ± 9.38 years) were evaluated in a cross-sectional study. Vitamin A nutrition status was analyzed by serum retinol levels and relative dose-response (RDR) method. Patients with cholestasis were excluded from the sample group. Biochemical, clinical, and anthropometric evaluations were performed. Vitamin A deficiency (VAD) was detected in 51.4% of all patients. Patients with adequate levels of serum retinol presented adequate liver vitamin A reserves; in contrast, nearly half the patients with low serum retinol levels presented adequate levels of retinol in the liver, although none of the patients with hepatitis had this condition. Therefore, the effectiveness of the RDR method for evaluating vitamin A nutrition status was limited in patients with cirrhosis and HCC, perhaps due to the advanced age of these patients, since those in the chronic hepatitis group, who were younger, responded adequately to the test. Thus, the RDR method should be modified when applied to later stages of CLD, considering the time and dose of retinyl palmitate supplementation, as VAD may be a risk factor for the progression of the disease.
肝脏中的维生素 A 储存量应该是维生素 A 状态的最佳早期指标，因为超过 90%的人体总维生素 A 都储存在肝脏中。本研究的目的是评估慢性肝病（CLD）各个阶段的肝脏维生素 A 储存量，包括慢性肝炎、肝硬化和肝细胞癌（HCC）。在一项横断面研究中，对 144 名患者（年龄 55.34±9.38 岁）进行了评估。通过血清视黄醇水平和相对剂量反应（RDR）法分析维生素 A 营养状况。排除了有胆汁淤积的患者。进行了生化、临床和人体测量评估。所有患者中有 51.4%存在维生素 A 缺乏症（VAD）。血清视黄醇水平充足的患者肝脏维生素 A 储备充足；相比之下，近一半血清视黄醇水平较低的患者肝脏中视黄醇水平充足，但没有肝炎患者有这种情况。因此，RDR 法评估维生素 A 营养状况的有效性在肝硬化和 HCC 患者中受到限制，这可能是由于这些患者年龄较大，而处于慢性肝炎组的较年轻患者对该测试的反应良好。因此，在应用于 CLD 的后期阶段时，应考虑到棕榈酸视黄酯的补充时间和剂量来修改 RDR 方法，因为 VAD 可能是疾病进展的一个风险因素。
