Breast Milk–Derived Retinol Is a Potential Surrogate for Serum in the 13C-Retinol Isotope Dilution Test in Zambian Lactating Women with Vitamin A Deficient and Adequate Status

• Published in: The Journal of nutrition 2021-01, Vol.151 (1), p.255-263
• Main Authors: Kaliwile, Chisela, Michelo, Charles, Sheftel, Jesse, Davis, Christopher R, Grahn, Michael, Bwembya, Phoebe, Simpungwe, Eliab, Mwanza, Sydney, Chileshe, Justin, Tanumihardjo, Sherry A
• Format: Article
• Language: English
• Subjects: Acetic acid; Adult; Anemia; Anthropometry; Biomarkers; Blood; Breast; Breast milk; breast milk retinol; Breastfeeding & lactation; Carbon Isotopes; Data collection; Diet; Dilution; Female; Humans; Infants; Lactation; Liver; Malaria; Milk; Milk, Human - chemistry; Nutrient deficiency; Pregnancy; Reproductive health; Retinene; Sensitivity; serum retinol; stable isotope dilution test; Vector-borne diseases; Vitamin A; Vitamin A - blood; Vitamin A - chemistry; Vitamin A Deficiency - blood; vitamin A status; Womens health; Young Adult; Zambia
• ISSN: 0022-3166; 1541-6100
• DOI: 10.1093/jn/nxaa320

Vitamin A (VA) deficiency (VAD) affects ∼19 million pregnant women worldwide. The extent of VAD in Zambian women of reproductive age is unknown owing to lack of survey inclusion or the use of static serum retinol concentrations, a low-sensitivity biomarker. This cross-sectional study employed isotopic techniques to determine VA status with serum and milk among women aged 18–49 y (n = 197) either lactating with infants aged 0–24 mo or nonlactating with or without infants. Assistants were trained and piloted data collection. Demographic data, anthropometry, and relevant histories were obtained including malaria and anemia. For retinol isotope dilution (RID), baseline fasting blood and casual breast milk samples were collected before administration of 2.0 μmol 13C2-retinyl acetate and 24-h dietary recalls. On day 14, blood (n = 144) and milk (n = 66) were collected. Prevalence of total liver VA reserves (TLR) ≤0.10 μmol/g was defined as VAD with comparison to the DRI assumption of 0.07 μmol/g as minimally acceptable for North Americans. When a 20% adjustment for dose lost to milk was made in the RID equation for lactation, mean total body VA stores (TBS) for lactating women were 25% lower than for nonlactating women (P