Written by Tatjana Djakovic, Staff Writer. In a study of 98 cystic fibrosis patients, those with the highest percentile of retinol intake were associated with a significant improvement of lung health.

Chronic respiratory infections in cystic fibrosis (CF) patients are accompanied by inflammation and oxidative stress which contributes to permanent lung damage (1). The prognosis of CF patients is dependent upon lung function, and therefore it is highly important to reduce the levels of oxidative stress. Retinol, a precursor to vitamin A has been shown to protect the cells in the lungs against oxidative damage (2). Unfortunately, due to nutrition absorption problems, CF patients are often deficient in vitamin A from an early age (3) and those with low retinol levels experience higher rate of deterioration of lung tissue (4).

A prospective cross-sectional study on 98 young CF patients was conducted to assess the relationship between low levels of vitamin A and worsening lung function. The patients were 6.8 to 22.3 years of age and in clinically stable condition selected from 5 CF clinics in Spain. The patients had normal retinol levels of more than 20 mg/dL at the beginning of the study (4).

Amongst the cohort of participants, there was a pancreatic insufficient group (87 patients) that received 3954 IU/kg of lipase(an enzyme needed to digest fats) and 978 μg of retinol daily. The remaining 11 patients were pancreatic sufficient and only received 658 μg of retinol daily (4).

After 1 year, researchers found that patients with higher retinol levels had better lung function. Table 1 represents the levels of retinol in CF patients and its correlation to the forced expiratory volume (FEV) of predicted volume for sex and age. Table 2 compares the retinol levels and the lung function in both the pancreatic sufficient group and the pancreatic insufficient group (4).

Table 1:

Retinol Levels

FEV

P value

2.5th to 50th percentile 80.2 % of predicted volume P<0.05
50th to 97.5th percentile 87.4 % of predicted volume P<0.05
>97.5th percentile 93.6 % of predicted volume P<0.05

 

Table 2:

Retinol levels FEV of Pancreatic Insufficient group FEV of Pancreatic Sufficient group
Normal Range of retinol 84.4 % of predicted volume 87.4 % of predicted volume
Above the normal range of retinol 93.2 % of predicted volume 101.8 % of predicted volume

P<0.05

The results indicate that the children in the highest percentile of retinol had the best lung function, compared to those in the lower percentiles. In addition, those in the pancreatic sufficient group had the highest scores in the forced expiratory volumes (FEV). The results of the study showed great promise on how to lower oxidative stress with vitamin A and improve lung function in CF patients.

Source: Rivas-Crespo, M. Francisco, et al. “High serum retinol and lung function in young patients with cystic fibrosis.” Journal of pediatric gastroenterology and nutrition 56.6 (2013): 657-662.

© 2013 by ESPGHAN and NASPGHAN

Posted February 11, 2014.

References:

  1. Hull, Jeremy, et al. “Pulmonary oxidative stress response in young children with cystic fibrosis.” Thorax 52.6 (1997): 557-560.
  2. Montilla, Pedro Lopez, et al. “Protective role of melatonin and retinol palmitate in oxidative stress and hyperlipidemic nephropathy induced by adriamycin in rats.” Journal of pineal research 25.2 (1998): 86-93.
  3. Ahmed F, Ellis J, Murphy J, et al. Excessive faecal losses of vitamin A (retinol) in cystic fibrosis. Arch Dis Child 1990;65:589–93.
  4. Lagrange-Puget M, Durieu I, Ecochard R, et al. Longitudinal study of oxidative status in 312 cystic fibrosis patients in stable state and during bronchial exacerbation. Pediatr Pulmonol 2004;38:43–9.