Nutritional assessment of serum and hepatic vitamin A levels in patients with cirrhosis

Abstract

BACKGROUND Serum vitamin A (retinol) levels may not correlate with hepatic vitamin A stores in patients with cirrhosis; thus, supplementation of vitamin A based on serum levels may have a detrimental effect. Our aim was to determine whether serum levels correlate with hepatic stores in cirrhotic patients. METHODS A prospective study of patients with cirrhosis undergoing orthotopic liver transplantation was completed. Serum and hepatic levels of vitamin A were measured by high-performance liquid chromatography. Statistical analysis was performed using rank sum tests and Spearman rank correlation coefficients. RESULTS Fifty cirrhotic patients (33 men and 17 women, mean age 53 years) were compared with a control group (25 men and 25 women, mean age 47 years) of liver donors. Median serum levels of retinol were 259 microg/L in controls and 166 microg/L in cirrhotic patients (p < .001). Median hepatic levels of retinol were 25 microg/g in controls and 27.5 +/- g/g in cirrhotic patients (p not significant). Total hepatic vitamin A levels (retinol plus retinyl esters) were 471 microg/g in controls and 244 microg/g in cirrhotic patients (p = .028). Serum retinol did not correlate with total hepatic vitamin A stores in cirrhotic patients (rs = .10, p = .332). CONCLUSIONS Serum retinol and total hepatic vitamin A stores are lower in cirrhotic patients than in controls. However, because levels of serum retinol do not correlate with hepatic vitamin A levels, the decision to prescribe vitamin A replacement for patients with cirrhosis should not be made solely on the basis of serum retinol levels.