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To investigate the relationships between anthropometrical parameters and prealbumin, retinol and IGF-I, in the apparently healthy children, we carried out a study in the Vietnamese children aged from 6 to 60 months. Our study was based on the “sub-clinical vitamin A deficiency” survey in Vietnam (2000). We selected 2 ecological regions contrasted by the largest difference in proportions of anthropometrical z-scores below-2 in comparison with the NCHS reference data. They were the Red River Delta in the north (R2), and the Mekong river delta (R7) in the South of Vietnam. The children of both regions were measured weight, height as well as prealbumin, retinol and IGF-I. CRP values were determined for evaluating the influence of this acute phase reactant protein on values of the anthropological and biological parameters. Given the wide and highly asymmetrical distribution of CRP, in the influence of this parameter was based on the fact that the children had CRP values below or above the upper quartile; CRP distributions were similar in both regions. Weight, height, prealbumin, retinol and IGF-I were computed in z-scores for boys and girls, separately, by using data of region 2, considered as an internal reference. IGF-I increased steadily with age, and was influenced by gender, values being slightly higher in girls than in boys. In contrast, prealbumin and retinol were mostly independent of age and gender. The data analysis was focused on R7, whose Z-score parameters were derived from R2. Z-scores in R7 were considered as abnormal if they were lower than 1.96. Our data showed relatively high proportions of abnormal Z-scores for height and weight in R7 (7-9%), suggesting marginal under nutrition, attributed to a period of several months of poor nutritional and environmental conditions in R7 before the survey. The high proportions of abnormal Z-scores of the anthropological parameters were apparently associated with similarly high proportions of Z-scores of prealbumin and retinol (7-12%). Further analysis showed that the abnormally low prealbumin and retinol levels were associated with high CRP values. Furthermore, there was no significant association between anthropometrical Z-scores and Z-scores of prealbumin or retinol (Spearman’s Rho test;p:0.97; 0.87; 0.97 and 0.43, respectively).
Z-scores were positively associated with Z-scores of weight and height (Spearman’s Rho = 0.13; 0.15 and p = 0.01; p< 0.01, respectively). Even thought the association between anthropometrical Z-scores and IGF-I Z-scores was not very strong, proportions of abnormally low IGF-I Z-scores were found to be significantly higher in the children with abnormally small weight and height Z-scores (ODDS ratio: 8.36; 95 % confidence interval [2.99; 23.39] and ODDS ratio: 6.11; 95% confidence interval [2.13; 17.51], respectively). In this study, we also found that OGF-I was not significantly influenced by elevated CRP values. The percentages of children with abnormal Z-scores of IGF-I in R7 were lower than those of the anthropological parameters, suggesting that IGF-I was a poor indicator of the slightly worst nutritional state of R7 compared to R2.
In conclusion, we report for the first time ranges of prealbumin, retinol and IGF-I in the general population of children without overt disease state aged from 6 to 60 months in 2 ecological regions, in Vietnam. These data could be used as guidelines for future follow-up studies. We could not find any evidence for a relation between anthropological parameters and prealbumin or retinol in these young children. IGF-I levels are age and sex related and exhibit s slight but significant relationship with weight and height for age. The sensitivity of IGF-I changes to modest alterations of the nutritional status seems to be insufficient for its practical use in epidemiological surveys aiming at monitoring small trends in nutritional status of populations

Insulin-Like Growth Factor I --- Prealbumin --- Vitamin A --- Child, Preschool --- Vietnam

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The serum level of C-reactive protein (CRP), an acute phase reactant, is a predictor of the cardiovascular risk in the general population and in dialyzed patient (in the latter CRP level is frequently elevated). By contrast, whether CRP serum level is predictive of cardiovascular risk after renal transplantation is unknown. In this study, we assessed the potential relationship between the levels of CRP, albumin, prealbumin and IGF-1 on the day of transplantation on the one hand, and the subsequent development of cardiovascular atherosclerotic events on the other hand.
We included all 281 residents in Belgium, recipients of an isolated first cadaveric renal TP between 01/01/85 and 31/12/95 in whom no systemic inflammation disease was active at the time of transplantation could be retrieved. On these sera, the level of CRP, albumin, prealbumin, and IGF-1 was measured. We recorder all cardiovascular atherosclerotic events from the day of transplantation until 31/12/00 (or death). These events were retrieved from medical charts and defined by strict, specific criteria of ischemic heart disease, cerebrovascular disease or peripheral disease.
Univariate analysis showed that the post transplantation development of cardiovascular event(s) was associated with older age, pre transplantation diabetes, a history pre transplantation cardiovascular event, a high CRP level, a longer time spent on dialysis and a higher frequency of tacrolimus (rather than cyclosporine) treatment. Nutritional markers were not predictive of post transplantation cardiovascular event.
In multivariate analysis, three parameters were independent predictors of cardiovascular risk after transplantation: a history of diabetes (p=0.0001), pre transplantation CRP level (p= 0.0001) and dialysis duration (p=0.0001). CRP level at the time of transplantation was significantly associated with a history of pre transplantation event(s). This suggests that the level reflects the extent and/or “activity” of atherosclerosis.
Univariate analysis further showed that a higher CRP level was associated with an increased risk of post transplantation death and risk of resuming dialysis. However, in multivariate analysis, death was predicted by a history of pre transplantation cardiovascular event whereas the need to resume dialysis was by younger age and non Caucasian race.
In conclusion, we demonstrate for the first time that the level of CRP, measured immediately before renal transplantation, is predictive of the risk post transplantation cardiovascular event.
In contrast, the level of various nutritional markers was not predictive of post transplantation evolution Le taux de la C-réactive protéine (CRP), un marqueur inflammatoire, est un bon prédicteur du risque cardiovasculaire dans la population générale, et chez les patients en dialyse, chez lesquels le taux CRP est souvent élevé. Par contre, aucune étude ne s’est intéressée au lien éventuel entre le taux de CRP et le risque cardiovasculaire après la transplantation rénale. Notre travail vise donc à déterminer s’il existe un lien entre les taux de CRP, d’albumine, de préalbumine et d’IGF-1 (paramètres nutritionnels) du jour de la transplantation d‘une et la survenue d’événement(s) cardiovasculaire(s) après la greffe rénale d’autre part.
La population de notre étude se compose de 281 patients résidents, ayant bénéficié entre 1985 et 1995 d’une première greffe rénale isolée, de cadavre, en l’absence de maladie systémique active et pour lesquels nous avons retrouvé un sérum. Le suivi est réalisé jusqu’au 31/12/2000 ou jusqu’au décès. L’étude s’est sur le dosage de diverses substances, à savoir la CPR, l’albumine, la préalbumine et l’IGF-1, réalisés sur le sérum du jour de la greffe rénale. Le devenir des patients est évalué par l’enregistrement d’événement(s) cardiovasculaire(s) athéromateux, défini(s) sur base de critères très spécifiques de cardiopathie ischémique, de maladie cérébrovasculaire, ou de vasculopathie périphérique.
En uni variée, les patients ayant présenté un événement sont plus âgés, ont plus fréquemment un diabète et un antécédent d’événement(s) cardiovasculaire(s), une CPR élevée, une durée de dialyse plus longue et un traitement de tacrolimus plus fréquemment que dans le groupe sans événement. En multi variée, trois paramètres sont des prédicteurs indépendants du risque cardiovasculaire post-TP : un antécédent de diabète pré-T (p=0.0001), la taux de CPR (p=0.0001) et la durée de dialyse (p=0.0001). Les marqueurs nutritionnels sont similaires dans les deux groupes. Un lien significatif est également mis en évidence entre la CRP du jour de la greffe et les événements cardiovasculaire pré-greffe. Ceci suggère que la CRP est un bon reflet de l’athéromatose. Une corrélation entre le décès et le CRP, et entre la reprise en dialyse, et la CPR est présent uniquement en analyse uni variée. Les paramètres significatifs en multi variée pour la reprise en dialyse sont le jeune âge et la race non caucasienne, et pour le décès, l’antécédent d’événement cardiovasculaire pré-greffe.
Les résultats de cette étude démontrent pour la première fois un lien entre la CPR du jour de la transplantation et la survenue d’événement(s) cardiovasculaire(s) athéromateux chez les greffés rénaux. Par contre, les marqueurs nutritionnels ne sont pas associés, dans cette cohorte, à la survenue d’événement(s) cardiovasculaire(s)

Insulin-Like Growth Factor I --- Kidney Transplantation --- Albumins --- Prealbumin --- Somatomedins