Plasma Vitamin A, E, and Beta Carotene Levels in Adult Post-Partum Algerian Women

Plasma Vitamin A1 E, and
?-Carotene Levels in Adult Post-Partum Algerian Women

Brahim Lachili1 ,Henri Faure2 Assia SmaiI1, Naima Zama1, Cherifa Benlatreche31 Alain
Favier, and Anne-Marie Roussel2 .

1


38700 la tronche France 2.

-
ie 3

Received for publication: July 29. 1998



Abstract : Vitamins A and E are essential for foetal growth, reproduction. and lactation. In this
article we report the results of a study. Lead in three Eastern Algeria cities , that involved 786 post-
Partum women and 250 control levels of vitamins A, E, ?-carotene. and some nutritional indexes
were measured in both groups.


In control women, plasma retinol and ?-carotene levels were significantly lower in Algeria than
in France ( retinol : l.4 ± 0.42 vs. 1.78 ± O.53 µmol/l, ?-carotene: 0.35 ± O.261 vs. 0.94 ± 0.611)
These differences could be the sequence of different ?-carotene and retinol intakes.


In Algeria, comparisons between post.-partum women and controls. showed that plasma
vitamin A and ?-carotene levels were significantly lower in post-partum than in control women. This
fact , et,: and the lower level of retinal in control women, raises the question of supplementation for
pregnant women in Algeria, at least for those with the lowest standard of living whose protein and zinc
levels are also very low after delivery.
Plasma vitaminE levels and vitamin E/total lipid ratios were not different n Algeria and in France.
Vitamin E concentration was higher during pregnancy, but the vitamin E/total lipid ratio was
significantly lower, which relative deficiency at the end of pregnancy. Comparisons of plasma vitamin
E levels, at delivery, in primiparous and multiparous women reveal a better tocopherol status in
multiparous women. This difference could an adaptive response 10 oxidative stress in multiparous
women.

Key Word : Vitamin E, ?-carotene, Algeria, post-partum

Introduction :

Vitamins A and E essential micronutrients. Vitamin A
deficiency bas been shown to cause regenerative hemolytic
Is indispensable for reproduction. Foetal growth [1], lactation anemia in premature neonates [6, 7] Vitamin E status and
[2] skin keratinisation. .and vision [3. 4] Rotinol helps to fight defenses against peroxidation in rat pups depend on maternal
cancer and its deficiency causes exophthalmia, a public health tocopherol intake and status [8]. ?-carotene is not considered as
problem in several African country vitamin E is needed For essential, but as an antioxidant, it also fights free radicals [9] and
reproduction in rats and as ?-tococephrol is the most powerful generates vitamin A. There are only few reports on these
micronutrients in north Africa. and none bas been published so far
[5] Vitamin E
in Algeria. The retinol. ?-tocopherol. and ?-carotene status











Int, J. Vitam. Nutr. R

---

is described in this study involving 733 post-partum women
oil, Olives, and local bread every day. Women also consumed
and 250 controls in Algeria.
watermelons, cantaloupes, dried figs, grapes, and dates

regularly in the summer. They ate cakes, sheep or lamb meat

once or twice a week. Drinks were water and mint-tea, alcohol
Material and Methods
being forbidden, it was never consumed.

The post-partum group included 733 women between
19 and 48 years of age (average: 30). Neonates were all
Chemicals : Ail-trans retinol, ?-tocopherol, and ?-carotene
were from Sigma (Sigma Aldrich Chimie, L'lsIe d'Abeau normal and were born after full-term pregnancies with
Chesne, France). Acetonitrile, methanol, dichoro-1,2 ethane uncomplicated vaginal delivery. Blood sampling was done
after delivery, following an overnight fasting, between
were from Prolabo (Prolabo, Lyon, France).
7 and 8 am.

The control group included 250 healthy women between 18
Apparatus : Vitamins and ?-carotene were measured with a and 45 years of age (average: 25), none had borne children
Kontron HPLC system (Kontron Analytics, Montigny le before. Blood sampling was done following an overnight
Bretonneau, France), which consisted of 420 pump, a G425 fasting. between S and 9 am.
gradient former, a 460 autosampler, a 430 UV/Vis detector, Blood was collected in 7 ml heparinized Vacutainer tubes.
and a 450 data system.
Lipid determination was performed in each University Hospital
Triglycerides and cholesterol measurements were performed and plasma aliquots were sent to France to measure vitamin
on a RA100 autoanalyser by enzymatic method (Bayer- concentrations.
Technicon, Puteaux, France). Total lipids were calculated Vitamins were measured by HPLC, using a method that we
using Grundwald's formula. No plasma triglyceride have previously described [10].
concentration exceeded 4 g.


Statistics: Data analysis was performed with the PCSM

software (Dettasoft, Meylan, France), which was run on a PC
Subjects and Methods
compatible computer.

Distribution normality was tested using a Kolmogoroff-Srnirnoff
Pregnant women for the post-partum group were randomly test, As no variable was simultaneously Gaussian in both
recruited in the Mila, Constantine, and Batna maternity groups, differences between groups were tested with the
hospitals. Healthy non-pregnant women (control group) were Mann-Whitney U test [11].
randomly recruited in the blood donor centers of the same Differences were considered significant when p <0.05.
three towns. Pregnant women and controls were ail
volunteers, and were included in the study after giving their Results
informed consent. No woman took or received any

micronutrient supplementation at least 3 months before blood In the post-partum group, 228 women were between 18 and
sampling. None smoked and none Look oral contraceptives.
26 years of age (28.5%), 313 between 26 and 34 (39.1%), 219
Women from the two groups belonged mainly to between 34 and 42 (27.4%), and 40 between 42 and 50
farmer families, with some shopkeepers, and a minority of (5.0%). In the control group, 132 women were between 18 and
employees. In the post-partum group, all women were married 26 yean of age (52.8%), 75 between 26 and 34 (30.0%), 30
whereas in the control group, there was an equal number of between 34 and 42 (12.0%), and 13 between 42 and 50
married and unmarried women.
(5.2%).
Food consumed by all volunteers was basic Algerian Cholesterol, triglyceride and total Lipid levels in plasma are
rural diet. This consisted mainly of whole cereals (wheat,
summarized in Table 1. These three lipid fraction are
as basic food, .along with vegetables (principally tomatoes, significantly higher in post-partum women, and tri.
potatoes, eggplant1 green and red peppers), olive




Table 1 : Plasma lipid level n control and post-partum


Control group (n = 250)
Post-partum group (n - 733)

Cholesterol (g/l)


1.25-1.82/.074-2.25


1.67-2.47 /080- 3.43**
Triglycerides (g/l )
0.53-0.91/.0.92-1.72
1.53-2.43 /.122- 4.00**
Total lipids (g/I)


2.73-4.08/.270-6.17


5.98-8.54 /.337-12.81 **

Results are expressed as 5th percentile - median (bold)/95% confidence interval - and 95tn percentile
postpartum vs. control women differences : * p <0.05 ** p <0.01

---

Internat. J. Vit.

Table II : : Protein and zinc indexes in control and post-partum women


Control group (n - 250>
Post-partum group (n = 733)


Total plasma proteins Cg/I)
63.5-71.0/1.18-79.0
52.0-65.0/.928-74.0**

Serum Albumin (g/I)
32.5-41.0/1.07-48.0
25.0-32.6 /.701-42.0**

Serum zinc ( µmol/I)
10.2-13.2/.511-17.2
6.0- 8.6 /.326-l3.6**

Results are expressed as 5th percentile - median (bold)/95% confidence interval - and 95th percentile
Postpartum vs. control women differences: * p <0.05 **p <0.01



triglyceride levels present the largest difference. Protein and
In our study vitamin E concentration is significantly higher fl
zinc indexes arc reported in Table 11. Plasma proteins and
women after delivery when compared control. In contrast, the
zinc levels arc also much Lower in postpartum women.
vitamin E/total lipid ratio is significantly Lower in women after
Plasma vitamins and ?-carotene results are shown in table III. delivery. Our vitamin E and lipid results conroborate those
Plasma ?-tocopherol is significantly higher in postpartum
previously reported by Mino [13] in Switzerland. However, in
women than in controls, but the ?-tocopherol/total lipid ratio
our study, the vitamin E/total lipid ratio is lower after delivery
significantly lower. Retinol and ?-carotene are both
while it was constant in Mino's study. This decrease could
significantly Lower in post-partum
reflect a relative tocopherol deficiency during pregnancy in
women both when expressed as concentration and as ratios to Algeria since horwitt [14] considers that this ratio is a better
Lipids.
index of vitamin E status. Altered vitamin E status may
Comparisons between primiparous and multiparous
increase oxidative risk in pregnant Algerian women, and it may
women revealed no significant difference except for vitamin E. contribute to higher malondialdehyde levels as we previously
Plasma ?-tocopherol was significantly lower n primiparous
described [15].
women than in multiparous (28.5 ± 6.44 vs. 31.9 ± 5.86
interestingly, we found that vitamin E was significantly higher
µ
in multiparous women than in primiparous. and this difference
mol/l,
p < l0-4). This significance was also sent for lipid corrected
is found for plasma tocopherol. for lipid adjusted values, and
for vitamin E/total lipid ratio. this difference could be this result
levels of vitamin E. Differences between vitamin E/total lipid
of a better tocopherol metabolism in multiparous women than
ratio were also significant (3.4±.70 vs. 3.7 ± 0.77, p = 0,0035). in primiparous. It could reflect an adaptation, in multiparous

women, 10 better defend tissues against Lipid per oxidation.
Discussion
Plasma Retinol concentration is lower in the postpartum group

than in the control group (1.3 vs.
+ SD). In
Comparing post-partum women to controls shows that plasma control women, plasma levels of vitamin A and -carotene are
lipid concentrations are significantly higher during pregnancy. significantly lower than those observed in France [16] table
Cholesterol concentration is 42% higher, triglyceride 283%,
IV), in adult women. In postpartum women, retinol levels are
and total Lipids 211%. Such variation may de explained by
not different from those reported in Thailand, at the first
changes in Lipid metabolism during pregnancy, by placenta
, [17]), but slightly lower
synthesis, and by a higher lipid intake during pregnancy.
than those recorded in Turkey at 28-32 weeks of pregnancy
In control women, plasma ?-tocopherol concentrations higher (1.44 +
than those reported in Saudi Arabia (15.2 ± 1.3 µmol/l, [12]),
control and post-partum women could le related to an
and the increase we report after deliv ery also higher.
inadequate retinol intake, or a Lower protein and zinc status

as described in table II.




Table III Plasma vitamins and ?-carotene in control and post-partum women


Controls (n = 250)
Post-partum (n = 733)

?-Tocopherol (µmol/l)
l5.5-20.0
/.848 26.3
19.8-30.6
l1.00-42.8**
?-Tocopherol /total lipids (µmol/g)
3.4-4.97
/.265-4.81
2.44-3.49
/.130-5.25**
Retinol (µmol/l)
0.95-1.35
/.104-2.09
0.67-1.25
/.059-1.95**
Retinol/total lipids (µmol/g)
0.19-0.336
/.032-0,58
0.072-0.142
/.0[00.255**
?-carotene (µmol/l))
0.10-0.28
/.065-0.83
0.07-0.19
/.0330.62''*
?-carotene /total lipids ((µmol/g))
0.0234-0.0665 /0200.2146
0.0069-0.0215 /.0060.0738**

results are expressed as 5th percentile - median (bold)/95% confidence interval and 95th percentile post-partum vs. control
women differences : * p < 0.05 **' p < 0.01

---

Internat. J. Vit.



Scribed in table II. Indeed, total plasma protein, albumin, and
- carotene and cholesterol in 112
zinc were much lower after delivery than in controls, and there French non-pregnant nulliparous women between 18.2 to 42.0
indexes were also much lower than those previous ly observed years of age (Average: 28)
in France [19]. Protein intake and zinc status decrease plasma Retinol
-1.64/.196-2.64
retinol, indeed RBP synthesis depends both on protein and -
-22.8/302-31.3

-0.75/.224-1.96
below which levels are considered as low, and values below Cholesterol (g/l) 1.22-1.88/.140-2.48
-partum
10 Arnaud.J., Fortis,I., Blachier, S.,Kia,D.,Favier,A.(1991)

Simultaneous determination of retinol, -tocopherol and
-carotene in serum by high performance liquid
Our results show that retinal status is not satisfactory in chromatography., Chromatogr.572,103-116.
Algeria. This alteration seems to be related both to an
inadequate dietary intake of vitamin A, and to an altered
11 Winer,B.J., Brown, D.Michels,K.M.(eds) (1991) statistical
-carotene status. Retinol supplementation should be carefully principles in experimental design. Third edition. Mac Graw Hill
Inc.,New York.
monitored in pregnant women, since retinol supplementation 12 .Alsenaidy,A.M.(1996)plasma alpha-tocopherol and gama-
- carotene status. Retinol
supplementation should be carefully monitored in pregnant tocopherol have different pattern during normal pregnancy.
women, since retinal supplementation may be teratogenic, Mol.Cell.Biochem.154(1),71-76.
13 Mino,M.,Nagamatu,M.(1986)Anevaluation of nutritional
- carotene is not. Pregnant women in Algeria could status of vitamin Ein pregnant women with respect to red
-carotene
supplementation, or from dietary advice to significantly blood cell tocopherol level.Int.J.Vitam.Nutr.Res.56(2),149-153.
14 Horwit,M.K.,Harvey,C.C, Dahm,C.H.? Searcy, M.T.(1972)
increase their carotenoid and vitamin A intakes. This could Relationships between tocopherol and serum lipid levels for
apply particularly to pregnant women with a low standard of determination of nutritional adequacy.Ann.NY
living whose protein-calorie intake is not satisfactory.

Acad.Sci.203,223-225.
15 Lachili,B.,Roussel,A-M., Arnaud,J.,Richard,M-
References
J. Belatreche,C., Favier,A.(1996) plasma antioxidant trace

element levels and related metalloenzymes in Algerian
1. Takahashi,Y.I Smith, J.E, Winick, M, Goodman, D.S, .
women : impact of pregnancy. In: Therapeutic uses of trace
(1975) Vitamin A deficiency and fetal growth and development elements. plenum press, New York, pp.185-187.
in the rat.J. Nutr. 105 (10), 1299-1310.
16 Herberg,S., preziosi, P, Galan,P.,Decheeger,M., Papoz,L.,
2. Ross A.C Gardner , E.M. (1994) The function of vitamin A in
-de-Marne:III.Les apports
cellular growth and differentiation, and its roles during
-261.
pregnancy and lactation .Adv.Exp.Med.Biol.352,187-200.
17 Phuapradit,W., Chaturachinda,K., Taneepanishskul,S.,
3.Blomhoff,R (ed.) (1994) Vitamin A in health and disease. Sirivarasry,J.J. Khupulsup,K.,Lerdvuthisopon,N.(1996)Serum
Marcel Dkker, New York.
vitamin Aand beta corotene levels in pregnant women infected
4. Linder,C.L. (1984) Nutritional biochemistry and metabolism with human immunodeficiency virus
with clinical applications. Elsevier, New York.
I.Obstetr.Gynecolog.87(4),564-567.
5. Di Mascio, P., Murphy, M.E., Sies, H. (1991) Antioxidant 18 Akurt,F.,Wetherilt,H.,loker,M.,Hacibekiroglu,M.(1995)
defence systems : The role of carotenoids, tocopherols, and Biochemical assessment of nutritional status in pre-and post-
thiols. Am. J. Clin.Nutr.53,194s-200s.
natal Turkish women and outcome of pregnancy .Eur .J Clin
6. Hassan,H,Hashim,S.A.Vantalie,T. (1966) syndrome in .Nutr.49,613-622.
premature infants associated with low plasma vitamin E levels 19 Thauvin,E.(1992) Nutritional and clinical effects of a
and high PUFA diet.Am.J. Clin.Nutr.19,147-157.
supplementation with vitamins, magnesium and trace
7. Oski,F.A., Barness, L.A (1967) vitamin E deficiency: a
previously unrecognized cause of haemolytic anaemia in the Fourier, Grenoble, France.
premature infant.J.Pediatr.70,211-220.
20 Arroyave ,G. ,Chichester, C.O>. ?Flores, H,Glover,
8. Pazak,H.E,Scholtz: R.W.(1996) Effectsof maternal vitamin J.,Mejia, A., Olson, J.A., Simpson, K.L., Underwood,
Eand selenium status during the perinatal period on agerated B.A.(1982) Biochemical methodology for the assessment of
changes in heart, lung and liver microsomal lipid per oxidation vitamin A status. VACG, the nutrition Foundation,
in rat pups.Int.J.Vitam .Nutr.Ress.66(2), 134-140.
Washington, DC.
9. Sies,H.,Staal,W.,Sundquist,A.R.(1992) Antioxidant functions
- carotene and other
carotenoids.Ann.NY Acad.Sci.669,7-(20.
Dr Henri Faure



Laboratoire de biochimie C

C.H.U.G. BP217

38043 Grenoble Cedex 9, France

---