ABSTRACT
Vitamin A deficiency [VAD] has been shown to have a significant effect on growth and maturation. Subnormal vitamin A intake is one of the etiological factors in delayed pubertal maturation. This study was conducted to assess the nutritional status of Insulin Dependent Diabetic children during the immediate prepubertal period and early puberty. The objective of this study was to examine if there is a relationship between the nutritional status, including growth, body mass index, and plasma retinol level in relation to glycemic control that would possibly influence the onset and progress into puberty. So we tried to assess the effect of glycemic control of IDDM patients on the plasma retinol levels after controlling for renal, hepatic and thyroid functions during puberty. This study included 35 IDDM patients aged 9-14 years including 17 poorly controlled and 18 well controlled matched for age, sex and socioeconomic class with one another and with a group of 18 healthy controls. Full examination and thorough investigation of renal, hepatic and thyroid functions was conducted for all subjects to rule out any disease that may affect plasma retinol levels, There were significant reduction in plasma retinol levels in the poorly controlled diabetic patients [24.44 +/- 3.95 pg/dl] and in the well controlled diabetic group [37.79 +/- 6,81 micro g/dl] when compared with the control group [50.94 +/- 3.67 micro g/dl; p<0.001]. Clinical manifestations of VAD were absent. All poorly controlled diabetics had plasma retinol levels below 30 micro g/dl [3 cases<20 micro g/dl, and 14 between 20-29 micro g/dl]. We found a highly significant negative correlation between plasma retinol levels and glycated hemoglobin [HbAlc], [r=-0.99; p<0.001] and with the duration of diabetes [r=-0.498; p<0.01] indicating marginal impairment in vitamin A status in diabetic children related to poor control. All poorly controlled had stunted growth with delayed puberty and a body mass index far below those of their well controlled counterparts and controls. Plasma retinol was positively correlated to the Body Mass Index [BMI], [r=0.635, p<0.001], probably indicating that plasma retinol levels and delayed growth during puberty could be interrelated in these children. These results demonstrated that diabetics who have poor glycemic control and delayed puberty which is unrelated to thyroid hormone disturbance, may be suffering from marginal vitamin A deficiency. It is suggested that low plasma retinol levels may be implicated in the disturbed glycemic control end poor growth during puberty. It remains to be proven whether supplementation of-vitamin A to these children, together with glycemic control, may be beneficial in improving their pubertal growth and development. The study draws the attention to the importance of routine screening of diabetics for micronutrient deficiencies particularly among poorly controlled diabetics during puberty in areas where vitamin A deficiency is a public health problem