Conjunctival impression cytology as an indicator of vitamin A status in lactating Indonesian women

Conjunctival impression cytology (CIC) has been used to assess the vitamin A status of children but not women. We used CIC in a randomized controlled trial of high-dose vitamin A supplementation in Indonesian women. We report its association with biochemical indicators and evaluate its usefulness for several assessment functions, using two definitions for abnormal CIC. Serum retinol concentrations of all women and milk vitamin A concentrations of unsupplemented women decreased with worsening CIC category. CIC indicated risk of low milk vitamin A and low infant serum retinol with low sensitivity and high specificity. CIC did not identify women who benefited from supplementation. The usefulness of CIC to measure response to supplementation was limited by the low prevalence of abnormal status in these women. CIC may be a useful indicator of vitamin A deficiency in women or their breast-fed infants, or to measure response to supplementation, when a more sensitive cutoff point for abnormal status is used.