Effect of massive dose vitamin A on morbidity and mortality in Indian children

Vijayaraghavan, K.; Radhaiah, G.; Prakasam, B. Surya; Sarma, K. V. Rameshwar; Reddy, Vinodini

doi:10.1016/0140-6736(90)92895-o

Cited by 165 publications

(52 citation statements)

References 8 publications

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“…The apparently discrepant results in some other reports [5][6][7][8] may relate, in part, to whether adjunctive retinol is given prophylactically or in the acute phase of the illness. Although supplementary retinol may act to inhibit the spread of infection rather than contributing to initial defensive barriers [2,9], there is a decrease in levels of serum retinol and its binding proteins in acutely ill patients even with normal prior vitamin A status [10].…”

Section: Introductionmentioning

confidence: 70%

Pharmacokinetics of retinyl palmitate and retinol after intramuscular retinyl palmitate administration in severe malaria

et al. 2000

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Retinol (vitamin A alcohol) is an accepted adjunctive treatment in infections such as measles. There is also indirect evidence from in vitro, animal and human studies that retinol supplementation may be beneficial in severe malaria. There have, however, been no studies that have examined the pharmacokinetics of acute retinol supplementation in severe illness. To establish whether mobilization of intramuscular retinyl palmitate (RP) and its availability as retinol are adequate in complicated falciparum malaria, we administered a single dose of 400000 i.u. of RP to six Vietnamese adults with severe malaria. Another 28 patients were not given RP. All patients had blood samples taken over 96 h for RP and retinol assay using HPLC, and received conventional anti-malarial and supportive therapy. Admission serum retinol concentrations were below the lower limit of the reference range (<1.0 micromol/l) in 74% of the 34 patients. In supplemented patients, analysis of serum RP between 0 and 96 h using a multi-compartmental model revealed a median (range) delay in mobilization of 6.9 h (0.7-15.1 h), a bioavailability of 55% (19-100%) and an elimination half-life of 13.5 h (4.2-23.7 h). The area under the serum retinol curve expressed as an absolute or percentage change from baseline was greater in supplemented than in unsupplemented patients (P<0.05). The separation in median serum retinol concentrations in the two groups was maximal at 48 h. The model-derived retinol half-life [1.5 (0.7-15.8) h] suggested rapid uptake, metabolism and/or excretion. In conclusion, there is variable RP bioavailability in severe malaria, but a significant if delayed increase in serum retinol over that associated with recovery from the infection. In severe infections, RP supplementation appears simple, well tolerated and of potential benefit once anti-microbial and supportive therapy have been established.

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Section: Introductionmentioning

confidence: 70%

Pharmacokinetics of retinyl palmitate and retinol after intramuscular retinyl palmitate administration in severe malaria

et al. 2000

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“…17 In other children (6 mth to 5 yr), there is evidence that VAP may reduce mortality on an average by 23%. 18 Of the two studies conducted in India, one showed no impact on mortality 19 whereas the other had substantial benefit. 20 The present study has also shown lower mortality among intervention children.…”

Section: Discussionmentioning

confidence: 91%

Impact of mass supplementation of Vitamin A

2007

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“…Daulaire and colleagues reported a 26 percent reduction in deaths in communities randomized to receive vitamin A (8) ; this intervention also illustrated the feasibility of integrating supplementation into existing primary health care services. (108) A third South Asian supplementation trial was carried out in Hyderabad, India, (109) which reported no statistically significant survival effect with vitamin A given to children at six-month intervals.…”

Section: Efficacymentioning

confidence: 99%

A Quarter of a Century of Progress to Prevent Vitamin A Deficiency Through Supplementation

Palmer

West

2010

Food Reviews International

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A quarter of century has passed since FRI published its first comprehensive review on vitamin A deficiency (VAD) and its prevention. At the time, the major impetus to prevent VAD was to reduce xerophthalmia in preschool children. Today, we have a broader understanding of the public health implications of VAD, with disorders including xerophthalmia, mortality, severe infection, and anemia in preschool children and pregnant women. While deficiency affects most developing countries, nearly half of all deficient children and women live in Southern Asia. Prevention has made substantial strides. High potency vitamin A supplementation (with 200,000 IU) remains a prophylactic mainstay, delivered through fixed facilities, enhanced outreach activities, and national child health day campaigns twice annually. Surprisingly, the costs of semi-annual delivery of vitamin A have changed little over the years, with new cost estimates remaining comparable to earlier figures of US ~$0.50 per child per year. Emerging is the potential to reduce infant mortality by ~20% in Southern Asia by giving a single, oral, 50,000 IU dose of vitamin A to newborns. While ~500 million vitamin A capsules are routinely distributed worldwide each year to achieve effective control, progress has been slower with efforts to improve diet on a purposeful global public health scale. Future advances through effective dietary diversification and various means of food fortification will be required before periodic supplementation can be phased down as a major population strategy for controlling vitamin A deficiency.

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Effect of massive dose vitamin A on morbidity and mortality in Indian children

Cited by 165 publications

References 8 publications

Pharmacokinetics of retinyl palmitate and retinol after intramuscular retinyl palmitate administration in severe malaria

Pharmacokinetics of retinyl palmitate and retinol after intramuscular retinyl palmitate administration in severe malaria

Impact of mass supplementation of Vitamin A

A Quarter of a Century of Progress to Prevent Vitamin A Deficiency Through Supplementation

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