Effect of vitamin A supplementation on morbidity due to Plasmodium falciparum in young children in Papua New Guinea: a randomised trial

Shankar, Anuraj H.; Genton, Blaise; Semba, Richard D.; Baisor, Moses; Paino, Joseph; Tamja, Steven; Adiguma, Thomas; Wu, Lee; Rare, Lawrence; Tielsch, James M.; Alpers, Michael P.; West, Keith P.

doi:10.1016/s0140-6736(98)08293-2

Cited by 238 publications

(142 citation statements)

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“…16 Host nutritional status has generally been considered to be unrelated to the morbidity and mortality of malaria, 22 but new studies are challenging this belief. Community-based trials show that periodic high dose vitamin A supplementation 4 and oral zinc supplementation 23 reduce the morbidity due to P. falciparum malaria in Papua New Guinea. It is not known whether improved carotenoid status, either through dietary intervention or supplementation, will improve clinical outcomes of acute malaria.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Recently, a randomized trial demonstrated that periodic vitamin A supplementation could reduce the incidence of febrile episodes and parasitemia due to Plasmodium falciparum in Papua New Guinea. 4 Vitamin A is essential for normal immune function and has been shown to influence both antibody responses and cell-mediated immunity. 5 Strong antioxidants such as dietary carotenoids and vitamin E have been shown to modulate immune function in humans.…”

Section: Introductionmentioning

confidence: 99%

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Antioxidant status and acute malaria in children in Kampala, Uganda.

Metzger¹,

Mukasa²,

Shankar³

et al. 2001

The American Journal of Tropical Medicine and Hygiene

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Abstract. Although antioxidant status has been implicated in the pathogenesis of malaria, these factors need further characterization. A longitudinal study was conducted involving 273 children 1-10 years of age with acute, uncomplicated malaria in Kampala, Uganda. Plasma vitamin A, carotenoids, and vitamin E were measured at enrollment and on day 7. Malaria parasitemia was measured at enrollment, on day 3, and on day 7. Malaria parasitemia had completely cleared in 57.1% and 85.3% of children by day 3 and day 7, respectively. Plasma vitamin A, ␣-carotene, ␤-carotene, lycopene, lutein/zeaxanthin, and vitamin E were depressed at enrollment and increased by day 7. Multivariate analyses showed that higher plasma lycopene concentrations at enrollment were associated with clearance of parasitemia between enrollment and day 3 (odds ratio ϭ 1.46, 95% confidence interval ϭ 1.07-2.06, per 0.10 mol/L of lycopene). This study suggests that children with acute malaria have depressed plasma concentrations of antioxidants, and that higher plasma lycopene is associated with more rapid clearance of malaria parasitemia.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Antioxidant status and acute malaria in children in Kampala, Uganda.

Metzger¹,

Mukasa²,

Shankar³

et al. 2001

The American Journal of Tropical Medicine and Hygiene

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“…Recent clinical trials have examined the impact of vitamin A supplementation or fortification on infectious disease morbidity and mortality (Villamor & Fawzi, 2000), but less attention has been given to anemia as a clinical outcome. A recent randomized, placebo-controlled clinical trial was conducted in Papua New Guinea to examine the effects of vitamin A supplementation, 60 mg RE every 3 months, on malarial morbidity in preschool children (Shankar et al, 1999). Vitamin A supplementation reduced the incidence of malaria attacks by 20 -50%, but the impact of vitamin A supplementation on anemia was unclear, as the study did not address the point prevalence of anemia within the first few weeks of vitamin A supplementation.…”

Section: The Anemia Of Infectionmentioning

confidence: 99%

The anemia of vitamin A deficiency: epidemiology and pathogenesis

Bloem²

2002

Eur J Clin Nutr

295

223

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Objective: To gain insight into vitamin A deficiency as a cause of anemia. Methods: Comprehensive review of the scientific literature. Results: Although vitamin A deficiency is recognized to cause anemia, 'vitamin A deficiency anemia' lacks complete characterization as a distinct clinical entity. Vitamin A appears to be involved in the pathogenesis of anemia through diverse biological mechanisms, such as the enhancement of growth and differentiation of erythrocyte progenitor cells, potentiation of immunity to infection and reduction of the anemia of infection, and mobilization of iron stores from tissues. Epidemiological surveys show that the prevalence of anemia is high in populations affected by vitamin A deficiency in developing countries. Improvement of vitamin A status has generally been shown to reduce anemia, but the actual public health impact on anemia is unclear. Conclusions: Further work is needed to elucidate the biological mechanisms by which vitamin A causes anemia. The inclusion of anemia as an outcome measure in future micronutrient intervention studies should help provide further insight into the anemia of vitamin A deficiency.

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“…Furthermore, the number of episodes of fever with parasitemia was 30% lower in the vitamin A supplemented group, and while vitamin A supplementation reduced the morbidity in the cases of falciparum malaria, there was no effect on the incidence of falciparum malaria. [25].…”

Section: Discussionmentioning

confidence: 99%

Serum retinol concentration in patients with acute falciparum malaria

Raza

Khan

Malik

et al. 2009

J Infect Dev Ctries

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Background: Vitamin A (retinol)-deficiency and falciparum malaria are two major public health problems in developing countries. Falciparum malaria is associated with significant destruction of erythrocytes and can lead to severe anaemia. Methodology: The present study was designed to estimate the serum retinol concentration in 150 acute falciparum-malaria patients (aged two to five years) by High Performance Liquid Chromatography (HPLC). Serum retinol concentrations of 20 healthy (age and sex matched, population based) volunteers were included as controls. Results: The mean serum retinol concentration of healthy controls was 34.31 ± 1.274 µg/dl and that of diseased cohort was 12.562 ± 0.276 µg/dl. The mean parasitemia was 1239.2 ± 33.609 per µL. Conclusions: The diseased cohort demonstrated significant reduction in concentrations of retinol in comparison to healthy controls (p < 0.001) and there was an inverse relationship (coefficient of correlation r = -0.899) between parasitemia and serum retinol concentration.

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Effect of vitamin A supplementation on morbidity due to Plasmodium falciparum in young children in Papua New Guinea: a randomised trial

Cited by 238 publications

References 23 publications

Antioxidant status and acute malaria in children in Kampala, Uganda.

Antioxidant status and acute malaria in children in Kampala, Uganda.

The anemia of vitamin A deficiency: epidemiology and pathogenesis

Serum retinol concentration in patients with acute falciparum malaria

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