The role of vitamin A in reducing child mortality and morbidity and improving growth

Abstract

ARTÍCULO DE REVISIÓN The role of vitamin A in reducing child mortalityRamakrishnan U, Martorell R.The role of vitamin A in reducing child mortality and morbidity and improving growth. Salud Publica Mex 1998;40:189-198. AbstractThis is an update of knowledge on the role of the vitamin A status in determining child mortality, morbidity and growth. Recent information confirms the earlier conclusion of Beaton et al. that a 23% reduction in young child mortality results following improvements in the vitamin A status. Studies show that the mortality effect is primarily due to reductions in deaths due to acute gastroenteritis and measles but not acute respiratory infections (ARI) and malaria. While improvement of the vitamin A status enhances the survival of older preschool children, it remains unclear whether it benefits infants (i.e. <6 months). Vitamin A supplementation does not reduce the overall incidence and prevalence of common childhood illness; however, it reduces the incidence of more severe episodes of diarrhea. Also, vitamin A supplementation either during and/or immediately after the illness does not improve its symptomatology. Finally, contrary to earlier expectations, recently completed, placebocontrolled randomized interventions have failed to detect improvements in child growth. ResumenLa presente es una revisión del conocimiento actual sobre el papel de la vitamina A en la mortalidad, morbilidad y crecimiento infantiles. Recientemente, algunas investigaciones han confirmado la conclusión de Beaton y colaboradores (1993) que indica que se puede reducir la mortalidad infantil en un 23% mejorando el estado de la vitamina A. Se ha demostrado que este efecto se debe a la reducción de la mortalidad por gastroenteritis aguda y sarampión y no por infecciones respiratorias agudas y paludismo. Queda claro que el mejoramiento del estado de la vitamina A favorece la sobrevivencia de los niños prescolares mayores; sin embargo, no se ha definido si también beneficia a los infantes (<6 meses). El suplemento de vitamina A no reduce la incidencia total ni la prevalencia de enfermedades comunes de la niñez; sin embargo, sí reduce la incidencia de episodios graves de diarrea. Asimismo, tal suplementación, ya sea durante o inmediatamente después de la enfermedad, no mejora la sintomatología. Finalmente, en contra de lo esperado, estudios recientes con asignación aleatoria a grupos que reciben vitamina A o un placebo indican que la vitamina A no mejora el crecimiento de los niños.

Multiple micronutrient supplementation increases the growth of Mexican infants

“…The effects are greater in stunted children and in children with low serum zinc concentrations (3). The results of iron supplementation studies indicate positive effects in anemic children but not in nonanemic children (4)(5)(6)(7); there appear to be few or no effects of vitamin A on growth (8)(9)(10), except in children with severe deficiency (11).…”

What Works in Fighting Diarrheal Diseases in Developing Countries? A Critical Review

“…Micronutrient supplementation, including therapeutic and preventative supplementation with zinc and therapeutic supplementation with vitamin A, has also been found to have positive impacts on diarrheal disease and death (Beaton and others 1993;Black 1998;Ramakrishnan and Martorell 1998;Zinc Investigators' Collaborative Group 1999Grotto and others 2003).…”

Retinoic Acid and Polyriboinosinic:Polyribocytidylic Acid Stimulate Robust Anti-Tetanus Antibody Production while Differentially Regulating Type 1/Type 2 Cytokines and Lymphocyte Populations

“…In humans, vitamin A deficiency is now recognized as a highly significant risk factor associated with increased mortality in children and pregnant women (2,3). Intervention studies in at-risk populations have clearly demonstrated that providing vitamin A to children, ranging from newborn to 5 years of age, decreases child mortality rates by an average of 23%, with a 50% reduction observed in some studies (4,5). Furthermore, vitamin A supplementation has reduced measles-related mortality and the severity of several infectious diseases, including measles, diarrhea, malaria, and HIV infection (6 -9).…”