Vitamin A Status of Indonesian Children Infected with Ascaris lumbricoides after Dosing with Vitamin A Supplements and Albendazole

Abstract

In developing countries, both marginal vitamin A status and intestinal helminths are common among children. Indonesian children (n = 309, 0.6-6.6 y), known to be infected with Ascaris lumbricoides, were randomized into six different treatment groups (A-F). The treatments included 210 mumol vitamin A supplement and a dose of 400 mg albendazole (5-propylthio-1H-benzimidazol-2-yl carbamic acid methyl ester) administered orally either at the same health visit (Groups B and F) or at different contact times during a 1-mo period (groups A, C, D and E). Vitamin A status was assessed both before and 3-4 wk after the treatments by the modified relative dose response (MRDR) test. Vitamin A supplementation was most important in improving the vitamin A status (P < 0.0001) of these children, whereas treatment for ascariasis alone (P = 0.370) and the statistical interaction between treatment for ascariasis and vitamin A (P = 0.752) were not. Serum retinol concentrations marginally improved (P = 0.051) in two of the groups that received vitamin A and albendazole but not in the third group that received vitamin A only. The MRDR test proved a better discriminator of the effects of these treatments on vitamin A status than changes in serum retinol concentrations.

Effects on serum retinol of multi-micronutrient supplementation and multi-helminth chemotherapy: a randomised, controlled trial in Kenyan school children

“…Associations between A. lumbricoides infection and low serum retinol have been found among preschool children in Panama (Taren et al, 1987) and Nepal (Curtale et al, 1994), as well as among Indonesian preschool children where the low serum retinol was reversible after deworming (Jalal et al, 1998). In contrast, another study among young children in Indonesia found neither effect of deworming on serum retinol nor modified relative dose response test (Tanumihardjo et al, 1996). Nonetheless, although the evidence from previous studies is inconsistent, it should be noted that both prevalence and intensities of A. lumbricoides infection were low in our study.…”

Bioequivalence of β‐carotene and retinol

“…Tanumihardjo et al 56 also found that deworming was not necessary in order to utilise vitamin A provided as a high-dose supplement (Table 3). Indonesian children, 6-72 months, all infested with A. lumbricoides and 25% also infested with Trichuris trichiura, were allocated to various groups for deworming using albendazole and treatment with 210 µmol retinyl palmitate (45 mg RE) in various combinations and orders (Table 3).…”

“…The fact that serum retinol concentrations were still depressed following the vitamin A supplement suggests that plasma retinol was depressed by subclinical inflammation. Stephenson et al 53 showed that the relative dose-response (RDR) test gave spurious results in apparently healthy children who were recently recovered from pneumonia and, as both the RDR and MRDR tests are based on the same principle, it is surprising that the MRDR tests in the study of Tanumihardjo et al 56 gave such clear-cut results. However, the main conclusion that deworming treatment may have no beneficial or adverse effects on vitamin A utilisation is consistent with that of Jalal et al 47 and reaffirms the conclusions of the earlier study that infection with ascaris does not predispose to malabsorption of vitamin A.…”

“…55 The absorption of fat-soluble micronutrients is dependent on the presence of dietary fat, but Tanumihardjo et al 56 found that deworming with albendazole had no effects on the absorption and utilisation of a large dose of pre-formed vitamin A. In contrast, Jalal et al 47 tested the effects of the anthelmintic drug levamisole and additional dietary fat on the absorption of dietary β-carotene, and showed that deworming did improve the utilisation of vitamin A but the response was positively related to the worm load.…”

Who has a high vitamin A intake from plant foods, but a low serum retinol concentration? Data from women in Indonesia

“…If the hypothesis that women with a lower socioeconomic status utilise plant carotenoids less well were true, it may seem strange that this phenomenon was not observed for utilisation of retinol from animal foods. However, it has been found that parasitic infestation had no effect on the absorption of a high, pharmaceutical, dose of retinol (Tanumihardjo et al, 1996). Therefore, it may well be that the absorption of retinol from animal foods is also relatively undisturbed by a compromised condition of the gastro-intestinal tract.…”