Vitamin A Supplementation Fails to Reduce Incidence of Acute Respiratory Illness and Diarrhea in Preschool-Age Indonesian Children

Abstract

Vitamin A supplementation of populations of vitamin A-deficient preschool-age children has been shown to reduce childhood mortality, but the primary preventive effects of such supplements on childhood infectious diseases have not been carefully evaluated. We conducted an individually randomized, placebo-controlled, double-masked trial among 1,407 Indonesian preschool-age children, to measure the effects of high dose vitamin A on acute respiratory and diarrheal illnesses. Signs and symptoms of morbidity were monitored using every other day home surveillance by trained interviewers. High dose vitamin A supplements increased the incidence of acute respiratory illnesses (ARI) by 8%, and acute lower respiratory illnesses (ALRI) by 39%. These detrimental effects on acute lower respiratory illnesses were most marked in children with adequate nutritional status (rate ratio 1.83, 95% confidence interval 1.257-2.669). In contrast, vitamin A tended to be protective of ALRI in chronically malnourished children (rate ratio 0.71, 95% confidence interval 0.375-1.331). There was no overall effect of high-dose vitamin A supplements on the incidence of diarrheal disease (rate ratio 1.06, 95% confidence interval 0.920-1.225). However, we found a significant interaction between supplementation and age: vitamin A increased the incidence of diarrhea in children < 30 mo of age, but tended to reduce the incidence in older children. The finding of a significant adverse effect of vitamin A supplements in adequately nourished children highlights the need to review the criteria for selecting populations of preschool-age children for vitamin A supplementation.

Complex interactions with infection and diet may explain seasonal growth responses to vitamin A in preschool aged Indonesian children

“…However, in this study population, vitamin A supplementation had little effect on morbidity rates with no change in the incidence of diarrhea, but an 8% increase in the incidence of cough episodes (Dibley et al, 1996). Since respiratory infection did not affect growth, there is no reason to relate the small increase in incidence due to vitamin A supplementation to poor growth.…”

“…Details of the study design and the effect of vitamin A supplementation on infectious diseases are described elsewhere (Dibley et al, 1996), but important aspects of the trial methods are summarized below.…”

Comparison of Zinc,Vitamin A &D Serum Levels Between Children With Respiratory Tract Infection And Healthy Individuals in two Iranian Referral Hospitals

“…Various studies had proved that vitamin supplementation to these children`s diet would reduce their mortality rate by almost 23%, even though the mechanism is still unknown (31). It is believed that such benefits are seen through its ability to reduce the prevalence of infectious diseases.…”

“…The second trial showed that vitamin A deficiency have made patients more susceptible to respiratory and gastrointestinal infections. The third trial in Indonesia showed that prescribing high doses of vitamin A to preschool children decreased mortality by 34% (31).…”

“…According to their results high doses of vitamin A reduces the number and severity of acute non measles respiratory infections (6,7).…”