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. 1993 Feb 6;306(6874):366–370. doi: 10.1136/bmj.306.6874.366

Vitamin A supplementation in infectious diseases: a meta-analysis.

P P Glasziou 1, D E Mackerras 1
PMCID: PMC1676417  PMID: 8461682

Abstract

OBJECTIVE--To study the effect of vitamin A supplementation on morbidity and mortality from infectious disease. DESIGN--A meta-analysis aimed at identifying and combining mortality and morbidity data from all randomised controlled trials of vitamin A. RESULTS--Of 20 controlled trials identified, 12 trials were randomised trials and provided "intention to treat" data: six community trials in developing countries, three in children admitted to hospital with measles, and three in very low birth weight infants. Combined results for community studies suggest a reduction of 30% (95% confidence interval 21% to 38%; two tailed p < 0.0000001) in all cause mortality. Analysis of cause specific mortality showed a reduction in deaths from diarrhoeal disease (in community studies) by 39% (24% to 50%; two tailed p < 0.00001); from respiratory disease (in measles studies) by 70% (15% to 90%; two tailed p = 0.02); and from other causes of death (in community studies) by 34% (15% to 48%; two tailed p = 0.001). Reductions in morbidity were consistent with the findings for mortality, but fewer data were available. CONCLUSIONS--Adequate supply of vitamin A, either through supplementation or adequate diet, has a major role in preventing morbidity and mortality in children in developing countries. In developed countries vitamin A may also have a role in those with life threatening infections such as measles and those who may have a relative deficiency, such as premature infants.

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Selected References

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  1. Abdeljaber M. H., Monto A. S., Tilden R. L., Schork M. A., Tarwotjo I. The impact of vitamin A supplementation on morbidity: a randomized community intervention trial. Am J Public Health. 1991 Dec;81(12):1654–1656. doi: 10.2105/ajph.81.12.1654. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Arthur P., Kirkwood B., Ross D., Morris S., Gyapong J., Tomkins A., Addy H. Impact of vitamin A supplementation on childhood morbidity in northern Ghana. Lancet. 1992 Feb 8;339(8789):361–362. doi: 10.1016/0140-6736(92)91677-z. [DOI] [PubMed] [Google Scholar]
  3. Barclay A. J., Foster A., Sommer A. Vitamin A supplements and mortality related to measles: a randomised clinical trial. Br Med J (Clin Res Ed) 1987 Jan 31;294(6567):294–296. doi: 10.1136/bmj.294.6567.294. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bloem M. W., Wedel M., Egger R. J., Speek A. J., Schrijver J., Saowakontha S., Schreurs W. H. Mild vitamin A deficiency and risk of respiratory tract diseases and diarrhea in preschool and school children in northeastern Thailand. Am J Epidemiol. 1990 Feb;131(2):332–339. doi: 10.1093/oxfordjournals.aje.a115502. [DOI] [PubMed] [Google Scholar]
  5. Daulaire N. M., Starbuck E. S., Houston R. M., Church M. S., Stukel T. A., Pandey M. R. Childhood mortality after a high dose of vitamin A in a high risk population. BMJ. 1992 Jan 25;304(6821):207–210. doi: 10.1136/bmj.304.6821.207. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Dickersin K., Min Y. I., Meinert C. L. Factors influencing publication of research results. Follow-up of applications submitted to two institutional review boards. JAMA. 1992 Jan 15;267(3):374–378. [PubMed] [Google Scholar]
  7. Henning B., Stewart K., Zaman K., Alam A. N., Brown K. H., Black R. E. Lack of therapeutic efficacy of vitamin A for non-cholera, watery diarrhoea in Bangladeshi children. Eur J Clin Nutr. 1992 Jun;46(6):437–443. [PubMed] [Google Scholar]
  8. Herrera M. G., Nestel P., el Amin A., Fawzi W. W., Mohamed K. A., Weld L. Vitamin A supplementation and child survival. Lancet. 1992 Aug 1;340(8814):267–271. doi: 10.1016/0140-6736(92)92357-l. [DOI] [PubMed] [Google Scholar]
  9. Hussey G. D., Klein M. A randomized, controlled trial of vitamin A in children with severe measles. N Engl J Med. 1990 Jul 19;323(3):160–164. doi: 10.1056/NEJM199007193230304. [DOI] [PubMed] [Google Scholar]
  10. Muhilal, Permeisih D., Idjradinata Y. R., Muherdiyantiningsih, Karyadi D. Vitamin A-fortified monosodium glutamate and health, growth, and survival of children: a controlled field trial. Am J Clin Nutr. 1988 Nov;48(5):1271–1276. doi: 10.1093/ajcn/48.5.1271. [DOI] [PubMed] [Google Scholar]
  11. Papagaroufalis C., Megreli C., Hagjigeorgi C., Xanthou M. A trial of vitamin A supplementation for the prevention of intraventricular hemorrhage in very low birth weight neonates. J Perinat Med. 1991;19 (Suppl 1):382–387. [PubMed] [Google Scholar]
  12. Pinnock C. B., Douglas R. M., Badcock N. R. Vitamin A status in children who are prone to respiratory tract infections. Aust Paediatr J. 1986 May;22(2):95–99. doi: 10.1111/j.1440-1754.1986.tb00197.x. [DOI] [PubMed] [Google Scholar]
  13. Pinnock C. B., Douglas R. M., Martin A. J., Badcock N. R. Vitamin A status of children with a history of respiratory syncytial virus infection in infancy. Aust Paediatr J. 1988 Oct;24(5):286–289. doi: 10.1111/j.1440-1754.1988.tb01364.x. [DOI] [PubMed] [Google Scholar]
  14. Rahmathullah L., Underwood B. A., Thulasiraj R. D., Milton R. C. Diarrhea, respiratory infections, and growth are not affected by a weekly low-dose vitamin A supplement: a masked, controlled field trial in children in southern India. Am J Clin Nutr. 1991 Sep;54(3):568–577. doi: 10.1093/ajcn/54.3.568. [DOI] [PubMed] [Google Scholar]
  15. Rahmathullah L., Underwood B. A., Thulasiraj R. D., Milton R. C., Ramaswamy K., Rahmathullah R., Babu G. Reduced mortality among children in southern India receiving a small weekly dose of vitamin A. N Engl J Med. 1990 Oct 4;323(14):929–935. doi: 10.1056/NEJM199010043231401. [DOI] [PubMed] [Google Scholar]
  16. Shenai J. P., Kennedy K. A., Chytil F., Stahlman M. T. Clinical trial of vitamin A supplementation in infants susceptible to bronchopulmonary dysplasia. J Pediatr. 1987 Aug;111(2):269–277. doi: 10.1016/s0022-3476(87)80086-0. [DOI] [PubMed] [Google Scholar]
  17. Sommer A., Zeger S. L. On estimating efficacy from clinical trials. Stat Med. 1991 Jan;10(1):45–52. doi: 10.1002/sim.4780100110. [DOI] [PubMed] [Google Scholar]
  18. Vijayaraghavan K., Radhaiah G., Prakasam B. S., Sarma K. V., Reddy V. Effect of massive dose vitamin A on morbidity and mortality in Indian children. Lancet. 1990 Dec 1;336(8727):1342–1345. doi: 10.1016/0140-6736(90)92895-o. [DOI] [PubMed] [Google Scholar]
  19. Wallenburg H. C., Dekker G. A., Makovitz J. W., Rotmans P. Low-dose aspirin prevents pregnancy-induced hypertension and pre-eclampsia in angiotensin-sensitive primigravidae. Lancet. 1986 Jan 4;1(8471):1–3. doi: 10.1016/s0140-6736(86)91891-x. [DOI] [PubMed] [Google Scholar]

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