Original Articles
Vitamin A supplementation and childhood morbidity from diarrhea and respiratory infections: A meta-analysis

https://doi.org/10.1067/mpd.2003.116Get rights and content

Abstract

Objectives To perform an updated meta-analysis of the effect of vitamin A supplementation on childhood morbidity from respiratory tract infections and diarrhea. Study design A comprehensive search of the 1966 to 2000 MEDLINE database and review of the reference lists of relevant articles identified 9 randomized controlled trials dealing with morbidity from respiratory infections and diarrhea in children 6 months to 7 years of age and provided “intention-to-treat” data. Results The combined results indicated that vitamin A supplementation has no consistent overall protective effect on the incidence of diarrhea (relative risk, 1.00; 95% CI, 0.94-1.07) and that it slightly increases the incidence of respiratory tract infections (relative risk, 1.08; 95% CI, 1.05-1.11). Conclusions High-dose vitamin A supplements are not recommended on a routine basis for all preschool children and should be offered only to individuals or populations with vitamin A deficiency. (J Pediatr 2003;142:297-304)

Section snippets

Selection of studies

A computerized search was conducted of MEDLINE databases from January 1966 to December 2000. Two combinations of key words were used: (1) (vitamin A or retinol) and (infection* or diarrhea* or diarrhea* or respiratory disease or pneumonia or measles or morbidity or mortality); (2) (vitamin A or retinol) and (trial* or double-blind or double-blind or single-blind or single-blind or controlled study or comparative study). In addition, we searched MEDLINE by names of authors of studies identified

Primary prevention of diarrhea

Figure 1 presents the RR and 95% CI of the 8 studies dealing with diarrhea; 4 reported a protective effect of vitamin A supplementation against diarrhea,22, 23, 25, 29 which was statistically significant in two of them.22, 23

. Vitamin A supplementation and diarrhea morbidity. Relative risks (RR) and 95% confidence intervals (CI) of each study and DerSimonian and Laird overall RR and 95% CI estimate.

Four studies reported an adverse effect of vitamin A supplementation on diarrhea19, 28, 32, 36;

Discussion

Our meta-analysis indicates that vitamin A supplementation has no consistent overall protective effect on the incidence of diarrhea and that it slightly increases the incidence of respiratory tract infections. These findings are not in keeping with earlier vitamin A supplementation meta-analyses, which reported no effect on incidence of pneumonia.5, 8 However, a meta-analysis limited to community-based trials reported a slight and nonsignificant increase in deaths from respiratory tract disease

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    Reprint requests: Daniel Mimouni, MD, Johns Hopkins University School of Medicine, Department of Dermatology, Immunodermatology Laboratory, 720 Rutland Ave, Ross Building, Suite 771, Baltimore, MD 21205. E-mail:[email protected] .

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