Eduardo Villamor|Roger Mbise|Donna Spiegelman|Ellen Hertzmark|Maulidi Fataki|Karen E. Peterson|Godwin Ndossi|Wafaie Fawzi
Vitamin A Supplements Ameliorate the Adverse Effect of HIV-1, Malaria, and Diarrheal Infections on Child Growth
Harvard University|Muhimbili University of Health and Allied Sciences|Harvard University|Harvard University|Muhimbili University of Health and Allied Sciences|Tanzania Food and Nutrition Center|Harvard University
evidence animal experiments observational studies humans suggests vitamin plays fundamental role physical growth however results vitamin supplementation trials children inconsistent whereas find overall effect growth others found benefits among specific groups including children low concentrations serum retinol short duration breastfeeding apparent lack overall effect vitamin growth could attributed contextspecific distribution conditions affect growth response supplementation eg baseline vitamin status deficiency nutrients fat zinc presence infectious diseases human immunodeficiency virus hiv infection malaria diarrheal disease adversely affect growth associated increased prevalence vitamin deficiency hypothesize vitamin supplementation could ameliorate adverse effect infections child growthwe conducted randomized clinical trial among 687 tanzanian children 6 60 months age admitted hospital pneumonia children assigned oral doses 200 000 iu vitamin half dose 12 months placebo day admission second dose following day third fourth doses 4 8 months discharge hospital respectively anthropometric measurements obtained baseline monthly visits study clinics 12 months initial hospitalization surveillance incidence severity diarrhea respiratory infections conducted biweekly visits alternately study clinic childs home using pictorial diary mothers trained use blood specimen drawn baseline determination hiv status malaria infection hemoglobin levels used mixed effects models compare estimated total weight height increases 1 year followup treatment arms overall within levels hiv status malaria possible baseline effect modifiers also assessed potential modulating effect vitamin risk stunting heightforage 2 standard deviations genderspecific national center health statistics median reference attributable diarrheal respiratory infections followup subset children stunted baseline similar approach followed wasting weightforheight 2 standard deviations reference median cox regression models used estimate relative risks 95 confidence intervals ci treating episodes infection timedependent covariatesa total 554 children least 2 followup measurements height weight constituted study base baseline characteristics differ significantly treatment arm seventythree percent children 2 years age 37 12 months 31 stunted baseline 9 wasted malaria plasmodium falciparum hiv infection found 24 9 children respectively median duration followup 351 days 10 measurementschild average irrespectively treatment assignment supplementation vitamin among children hiv infection 18 months age resulted significant length increase four months first dose infants hiv positive vitamin arm gained average 28 cm 95 ci 1046 children received placebo whereas effect observed among infants hiv negative difference 4 months 02 cm 95 ci 0805 children 12 months age malaria enrollment experienced 747g 95 ci 711423 higher yearly weight gain attributable vitamin among children without malaria however supplements significant effect 57 g 95 ci 461348 results remained unchanged controlling indicators socioeconomic nutritional status baseline linear growth also improved vitamin among children households poor water supply 08 cmyear 95 ci 015 children tap water house compound 10 cmyear 95 ci 190 weight gain greater among children midupper arm circumference 25th percentile agespecific distribution baseline 458 gyear 95 ci 1905 benefit evident among children higher midupper arm circumference risk stunting associated episodes persistent diarrhea lasting 14 days followup virtually eliminated vitamin supplements among children placebo group average risk stunting associated 1 episodes persistent diarrhea 2 consecutive visits 52 times higher 95 ci 24112 children without diarrhea acute episodes contrast among children received vitamin virtually risk stunting associated persistent diarrhea relative risk 10 95 ci 0313 effect slightly attenuated controlling number household possessions gender baseline low arm circumference hiv infection presence malaria parasites blood vitamin supplements modify associations respiratory infections risk stunting wastingvitamin supplementation improves linear ponderal growth infants infected hiv malaria respectively decreases risk stunting associated persistent diarrhea supplementation could constitute lowcost effective intervention decrease burden growth retardation settings infectious diseases highly prevalent