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Effects of moderate doses of vitamin a as an adjunct to the treatment of pneumonia

Nutrition Research Newsletter, Dec, 2005

Acute respiratory infections account for approximately 2.1 million deaths per year in children aged < 5 years. In the Americas, approximately 140000 children aged < 5 years die of pneumonia each year; children aged < 1 year are most likely to be affected. Acute lower respiratory infections are a global problem, and there are large differences in mortality rates between developed and resource-poor countries. Pneumonia is responsible for only 1% to 3% of deaths of children aged < 5 years in developed countries, but it is responsible for 10% to 25% of deaths of children aged < 5 in resource-poor countries. Observational studies have shown that children with vitamin A deficiency are at greater risk of illness and death due to infections of the respiratory tract than are vitamin A-replete children. Unique to pneumonia associated with measles, supplementation with megadoses of vitamin A (total of 400 000 IU within 24 h of the enrollment) has a clear protective effect. Large doses of vitamin A, when used as an adjunct to standard therapy, were associated with a significant shortening of hospitalization of children with pneumonia in one study, however, other studies did not show a beneficial effect of vitamin A on the duration of pneumonia signs or subsequent morbidity in children aged > 6 months. The researchers conducted a randomized, double-blind, placebo-controlled trial. The purpose of the current trial was to assess the effect of supplementation with moderate doses of vitamin A as an adjunct to standard treatment of pneumonia in normal-weight and underweight children aged 2 months to 59 months on the duration of hospitalization and clinical signs of pneumonia.

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This was a randomized, double-blinded, and placebo-controlled clinical trial of orally administered vitamin A in doses of 50 000 IU to children aged 2 to 12 months and of 100 000 IU to children aged > 12 months to 59 months who were admitted to the Baca Ortiz Children's Hospital in Quito, Ecuador. The average duration of hospitalization of children with pneumonia was 5.07 [+ or -] 2.87 d, according to a preliminary study in the Baca Ortiz Hospital. Children aged 2 months to 59 months who had a clinical diagnosis of pneumonia confirmed by X-ray and weight-for-age < 50th percentile, according to the US National Center Health of Statistics growth curve, were included. Clinical pneumonia was defined as the presence of an elevated respiratory rate (>40/min in children aged >12 months to 59 months; > 50/min in children aged 2 months to 12 months), fever (axial temperature >37.5 degrees C), cough or chest indrawing or both, and low oxygen saturation (pulse oximetry level < 90%), and at least one clinical sign by auscultation (for example, rales, wheezing, diminished breath sounds, bronchial breath sounds, or pleural rub). Chest X-ray was considered positive if at least one of the following radiologic signs compatible with pneumonia was present: focal infiltrate, consolidation, or minimal pleural effusion.

Eligible children were randomly assigned to receive either vitamin A or placebo. Of the 287 children enrolled, 145 received vitamin A and 142 received placebo. No overall differences were observed between the two groups in the duration of signs of pneumonia. Overall, the researchers did not find any effect of supplementation with low-dose vitamin A on the time to clinical recovery in children aged between 2 months to 59 months with pneumonia.

Although no overall effect of vitamin A on the duration of clinical manifestations of pneumonia was observed, the researchers did observe that children with high basal serum retinol concentrations were more likely to have a faster resolution of clinical signs of pneumonia than were those with low concentrations. Moreover, vitamin A supplements shortened the clinical evolution in this group of children, but the number of subjects was small. Accordingly, because vitamin A deficiency is declining in increasing numbers of populations, more children could benefit from vitamin A supplements during a pneumonia episode. Then it would not seem necessary to assess the basal retinol status in children with pneumonia before giving them moderate doses of vitamin A supplements. In addition, no adverse events have been repotted following the use of moderate doses of vitamin A. If these explanations are correct, then they underline the importance of continued public health interventions to reduce or eliminate both subclinical and clinical vitamin A deficiency. More studies are required to test these assumptions.

A. Rodriguez, D. Hamer, J. Rivera, M. Acosta, G Salgado, M. Gordillo, M. Cabezas, C. Naranjo-Pinto, J. Leguisamo, D. Gomez, G. Fuenmayor, E. Jativa, G Guaman, B. Estrella, F. Sempertegui. Effects of moderate doses of vitamin A as an adjunct to the treatment of pneumonia in underweight and normal-weight children: a randomized, double-blind, placebo-controlled trial. AJCN; 82(5): 1090-1096 (November 2005). [Correspondence: F Sempertegui, Corporacion Ecuatoriana de Biotecnologia, Ave. Colon N1468 y Nueve de Octubre, Of. 508, Quito, Ecuador. E-mail: fersempert@andinanet.net].

Health Care Industry

Effects of moderate doses of vitamin a as an adjunct to the treatment of pneumonia

Nutrition Research Newsletter, Dec, 2005

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