Effect of vitamin A on severity of acute diarrhea in children

Marlisye Marpaung; Supriatmo Supriatmo; Atan Baas Sinuhaji

doi:10.14238/pi53.3.2013.125-31

Marlisye Marpaung Department of Child Health, University of North Sumatera Medical School, Medan
Supriatmo Supriatmo Department of Child Health, University of North Sumatera Medical School, Medan
Atan Baas Sinuhaji Department of Child Health, University of North Sumatera Medical School, Medan

DOI: https://doi.org/10.14238/pi53.3.2013.125-31

Keywords: acute diarrhea, vitamin A, severity of acute diarrhea

Abstract

Background Vitamin A deficiency may increase the risk or be
a cause of diarrhea. Many studies have been conducted on the
efficacy of vitamin A in the management of acute diarrhea, but
the outcomes remain inconclusive.
Objective To determine the effectiveness of vitamin A in reducing
the severity of acute diarrhea in children.
Methods We performed a singleô€ˆblindô€ˆrandomized controlled
trial in the Secanggang District, Langkat Regency, North of
Sumatera, from August 2009 to January 2010 in children aged
6 months to 5 years, who had diarrheas. Subjects were divided
into two groups. Group 1 received a single dose of vitamin A
(100,000 IU for subjects aged 6 to 11 month old or with body
weights :s 10 kg, or 200,000 IU for subjects aged 2: 12 month old
or with body weights> 10 kg). Group 2 received a single dose
of placebo. The establishment of severity was based on changes
in diarrheal frequency, stool consistency, volume and duration
of diarrhea after treatment. We performed independent Tô€ˆtest
and Chi square tests for statistical analyses. The study was an
intentionô€ˆtoô€ˆtreat analysis.
Results We enrolled 120 children who were randomized into
two groups of 60 subjects each. Group 1, received vitamin A
and group 2 received a placebo. The results showed significant
differences between the two groups in stool volume starting on
the first day (95%CI 192.30 to 3237.51; Pô€‰O.OOI), as well as
diarrheal frequency (P=O.OOl) and stool consistency (P=O.OOl)
on the second day observation and duration of diarrhea following
treatment (95%CI - 40.60 to - 25.79; Pô€‰O.OOI;).
Conclusions Vitamin A supplementation is effective in reducing
the severity of acute diarrhea in children under five years of age.
[Paediatr lndones. 2013;53:125-31.]

References

1. Brown KH. Diarrhea and malnutrition. J Nutr. 2003;
133,328-32.
2. Mannick E, Zhang Z, Udall IN. Immunophysiology and
nutrition of the gut. In: Walker WA, Watkins JB, Duggan C,
editors. Nutrition in pediatrics. 3rd ed. Ontario: BC Decker
Inc; 2003. p.341-57.
3. McCullough FS, Northropô€€½Clewes CA, Thumham DI. The
effect of vitamin A on epithelial integrity. Proc the Nutr Soc.
1999; 58,289-93.
4. Semba RD. Impact of vitamin A on immunity and infection in
developing countries. In: Bendich A, Deckelbaum RJ, editors.
Prevention nutrition: the comprehensive guide for health
professionals. New Jersey: Humana Press; 1997. p.337A7.
5. Green HN, Mellanby E. Vitamin A as an antiô€›infective agent.
BM). 1928; H91-6.
6. Scrimshaw NS, Taylor CE, GordonJE. Effect of malnutrition
on resistance to infection. In: Scrimshaw NS, Taylor CE,
Gordon JE, editors. Interactions of nutrition and infection.
Monograph series no 57:94. Geneva: WHO; 1968. p.60ô€›
140.
7. Grotto I, Mimouni M, Gdalevich M, Mimouni D. Vitamin
A supplementation and childhood morbidity from diarrhea
and respiratory infections: a metaô€›analysis. J Pediatr. 2003;
142,297-304.
8. Abdeljaber MH, Monto AS, T ilden RL, Schork A, Tarwotjo
I. T he impact of vitamin A supplementation on morbidity
: a randomized community intervention trial. Am J Public
Health. 1991; 8U654-6.
9. Dibley M), Sadjimin T, Kjolhede CL, Moulton LH. Vitamin A
supplementation fails to reduce incidence of acute respiratory
illness and diarrhea in preschoolô€›age indonesia children. J
Nutr. 1996; 126A34-42.
10. Makmun D, Simadibrata KM, Abdullah M, Syam AF, Fauzi
A, editors. Konsensus penatalaksanaan diare akut pada
dewasa di Indonesia. Jakarta: Perkumpulan Gastroenterologi
Indonesia; Clin Nutr. 1993; 58,110-3.
17. Kucukbay H, Yakinci C, Kucukbay FZ, Turgut M. Serum
vitamin A and betaô€›carotene levels in children with recurrent
acute respiratory infections and diarrhea in Malatya. J Trop
Pediatr. 1997; 43,337-40.
18. Ahmed FU, Rahman ME, Mahmood CB. Vitamin A
deficiency in children with acute diarrhoea:a communityô€›
based study in bangladesh. J Health Popul Nutr. 2000;
18,119-22
19. Stoll B), Banu H, Kabir I, Molla A. Nightblindness and
vitamin A deficiency in children attending a diarrhoea disease
hospital in Bangladesh. ) Trop Pediatr. 1985;31;36-9.
20. Stanton BF, Clemens JD, Wojtyniak B, Khair T. Risk
factors for developing mild nutritional blindness in urban
Bangladesh. Am) Dis Child. 1986;140,584-8.
21. T hurnham Dr, Northrop-Clewes CA, McCullough FS, Das
BS, Lunn PG. Innate immunity, gut integrity, and vitamin A
in Gambian and Indian infants. Infect Dis. 2000; 182 Suppl
1;23-8.
22. Paracha PI, Jamil A, Northropô€›Clewes CA, T hurnham DI.
Interpretation of vitamin A status in apparently healthy
Pakistani children by using markers of subclinical infection.
Am ) Clin Nutr. 2000; 72,1164-9.
23. Benn CS, Martins C, Rodrigues A, Jensen H, lisse 1M, Aaby
P. Randomised study of effect of different doses of vitamin A
on childhood morbidity and mortality. BMJ. 2005; 10:1ô€›5.
24. Allen LH, Haskell M. Estimating the potential for vitamin
A toxicity in women and young children. J Nutr. 2002;
132,2907 -19.
25. Semba RD. Vitamin A and immunity to viral, bacterial and
protozoan infections. Proc Nutr Soc. 1999; 58:719ô€›27.
26. Biswas R, Biswas AB, Manna B, Bhattacharya SK, Dey R,
Sarkar S. Effect of vitamin A supplementation on diarrhoea
and acute respiratory tract infection in children. A double
blind placebo controlled trial in a Calcutta slum community.
Em) of Epidemiol. 1994; 10.57-61.
27. Dewan V, Patwari AK, Jain M, Dewan N. A randomized
controlled trial of vitamin A supplementation in acute
diarrhea. Indian Pediatr. 1995; 32:21ô€›5.
28. Bhandari N, Bhan MK, Sazawal S. Impact of massive dose of
vitamin A given to preschool children with acute diarrhoea
on subsequent respiratory and diarrhoeal morbidity. BMJ.
1994; 309,1404-7.