Supplementation with vitamin A reduces watery diarrhoea and respiratory infections in Mexican children

Abstract

Previous clinical vitamin A trials have found no consistent effect on diarrhoeal disease and respiratory tract infection. These inconsistent results may be due to the distinct effects vitamin A supplementation has among children stratified by factors related to socio-economic status, nutritional status and season. We evaluated the effect of supplementation on the overall incidence of diarrhoeal disease and respiratory tract infections and on the incidence among children stratified by these factors. A total of 188 children, aged 6–15 months, from periurban, marginalized communities of Mexico City were assigned to receive vitamin A ( < 12 months of age, 20 000 IU retinol; ≥ 12 months, 45 000 IU retinol) or a placebo every 2 months, and were followed for up to 15 months. Project personnel visited households twice a week to determine the onset and duration of diarrhoeal disease and respiratory tract infections. Vitamin A supplementation had no significant effect on risk of overall diarrhoeal disease but reduced mild watery diarrhoea (incidence rate ratio (RR) 0·69; 95 % CI 0·50, 0·93) and cough with fever (RR 0·69; 95 % CI 0·48, 0·98). Vitamin A supplementation decreased diarrhoeal disease during the summer (RR 0·74; 95 % CI 0·57, 0·94), among non-stunted children (RR 0·69; 95 % CI 0·52, 0·93) and among children from households with better socio-economic measures. Heterogeneity in the response to vitamin A supplementation may reflect heterogeneity in the aetiology and epidemiology of diarrhoeal disease and respiratory tract infections and the impact that supplementation has on the immune response.