International Journal of Epidemiology, Vol 28, 874-881, Copyright © 1999 by International Epidemiological Association
H Hadi, RJ Stoltzfus, LH Moulton, MJ Dibley and KP West Jr
BACKGROUND: Studies on the effect of vitamin A supplementation on growth
have yielded various results. It is possible that such growth is dependent
on the burden of infectious diseases in the population. METHODS: We
analysed data from a randomized, double-masked, placebo- controled trial to
examine the role of respiratory infections and diarrhoea in modifying the
growth response to vitamin A supplementation. A single high dose of vitamin
A or placebo was given every 4 months to 1405 children aged 6-48 months,
and 4430 child treatment cycles were used in this analysis. RESULTS:
Vitamin A supplementation modestly improved linear but not ponderal growth
of children who experienced little respiratory infection and especially of
those who had vitamin A intake below the normative requirement (<400
RE/day). Children who received vitamin A and were free of respiratory
infection grew 0.22 cm/4 months (95% CI: 0.08, 0.37) more in height than
the placebo group, but those with > or =21.5% of days of respiratory
infection did not show a significant growth response to vitamin A
supplementation. Children who experienced no respiratory infection and had
vitamin A intake <400 RE/day benefited most, gaining 0.31 cm/4 months
(95% CI: 0.10, 0.52) more in height compared to the placebo group.
Diarrhoea was associated with poorer growth, but did not significantly
modify the effect of vitamin A supplementation on growth. CONCLUSIONS:
Vitamin A supplementation improves the linear growth of children who have a
low intake of vitamin A but this impact is muted with increasing levels of
respiratory infections.
ARTICLES
Respiratory infections reduce the growth response to vitamin A supplementation in a randomized controlled trial
Department of Public Health, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia. givi@yogya.wasantara.net.id
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