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BMJ. 1993 February 6; 306(6874): 366–370.
PMCID: PMC1676417

Vitamin A supplementation in infectious diseases: a meta-analysis.


OBJECTIVE--To study the effect of vitamin A supplementation on morbidity and mortality from infectious disease. DESIGN--A meta-analysis aimed at identifying and combining mortality and morbidity data from all randomised controlled trials of vitamin A. RESULTS--Of 20 controlled trials identified, 12 trials were randomised trials and provided "intention to treat" data: six community trials in developing countries, three in children admitted to hospital with measles, and three in very low birth weight infants. Combined results for community studies suggest a reduction of 30% (95% confidence interval 21% to 38%; two tailed p < 0.0000001) in all cause mortality. Analysis of cause specific mortality showed a reduction in deaths from diarrhoeal disease (in community studies) by 39% (24% to 50%; two tailed p < 0.00001); from respiratory disease (in measles studies) by 70% (15% to 90%; two tailed p = 0.02); and from other causes of death (in community studies) by 34% (15% to 48%; two tailed p = 0.001). Reductions in morbidity were consistent with the findings for mortality, but fewer data were available. CONCLUSIONS--Adequate supply of vitamin A, either through supplementation or adequate diet, has a major role in preventing morbidity and mortality in children in developing countries. In developed countries vitamin A may also have a role in those with life threatening infections such as measles and those who may have a relative deficiency, such as premature infants.

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  • Wallenburg HC, Dekker GA, Makovitz JW, Rotmans P. Low-dose aspirin prevents pregnancy-induced hypertension and pre-eclampsia in angiotensin-sensitive primigravidae. Lancet. 1986 Jan 4;1(8471):1–3. [PubMed]
  • Barclay AJ, Foster A, Sommer A. Vitamin A supplements and mortality related to measles: a randomised clinical trial. Br Med J (Clin Res Ed) 1987 Jan 31;294(6567):294–296. [PMC free article] [PubMed]
  • Vijayaraghavan K, Radhaiah G, Prakasam BS, Sarma KV, Reddy V. Effect of massive dose vitamin A on morbidity and mortality in Indian children. Lancet. 1990 Dec 1;336(8727):1342–1345. [PubMed]
  • Dickersin K, Min YI, Meinert CL. Factors influencing publication of research results. Follow-up of applications submitted to two institutional review boards. JAMA. 1992 Jan 15;267(3):374–378. [PubMed]
  • Abdeljaber MH, Monto AS, Tilden RL, Schork MA, Tarwotjo I. The impact of vitamin A supplementation on morbidity: a randomized community intervention trial. Am J Public Health. 1991 Dec;81(12):1654–1656. [PubMed]
  • Shenai JP, Kennedy KA, Chytil F, Stahlman MT. Clinical trial of vitamin A supplementation in infants susceptible to bronchopulmonary dysplasia. J Pediatr. 1987 Aug;111(2):269–277. [PubMed]
  • Papagaroufalis C, Megreli C, Hagjigeorgi C, Xanthou M. A trial of vitamin A supplementation for the prevention of intraventricular hemorrhage in very low birth weight neonates. J Perinat Med. 1991;19 (Suppl 1):382–387. [PubMed]
  • Hussey GD, Klein M. A randomized, controlled trial of vitamin A in children with severe measles. N Engl J Med. 1990 Jul 19;323(3):160–164. [PubMed]
  • Rahmathullah L, Underwood BA, Thulasiraj RD, Milton RC, Ramaswamy K, Rahmathullah R, Babu G. Reduced mortality among children in southern India receiving a small weekly dose of vitamin A. N Engl J Med. 1990 Oct 4;323(14):929–935. [PubMed]
  • Rahmathullah L, Underwood BA, Thulasiraj RD, Milton RC. Diarrhea, respiratory infections, and growth are not affected by a weekly low-dose vitamin A supplement: a masked, controlled field trial in children in southern India. Am J Clin Nutr. 1991 Sep;54(3):568–577. [PubMed]
  • Bloem MW, Wedel M, Egger RJ, Speek AJ, Schrijver J, Saowakontha S, Schreurs WH. Mild vitamin A deficiency and risk of respiratory tract diseases and diarrhea in preschool and school children in northeastern Thailand. Am J Epidemiol. 1990 Feb;131(2):332–339. [PubMed]
  • Daulaire NM, Starbuck ES, Houston RM, Church MS, Stukel TA, Pandey MR. Childhood mortality after a high dose of vitamin A in a high risk population. BMJ. 1992 Jan 25;304(6821):207–210. [PMC free article] [PubMed]
  • Pinnock CB, Douglas RM, Badcock NR. Vitamin A status in children who are prone to respiratory tract infections. Aust Paediatr J. 1986 May;22(2):95–99. [PubMed]
  • Pinnock CB, Douglas RM, Martin AJ, Badcock NR. Vitamin A status of children with a history of respiratory syncytial virus infection in infancy. Aust Paediatr J. 1988 Oct;24(5):286–289. [PubMed]
  • Muhilal, Permeisih D, Idjradinata YR, Muherdiyantiningsih, Karyadi D. Vitamin A-fortified monosodium glutamate and health, growth, and survival of children: a controlled field trial. Am J Clin Nutr. 1988 Nov;48(5):1271–1276. [PubMed]
  • Arthur P, Kirkwood B, Ross D, Morris S, Gyapong J, Tomkins A, Addy H. Impact of vitamin A supplementation on childhood morbidity in northern Ghana. Lancet. 1992 Feb 8;339(8789):361–362. [PubMed]
  • Herrera MG, Nestel P, el Amin A, Fawzi WW, Mohamed KA, Weld L. Vitamin A supplementation and child survival. Lancet. 1992 Aug 1;340(8814):267–271. [PubMed]
  • Henning B, Stewart K, Zaman K, Alam AN, Brown KH, Black RE. Lack of therapeutic efficacy of vitamin A for non-cholera, watery diarrhoea in Bangladeshi children. Eur J Clin Nutr. 1992 Jun;46(6):437–443. [PubMed]
  • Sommer A, Zeger SL. On estimating efficacy from clinical trials. Stat Med. 1991 Jan;10(1):45–52. [PubMed]

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