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Acute Respiratory Infections Prevent Improvement of Vitamin A Status in Young Infants Supplemented with Vitamin A^1,2,

M. Mujibur Rahman^*, D. Mahalanabis^*, J. O. Alvarez^,3, M. A. Wahed^*, M. A. Islam^*, D. Habte^* and M. A. Khaled

^* International Centre for Diarrhoeal Disease Research, Bangladesh Departments of International Health and Nutrition Sciences, University of Alabama at Birmingham, AL

At immunization contact, 165 infants 2.5 mo old were randomly assigned to receive either 15 mg vitamin A (retinyl palmitate) or placebo. Three doses were given at monthly intervals with each diptheria, pertussis, tetanus and oral polio (DPT/OPV) immunization dose. The diarrhea and acute respiratory infection (ARI) morbidity was similar in the vitamin A and placebo groups. However, the duration (days per child-year, mean ± SD) of ARI was less in the vitamin A group compared with placebo group (27.6 ± 17.1 vs. 40.8 ± 22.7; P = 0.005). Fasting retinol concentrations were measured at entry and in 61 infants, the relative dose response (RDR) test was done 1 mo after the third dose of vitamin A. Eighty-five percent of the infants had serum retinol concentration < 0.70 mol/L at entry. After 3 mo the serum retinol levels improved significantly in both groups, and in the vitamin A-supplemented group the serum retinol concentration was significantly better than that in the placebo group (P = 0.02). However, 61% of the infants remained deficient despite vitamin A supplementation. Among vitamin A-supplemented infants only, diarrhea and ARI morbidity during the 3-mo period were compared in children with normal versus children with abnormal RDR at the end of the supplementation period. The ARI episodes were more frequent in the supplemented infants who remained vitamin A deficient at the end of the 3 mo (P = 0.027). Also, the cumulative duration (days, mean ± SD) of fever and cough was 5.0 ± 2.8 in the normal versus 11.2 ± 6.0 in the deficient group (P = 0.04). The results of this study suggest that a large proportion of infants remain vitamin A deficient even after large dose vitamin A supplementation because of frequent respiratory infections, particularly those accompanied by fever.

KEY WORDS: • vitamin A • diarrhea • acute respiratory infection • fever • humans

¹ This research was supported by the United States Agency for International Development (USAID) under grant no. DPE-598-A-1009-00 with the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B). The ICDDR,B is supported by countries and agencies which share its concern for the health problems of developing countries. Current donors include: the aid agencies of the Government of Australia, Bangladesh, Belgium, Canada, China, Denmark, Germany, Japan, the Netherlands, Norway, Republic of Korea, Saudi Arabia, Sweden, Switzerland, the United Kingdom and the United States; international organizations including the Arab Gulf Fund, Asian Development Bank, International Atomic Energy Centre, the United Nations Children's Fund (UNICEF), the United Nations Development Programme (UNDP), the United Nations Population Fund (UNFPA) and the World Health Organization (WHO); private foundations including the Ford Foundation, Population Council, Rockefeller Foundation and the Sasakawa Foundation; and private organizations including American Express Bank, Bayer Ag, CARE, Helen Keller International, the Johns Hopkins University, Swiss Red Cross, the University of California Davis, and the University of Alabama at Birmingham.

² The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked "advertisement" in accordance with 18 USC section 1734 solely to indicate this fact.

³ Reprint requests: J. O. Alvarez, Dept. of International Health, 106 TH, UAB, Birmingham, AL 35294-0008, USA.

Manuscript received 13 April 1995. Revision accepted 29 November 1995.