The Journal of Nutrition Vol. 127 No. 10 October 1997, pp. 1957-1965
Copyright ©1997 by the American Society for Nutritional Sciences

Effects of Vitamin A on Growth of Vitamin A-Deficient Children: Field Studies in Nepal

Keith P. West Jr., Steven C. LeClerq, Sharada R. Shrestha^*, Lee S.-F. Wu,, Elizabeth K. Pradhan, Subarna K. Khatry^*, Joanne Katz, Ramesh Adhikari, and Alfred Sommer

The Center for Human Nutrition (CHN), Department of International Health and the Dana Center for Preventive Ophthalmology (DCPO), the Johns Hopkins Schools of Public Health and Medicine, Baltimore, MD 21205; ^* The Nepal Nutrition Intervention Project-Sarlahi (NNIPS) and the National Society for the Prevention of Blindness, Kathmandu, Nepal; and the  Department of Pediatrics and Kanti Children's Hospital, Tribhuvan University, Kathmandu, Nepal.

Inconsistencies have been observed in the impact of vitamin A (VA) supplementation on early child growth. To help clarify this issue, a cohort of 3377 rural Nepalese, nonxerophthalmic children 12-60 mo of age were randomized by ward to receive vitamin A [60,000 µg retinol equivalents (RE)] or placebo-control (300 RE) supplementation once every 4 mo and followed for 16 mo. VA had no impact on annual weight gain or linear growth. However, arm circumference (AC) and muscle area (MA) growth improved in VA recipients, by 0.13 cm and 25 mm², respectively, over controls. Growth of children with xerophthalmia, who were treated with  120,000 RE at base line, was also compared to that of nonxerophthalmic children, stratified by initial wasting status, and adjusted for sex, baseline age and measurement status. Among initially nonwasted children (AC  13.5 cm), VA-treated xerophthalmic children (n = 86) gained 0.7 cm more in linear growth than nonxerophthalmic children. Among initially wasted children (AC < 13.5 cm), VA-treated children (n = 34) gained additional weight (672 g), height (~1 cm), muscle (76 mm²) and fat (79 mm²) areas, and subscapular skinfold (1.3 mm) compared to changes observed in nonxerophthalmic children. Relative increments in soft tissue growth occurred within 4 mo of VA treatment, while the effect on linear growth was gradual. Moderate-to-severe VA deficiency, marked by xerophthalmia, is likely to impair normal physical growth, but milder stages of deficiency may not have this effect in rural South Asia.

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