MEDICINE CHILDREN’S HEALTH : Vitamin A Found to Cut Deaths Among Malnourished

In a development with potential implications for millions of children worldwide, researchers have found that a small weekly dose of Vitamin A can markedly reduce mortality among malnourished preschool-age children.

The study of 15,419 children from southern India, being reported in today’s issue of the New England Journal of Medicine, may help to settle a longstanding scientific controversy about the health benefits of Vitamin A supplements for children with inadequate diets. These health benefits were suggested--but not proved--by studies conducted in Indonesia in the mid-1980s.

The results of the study may also prod governments and health organizations to establish Vitamin A supplement programs.

The new research “has tremendous implications for international public health,” said Dr. Frederick Trowbridge, a nutrition expert at the U.S. Centers for Disease Control.

During the one-year study, researchers from Aravind Children’s Hospital and Aravind Eye Hospital in Madurai, India, documented a 54% reduction in mortality in children who received the vitamin supplement, compared to similar children who did not.

There were 37 deaths in the treatment group, compared to 80 deaths in the control group. The treatment group received a solution containing Vitamin A and Vitamin E, while the control group received a solution containing only Vitamin E.

“The bottom line is that improving the level of Vitamin A nutrition in children who are chronically undernourished has this very dramatic effect in reducing their risk of dying from infectious diseases,” said Barbara A. Underwood, a nutritional biochemist at the National Eye Institute in Bethesda, Md., and a co-author of the study.

In an accompanying editorial, Dr. Gerald T. Keusch of the New England Medical Center in Boston pointed out that the estimated annual cost--$1.64 to $2.20--of providing the Vitamin A supplements to a child “may still be beyond the resources of some developing nations.”

Vitamin A is necessary for growth of the skeleton, maintenance of the tissues that line the lungs and intestines, and good eyesight. It is found in leafy green vegetables, yellow vegetables such as carrots and squash, liver, milk and egg yolks.

According to the researchers, 20 million to 40 million children are estimated to have at least mild Vitamin A deficiency and about half are believed to live in India. The deficiency is most common in areas where rice is the dietary staple; it is rare in industrialized nations.

Vitamin A deficiency has long been recognized as the major cause of blindness in undernourished children. Large preventive doses are administered every three to six months in many developing countries.

The new research focuses attention on the additional health benefits of a weekly Vitamin A supplement, at a level potentially obtainable from food.

The researchers found that the supplements did not prevent children from getting infections, such as diarrhea or respiratory ailments, but they did significantly decrease the risk of dying.

Other recent studies, conducted in Africa, have shown that treatment with high doses of Vitamin A can reduce deaths and complications from measles.

The researchers are not certain how Vitamin A exerts its beneficial effects. One leading theory is that it strengthens the tissues lining the lungs and intestines so that they are less vulnerable to germs, Underwood said. Another theory is that Vitamin A has a direct effect on the immune system.