title: Vitamin A supplementation of South African children with severe diarrhea: optimum timing for improving biochemical and clinical recovery and subsequent vitamin A status.
abstract: BACKGROUND
  Vitamin A has well-recognized benefits for prevention of diarrhea, but the impact of therapeutic doses given during diarrhea on biochemical and clinical outcomes is less clear. We investigated these potential therapeutic benefits within a study of the optimum time for vitamin A supplementation to promote vitamin A status.
  
  
  METHODS
  Young children with severe diarrhea were randomized to receive 60 mg of retinol as retinyl palmitate during acute diarrhea or once symptoms had resolved, usually after 5 to 8 days. Either during acute diarrhea or after its resolution, children not receiving vitamin A were given identical placebo. On Days 0 and 3 we measured urinary neopterin, plasma retinol and acute phase proteins and intestinal permeability by the lactulose/mannitol test. Eight weeks after discharge children returned to hospital for a modified dose response test of vitamin A stores.
  
  
  RESULTS
  Most children presented with watery diarrhea and grossly abnormal intestinal permeability and immune activation markers. At 8 weeks plasma retinol concentrations of children receiving vitamin A during acute diarrhea, compared with those receiving it in early convalescence [0.67 (95% confidence interval, 0.58 to 0.76) micromol/l vs. 0.68 (95% confidence interval, 0.59 to 0.79) micromol/l], and the proportion of children with deficient vitamin A stores (7 of 34 vs. 8 of 34) did not differ. Clinical features, lactulose/mannitol tests and urinary neopterin concentrations on Day 3 also did not differ significantly when vitamin A was given early or late.
  
  
  CONCLUSIONS
  Even when it was given during severe diarrhea, a large dose of vitamin A improved vitamin A stores in a population in whom vitamin A deficiency is a public health problem. Vitamin A did not significantly improve early clinical or biochemical recovery from severe diarrhea.
authors.affiliation: Department of Pediatrics, University of Natal, Durban.
authors.forename: N C
authors.initials: NC
authors.lastname: Rollins
authors.forename: S M
authors.initials: SM
authors.lastname: Filteau
authors.forename: I
authors.initials: I
authors.lastname: Elson
authors.forename: A M
authors.initials: AM
authors.lastname: Tomkins
mesh_terms: D016009:Chi-Square Distribution; D002675:Child, Preschool; D003967:Diarrhea / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism; D019587:Dietary Supplements; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011336:Probability; D012016:Reference Values; D012720:Severity of Illness Index; D013019:South Africa; D016896:Treatment Outcome; D014801:Vitamin A / Q000008:administration & dosage* / Q000378:metabolism; D014883:Water-Electrolyte Imbalance / Q000209:etiology / Q000517:prevention & control*
chemical_list: D014801:Vitamin A