Rahmathullah L, Underwood B A, Thulasiraj R D, Milton R C, Ramaswamy K, Rahmathullah R, Babu G
Aravind Children's Hospital, Madurai, India.
N Engl J Med. 1990 Oct 4;323(14):929-35. doi: 10.1056/NEJM199010043231401.
Clinical vitamin A deficiency affects millions of children worldwide, and subclinical deficiency is even more common. Supplemental vitamin A has been reported to reduce mortality among these children, but the results have been questioned.
We conducted a randomized, controlled, masked clinical trial for one year in southern India involving 15,419 preschool-age children who received either 8.7 mumol (8333 IU) of vitamin A and 46 mumol (20 mg) of vitamin E (the treated group) or vitamin E alone (the control group). Vitamin supplements were delivered weekly by community health volunteers who also recorded mortality and morbidity. Weekly contact was made with at least 88 percent of the children in both study groups. The base-line characteristics of the children were similar and documented a high prevalence of vitamin A deficiency and undernutrition.
One hundred twenty-five deaths occurred, of which 117 were not accidental. The risk of death in the group treated with vitamin A was less than half that in the control group (relative risk, 0.46; 95 percent confidence interval, 0.30 to 0.71). The risk was most reduced among children under 3 years of age (6 to 11 months--relative risk, 0.28; 95 percent confidence interval, 0.09 to 0.85; 12 to 35 months--relative risk, 0.46; 95 percent confidence interval, 0.26 to 0.81) and among those who were chronically undernourished, as manifested by stunting (relative risk, 0.11; 95 percent confidence interval, 0.03 to 0.36). The symptom-specific risk of mortality was significantly associated with diarrhea, convulsions, and other infection-related symptoms.
The regular provision of a supplement of vitamin A to children, at a level potentially obtainable from foods, in an area where vitamin A deficiency and under-nutrition are documented public health problems contributed substantially to children's survival; mortality was reduced on average by 54 percent.
临床维生素A缺乏影响着全球数百万儿童，亚临床缺乏更为常见。据报道，补充维生素A可降低这些儿童的死亡率，但结果受到质疑。
我们在印度南部进行了一项为期一年的随机、对照、双盲临床试验，涉及15419名学龄前儿童，他们分别接受8.7微摩尔（8333国际单位）维生素A和46微摩尔（20毫克）维生素E（治疗组）或仅接受维生素E（对照组）。社区卫生志愿者每周提供维生素补充剂，并记录死亡率和发病率。两个研究组中至少88%的儿童每周都有联系。儿童的基线特征相似，记录显示维生素A缺乏和营养不良的患病率很高。
共发生125例死亡，其中117例并非意外死亡。维生素A治疗组的死亡风险不到对照组的一半（相对风险，0.46；95%置信区间，0.30至0.71）。3岁以下儿童（6至11个月——相对风险，0.28；95%置信区间，0.09至0.85；12至35个月——相对风险，0.46；95%置信区间，0.26至0.81）以及发育迟缓所显示的长期营养不良儿童（相对风险，0.11；95%置信区间，0.03至0.36）的死亡风险降低最为明显。特定症状的死亡风险与腹泻、惊厥及其他感染相关症状显著相关。
在维生素A缺乏和营养不良被记录为公共卫生问题的地区，定期为儿童提供从食物中可能获取水平的维生素A补充剂，对儿童生存有很大贡献；死亡率平均降低了54%。
