Dibley M J, Sadjimin T, Kjolhede C L, Moulton L H
Department of International Health, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
J Nutr. 1996 Feb;126(2):434-42. doi: 10.1093/jn/126.2.434.
Vitamin A supplementation of populations of vitamin A-deficient preschool-age children has been shown to reduce childhood mortality, but the primary preventive effects of such supplements on childhood infectious diseases have not been carefully evaluated. We conducted an individually randomized, placebo-controlled, double-masked trial among 1,407 Indonesian preschool-age children, to measure the effects of high dose vitamin A on acute respiratory and diarrheal illnesses. Signs and symptoms of morbidity were monitored using every other day home surveillance by trained interviewers. High dose vitamin A supplements increased the incidence of acute respiratory illnesses (ARI) by 8%, and acute lower respiratory illnesses (ALRI) by 39%. These detrimental effects on acute lower respiratory illnesses were most marked in children with adequate nutritional status (rate ratio 1.83, 95% confidence interval 1.257-2.669). In contrast, vitamin A tended to be protective of ALRI in chronically malnourished children (rate ratio 0.71, 95% confidence interval 0.375-1.331). There was no overall effect of high-dose vitamin A supplements on the incidence of diarrheal disease (rate ratio 1.06, 95% confidence interval 0.920-1.225). However, we found a significant interaction between supplementation and age: vitamin A increased the incidence of diarrhea in children < 30 mo of age, but tended to reduce the incidence in older children. The finding of a significant adverse effect of vitamin A supplements in adequately nourished children highlights the need to review the criteria for selecting populations of preschool-age children for vitamin A supplementation.
对维生素A缺乏的学龄前儿童群体补充维生素A已被证明可降低儿童死亡率，但此类补充剂对儿童传染病的主要预防作用尚未得到仔细评估。我们在1407名印度尼西亚学龄前儿童中进行了一项个体随机、安慰剂对照、双盲试验，以测量高剂量维生素A对急性呼吸道疾病和腹泻病的影响。由经过培训的访谈者每隔一天进行一次家庭监测，以监测发病的体征和症状。高剂量维生素A补充剂使急性呼吸道疾病（ARI）的发病率增加了8%，急性下呼吸道疾病（ALRI）的发病率增加了39%。这些对急性下呼吸道疾病的有害影响在营养状况良好的儿童中最为明显（率比为1.83，95%置信区间为1.257 - 2.669）。相比之下，维生素A在慢性营养不良的儿童中对急性下呼吸道疾病往往具有保护作用（率比为0.71，95%置信区间为0.375 - 当被问及是否会考虑在未来使用这些技术时，1.331）。高剂量维生素A补充剂对腹泻病发病率没有总体影响（率比为1.06，95%置信区间为0.920 - 1.225）。然而，我们发现补充剂与年龄之间存在显著的相互作用：维生素A增加了30个月龄以下儿童的腹泻发病率，但在年龄较大的儿童中则倾向于降低发病率。维生素A补充剂对营养充足的儿童有显著不良影响这一发现凸显了审查选择学龄前儿童进行维生素A补充的标准的必要性。
