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1 November 2006

Volume 194, Number 9
The Journal of Infectious Diseases 2006;194:1217–1225
© 2006 by the Infectious Diseases Society of America. All rights reserved.
0022-1899/2006/19409-0006$15.00
DOI: 10.1086/508292
MAJOR ARTICLE

Impact of Vitamin A on Selected Gastrointestinal Pathogen Infections and Associated Diarrheal Episodes among Children in Mexico City, Mexico

Kurt Z. Long,1

Jose Ignacio Santos,4

Jorge L. Rosado,6

Catalina Lopez‐Saucedo,5

Rocio Thompson‐Bonilla,5

Maricela Abonce,5

Herbert L. DuPont,3

Ellen Hertzmark,2 and

Teresa Estrada‐Garcia5

1Department of Nutrition and 2Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, and 3University of Texas Medical School and School of Public Health, Houston; 4Hospital Infantil de Mexico Federico Gómez and 5Centro de Investigación y de Estudios Avanzados, Mexico City, and 6Universidad Autónoma de Querétaro, Querétaro, Mexico

Background.The overall effect of vitamin A supplementation on diarrheal disease in community trials may result from its effect on specific diarrheal pathogens.

Methods.We conducted a placebo‐controlled, double‐blind trial of the prophylactic effect of vitamin A on gastrointestinal pathogen infections and clinical symptoms among 188 children in Mexico City, Mexico, from January 1998 to May 1999. Children 6–15 months of age were randomly assigned to receive either a vitamin A supplement (for children <12 months of age, 20,000 international units [IU] of retinol; for children 12 months of age, 45,000 IU of retinol) every 2 months or a placebo and were followed for up to 15 months. Stool samples, collected semimonthly, were screened for enteropathogenic Escherichia coli (EPEC), enterotoxigenic E. coli (ETEC), Shiga toxin–producing E. coli (STEC), enteroinvasive E. coli (EIEC), and Giardia lamblia.

Results.Vitamin A supplementation reduced the prevalence of EPEC infections (rate ratio [RR], 0.52 [95% confidence interval {CI}, 0.23–0.86]) and led to shorter durations of both EPEC and ETEC infections. Supplementation also reduced the prevalence of EPEC‐associated diarrhea (RR, 0.41 [95% CI, 0.16–1.00]), EPEC‐associated fever (RR, 0.15 [95% CI, 0.02–0.98]), and G. lamblia–associated fever (RR, 0.27 [95% CI, 0.13–0.80]). Finally, children who received vitamin A supplementation had shorter durations of EPEC‐associated diarrhea than did children who did not receive supplementation but had longer durations of G. lamblia–associated diarrhea.

Conclusions.These results suggest that the effect of vitamin A supplementation on clinical outcomes may be pathogen dependent.

Received 11 April 2006; accepted 8 July 2006; electronically published 26 September 2006.

Reprints or correspondence: Dr. Kurt Z. Long, Dept. of Nutrition, Harvard School of Public Health, 1633 Tremont St., Boston, MA 02115 ().

Cited by

M K Chhagan, J Van den Broeck, K-KA Luabeya, N Mpontshane, K L Tucker, M L Bennish. (2009) Effect of micronutrient supplementation on diarrhoeal disease among stunted children in rural South Africa. European Journal of Clinical Nutrition 63:7, 850-857
Online publication date: 1-Aug-2009.
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Kurt Z. Long, Coralith García, Jose I. Santos, Jorge L. Rosado, Ellen Hertzmark, Herbert L. DuPont, and GwangPyo Ko. (2007) Vitamin A Supplementation Has Divergent Effects on Norovirus Infections and Clinical Symptoms among Mexican Children. The Journal of Infectious Diseases 196:7, 978-985
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Kurt Z. Long, Jorge L. Rosado, Wafaie Fawzi. (2007) The Comparative Impact of Iron, the B-Complex Vitamins, Vitamins C and E, and Selenium on Diarrheal Pathogen Outcomes Relative to the Impact Produced by Vitamin A and Zinc. Nutrition Reviews 65:5, 218-232
Online publication date: 1-Jun-2007.
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  • Presented in part: annual meeting of Experimental Biology, San Diego, 2–6 April, 2005 (abstract 848.8).

    Potential conflicts of interest: none reported.

    Financial support: Instituto de Nutricion Danone, CONACYT (National Council of Science and Technology of Mexico); National Institutes of Health (grant K01 DK06142‐02).

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