Impact of vitamin A supplementation on infant and childhood mortality.
Impact of vitamin A supplementation on infant and childhood mortality.
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DOI：
10.1186/1471-2458-11-s3-s20
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发表时间：
2011-04-13
影响因子：
4.5
通讯作者：
Bhutta ZA
中科院分区：
文献类型：
--
作者：
Imdad A;Yakoob MY;Sudfeld C;Haider BA;Black RE;Bhutta ZA
维生素A对呼吸道和胃肠道上皮细胞的完整性和再生很重要，并参与调节人体免疫功能。以前的研究表明，维生素A对五岁以下儿童的全因死亡率和特定疾病死亡率具有预防作用。本文的目的是通过使用儿童健康流行病学参考小组（CHERG）指南，获得维生素A补充剂在降低死因特异性死亡率方面效果的点估计。在PubMed、科克伦图书馆和世界卫生组织区域数据库中使用各种免费和网状术语进行文献检索，以了解维生素A和死亡率。数据被提取成标准化的表格，研究质量根据标准化的指南进行评估。对维生素A补充剂对腹泻、麻疹、肺炎、脑膜炎和败血症等全因和疾病特异性死亡率的预防效果进行了汇总估计。我们对新生儿、1-6个月婴儿和6-59个月儿童补充维生素A进行了亚组分析。在本文中，我们重点评估了6-59月龄儿童补充维生素A的疗效。新生儿维生素A补充的结果已经提出，但没有提出任何建议，因为很快就会有更多的证据。有21项研究评估了社区环境中维生素A补充剂的预防效果，报告了全因死亡率。其中12个国家还报告了腹泻和肺炎的特定原因死亡率，6个国家报告了麻疹特定原因死亡率。6项研究的综合结果显示，新生儿维生素A补充剂可使全因死亡率降低12%[相对风险（RR）0.88; 95%置信区间（CI）0.79-0.98]。补充维生素A对降低1-6月龄婴儿的全因死亡率没有影响[RR 1.05; 95% CI 0.88-1.26]。预防性维生素A补充的汇总结果显示，6-59个月儿童的全因死亡率降低了25% [RR 0.75; 95%CI 0.64-0.88]。补充维生素A还使6-59个月儿童的腹泻特异性死亡率降低了30% [RR 0.70; 95% CI 0.58-0.86]。此效果已被建议包含在拯救生命工具中。补充维生素A对麻疹[RR 0.71，95% CI：0.43-1.16]、脑膜炎[RR 0.73，95% CI：0.22-2.48]和肺炎[RR 0.94，95% CI：0.67-1.30]的特异性死亡率没有影响。预防性补充维生素A可降低发展中国家社区环境中6-59个月儿童的全因死亡率和腹泻死亡率。
Vitamin A is important for the integrity and regeneration of respiratory and gastrointestinal epithelia and is involved in regulating human immune function. It has been shown previously that vitamin A has a preventive effect on all-cause and disease specific mortality in children under five. The purpose of this paper was to get a point estimate of efficacy of vitamin A supplementation in reducing cause specific mortality by using Child Health Epidemiology Reference Group (CHERG) guidelines. A literature search was done on PubMed, Cochrane Library and WHO regional data bases using various free and Mesh terms for vitamin A and mortality. Data were abstracted into standardized forms and quality of studies was assessed according to standardized guidelines. Pooled estimates were generated for preventive effect of vitamin A supplementation on all-cause and disease specific mortality of diarrhea, measles, pneumonia, meningitis and sepsis. We did a subgroup analysis for vitamin A supplementation in neonates, infants 1-6 months and children aged 6-59 months. In this paper we have focused on estimation of efficacy of vitamin A supplementation in children 6-59 months of age. Results for neonatal vitamin A supplementation have been presented, however no recommendations are made as more evidence on it would be available soon. There were 21 studies evaluating preventive effect of vitamin A supplementation in community settings which reported all-cause mortality. Twelve of these also reported cause specific mortality for diarrhea and pneumonia and six reported measles specific mortality. Combined results from six studies showed that neonatal vitamin A supplementation reduced all-cause mortality by 12 % [Relative risk (RR) 0.88; 95 % confidence interval (CI) 0.79-0.98]. There was no effect of vitamin A supplementation in reducing all-cause mortality in infants 1-6 months of age [RR 1.05; 95 % CI 0.88-1.26]. Pooled results for preventive vitamin A supplementation showed that it reduced all-cause mortality by 25% [RR 0.75; 95 % CI 0.64-0.88] in children 6-59 months of age. Vitamin A supplementation also reduced diarrhea specific mortality by 30% [RR 0.70; 95 % CI 0.58-0.86] in children 6-59 months. This effect has been recommended for inclusion in the Lives Saved Tool. Vitamin A supplementation had no effect on measles [RR 0.71, 95% CI: 0.43-1.16], meningitis [RR 0.73, 95% CI: 0.22-2.48] and pneumonia [RR 0.94, 95% CI: 0.67-1.30] specific mortality. Preventive vitamin A supplementation reduces all-cause and diarrhea specific mortality in children 6-59 months of age in community settings in developing countries.