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Impact of Vitamin A on Immunity and Infection in Developing Countries

  • Richard D. Semba
Part of the Nutrition ◊ and ◊ Health book series (NH)

Abstract

The prevention of vitamin A deficiency has emerged as one of the most important public health efforts of this century. The observation that vitamin A supplementation reduces child morbidity and mortality in developing countries (1) has led to programs and new directions of research. Vitamin A capsules have entered the armamentarium for child survival, along with vaccines, oral rehydration, and the promotion of breastfeeding. Vitamin A plays an important role in immune function and resistance to disease. Improving vitamin A intake, whether through improved diet, fortification of foods, or periodic supplementation, is expected to reduce morbidity and mortality for millions of children (2), and there may be many other therapeutic applications for vitamin A that have not yet been realized. The purpose of this chapter is to provide health professionals with a concise review of epidemiological, immunological, and clinical studies of vitamin A, and to present the current recommendations regarding treatment and prevention of vitamin A deficiency in populations in developing countries.

Keywords

Retinoic Acid Respiratory Syncytial Virus Infection Tetanus Toxoid Acute Measle Dark Green Leafy Vegetable 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Beaton GH, Martorell R, L’Abbé KA, et al. Effectiveness of Vitamin A Supplementation in the Control of Young Child Morbidity and Mortality in Developing Countries. Toronto, Canada: University of Toronto, 1992; 1–108.Google Scholar
  2. 2.
    Humphrey JH, West KP Jr, Sommer A. Vitamin A defiiciency and attributable mortality among under-5-year-olds. Bull WHO 1992; 70:225–232.Google Scholar
  3. 3.
    Goodman DS. Biosynthesis, absorption, and hepatic metabolism of retinol. In: The Retinoids, vol. 2. Spom MB, Roberts AB, Goodman DS, eds. New York: Academic; 1984: 1–39.Google Scholar
  4. 4.
    Blaner WS, Olson JA. Retinol and retinoic acid metabolism. In: The Retinoids: Biology, Chemistry, and Medicine, 2nd ed. Spom MB, Roberts AB, Goodman DS eds. New York: Raven, 1994; pp. 229–255.Google Scholar
  5. 5.
    Olson JA, Gunning DB, Tilton RA. Liver concentrations of vitamin A and carotenoids, as a function of age and other parameters, of American children who died of various causes. Am J Clin Nutr 1984; 39:903–910.Google Scholar
  6. 6.
    West KP Jr, Sommer A. Periodic, large oral doses of vitamin A for the prevention of vitamin A deficiency and xerophthalmia: a summary of experiences. Washington, DC: Nutrition Foundation, 1984; 1–44.Google Scholar
  7. 7.
    Soprano DR, Blaner WS. Plasma retinol-binding protein. In: The Retinoids: Biology, Chemistry, and Medicine, 2nd ed. Sporn MB, Roberts AB, Goodman DS eds. New York: Raven, 1994; 257–281.Google Scholar
  8. 8.
    Ross AC, Ternus ME. Vitamin A as a hormone: recent advances in understanding the actions of retinol, retinoic acid, and beta carotene. J Am Diet Assoc 1993; 93:1285–1290.CrossRefGoogle Scholar
  9. 9.
    Evans RM. The steroid and thyroid hormone receptor superfamily. Science 1988; 240:889–895.CrossRefGoogle Scholar
  10. 10.
    De Luca LM. Retinoids and their receptors in differentiation, embryogenesis, and neoplasia. FASEB J 1991; 5:2924–2933.Google Scholar
  11. 11.
    Kliewer SA, Umesono K, Mangelsdorf DJ, Evans RM. Retinoid X receptor interacts with nuclear receptors in retinoic acid, thyroid hormone and vitamin D3 signalling. Nature 1992; 355:446–449.CrossRefGoogle Scholar
  12. 12.
    Campos FACS, Flores H, Underwood BA. Effect of an infection on vitamin A status of children as measured by the relative dose response (RDR). Am J Clin Nutr 1987; 46:91–94.Google Scholar
  13. 13.
    Sommer A. Nutritional Blindness. New York: Oxford University Press; 1982; 1–282.Google Scholar
  14. 14.
    Green JM, Pindar D, Davis G, Mellanby E. Diet as a prophylactic agent against puerperal sepsis with specific reference to vitamin A as an anti-infective agent. Br Med J 1931; ii:595–598.Google Scholar
  15. 15.
    Semba RD, Caiaffa WT, Graham NMH, Cohn S, Vlahov D. Vitamin A deficiency and wasting as predictors of mortality in human immunodeficiency virus-infected injection drug users. J Infect Dis 1995; 171:1196–1202.CrossRefGoogle Scholar
  16. 16.
    Sher R, Shulman G, Baily P, Politzer WM. Serum trace elements and vitamin A in leprosy subtypes. Am J Clin Nutr 1981; 34:1918–1924.Google Scholar
  17. 17.
    Stürchler D, Tanner M, Hanck A, et al. A longitudinal study on relations of retinol with parasitic infections and the immune response in children of Kikwawila village, Tanzania. Acta Trop 1987; 44:213–227.Google Scholar
  18. 18.
    Markowitz LE, Nzilambi N, Driskell WJ, et al. Vitamin A levels and mortality among hospitalized measles patients, Kinshasa, Zaire. J Trop Pediatr 1989; 35:109–112.CrossRefGoogle Scholar
  19. 19.
    a. Semba RD, Bulterys M, Munyeshuli V, Gatsinzi T, Saah A, Chao A, Dushimimana A. Vitamin A deficiency and T-cell subpopulations in children with meningococcal disease. J Trop Pediatr, in press.Google Scholar
  20. 19b.
    Lloyd-Puryear M, Humphrey JH, West KP Jr, et al. Vitamin A defiiciency and anemia among Micronesian children. Nutr Res 1989; 9:1009–1016.CrossRefGoogle Scholar
  21. 20.
    Lindquist T. Untersuchungen über das Vitamin A bei Pneumonie. Klin Wochenschr 1937; 39:1345–1348.CrossRefGoogle Scholar
  22. 21.
    Neuzil KM, Gruber WC, Chytil F, Stahlman MT, Engelhardt B, Graham BS. Serum vitamin A levels in respiratory syncytial virus infection. J Pediatr 1994; 124:433–436.CrossRefGoogle Scholar
  23. 22.
    Shank RE, Coburn AF, Moore LV, Hoagland CL. The level of vitamin A and carotene in the plasma of rheumatic subjects. J Clin Invest 1944; 23:289–295.CrossRefGoogle Scholar
  24. 23.
    Solon FS, Popkin BM, Fernandez TL, Latham MC. Vitamin A deficiency in the Philippines: a study of xerophthalmia in Cebu. Am J Clin Nutr 1978; 31:360–368.Google Scholar
  25. 24.
    Abdelgani SM, Hussein L, Shaaban S. Vitamin A status in different stages of schistosomal cases and the effectiveness of oral vitamin A therapy. Z Ernahrungswiss 1990; 29:249–255.CrossRefGoogle Scholar
  26. 25.
    Blegvad O. Xerophthalmia, keratomalacia, and xerosis conjunctivae. Am J Ophthalmol 1924; 7:89–117.Google Scholar
  27. 26.
    Stephensen C, Alvarez J, Kohatsu J, et al. Vitamin A is excreted in the urine during acute infection. Am J Clin Nutr 1994; 60:388–392.Google Scholar
  28. 27.
    Semba RD. Vitamin A, immunity, and infection. Clin Infect Dis 1994; 19:489–499.Google Scholar
  29. 28.
    Sommer A, Tarwotjo I, Hussaini G, Susanto D. Increased mortality in children with mild vitamin A deficiency. Lancet 1983; 2:585–558.CrossRefGoogle Scholar
  30. 29.
    Sommer A, Katz J, Tarwotjo I. Increased risk of respiratory disease and diarrhea in children with preexisting mild vitamin A deficiency. Am J Clin Nutr 1984; 40:1090–1095.Google Scholar
  31. 30.
    Sommer A, Tarwotjo I, Katz J. Increased risk of xerophthalmia following diarrhea and respiratory disease. Am J Clin Nutr 1987; 45:977–980.Google Scholar
  32. 31.
    Sommer A. Vitamin A status, resistance to infection, and childhood mortality. Ann NY Acad Sci 1990; 587:17–23.Google Scholar
  33. 32.
    Milton RC, Reddy V, Naidu AN. Mild vitamin A deficiency and childhood morbidity-an Indian experience. Am J Clin Nutr 1987; 46:827–829.Google Scholar
  34. 33.
    Bloem MW, Wedel M, Egger RJ, et al. Mild vitamin A deficiency and risk of respiratory tract diseases and diarrhea in preschool and school children in northeastern Thailand. Am J Epidemiol 1990; 131:332–339.Google Scholar
  35. 34.
    Semba RD, Graham NMH, Caiaffa WT, et al. Increased mortality associated with vitamin A deficiency during human immunodeficiency virus type 1 infection. Arch Intern Med 1993; 153:2149–2154.CrossRefGoogle Scholar
  36. 35.
    Buck J, Ritter G, Dannecker L, et al. Retinol is essential for growth of activated human B cells. J Exp Med 1990; 171:1613–1624.CrossRefGoogle Scholar
  37. 36.
    Wang W, Napoli JL, Ballow M. The effects of retinol on in vitro immunoglobulin synthesis by cord blood and adult peripheral blood mononuclear cells. Clin Exp Immunol 1993; 92:164–168.CrossRefGoogle Scholar
  38. 37.
    Wang W, Ballow M. The effects of retinoic acid on in vitro immunoglobulin synthesis by cord blood and adult peripheral blood mononuclear cells. Cell Immunol 1993; 148:291–300.CrossRefGoogle Scholar
  39. 38.
    Coutsoudis A, Kiepiela P, Coovadia HM, Broughton M. Vitamin A supplementation enhances specific IgG antibody levels and total lymphocyte numbers while improving morbidity in measles. Pediatr Infant Dis J 1992; 11:203–209.CrossRefGoogle Scholar
  40. 39.
    Nauss KM. Influence of vitamin A status on the immune system. In: Vitamin A Deficiency and Its Control. Bauernfeind JC, ed. Orlando, FL: Academic, 1986; 207–243.Google Scholar
  41. 40.
    Ross AC. Vitamin A status: relationship to immunity and the antibody response. Proc Soc Exp Biol Med 1992; 200:303–320.Google Scholar
  42. 41.
    Semba RD, Muhilal, Scott AL, et al. Depressed immune response to tetanus in children with vitamin A deficiency. J Nutr 1992; 122:101–107.Google Scholar
  43. 42.
    West KP Jr. Dietary vitamin A defiiciency: effects on growth, infection, and mortality. Bull Food Nutr 1991; 13:119–131.Google Scholar
  44. 43.
    Bedo G, Santisteban P, Aranda A. Retinoic acid regulates growth hormone expression. Nature 1989; 339:231–234.CrossRefGoogle Scholar
  45. 44.
    West KP Jr, Djunaedi E, Pandji A, et al. Vitamin A supplementation and growth: a randomized community trial. Am J Clin Nutr 1988; 48:1257–1264.Google Scholar
  46. 45.
    Muhilal, Permeisih D, Idjradinata YR, et al. Vitamin A-fortified monosodium glutamate and health, growth, and survival of children: a controlled field trial. Am J Clin Nutr 1988; 48:1271–1276.Google Scholar
  47. 46.
    Ramakrishnan U, Latham MC, Abel R. Vitamin A supplementation does not improve growth of preschool children: a randomized, double-blind fiield trial in South India. J Nutr 1995; 125:202–211.Google Scholar
  48. 47.
    Eskild W, Hansson V. Vitamin A functions in the reproductive organs. In: Vitamin A in Health and Disease. Blomhoff R, ed. New York: Marcel Dekker, 1994; 531–559.Google Scholar
  49. 48.
    Semba RD, Miotti PG, Chiphangwi JD, et al. Maternal vitamin A defiiciency and mother-to-child transmission of HIV-1. Lancet 1994; 343:1593–1597.CrossRefGoogle Scholar
  50. 49.
    Birnbacher T, Klaften E. Die Hemeralopie der Schwangeren. Z Augenheilk 1923; 51:309–324.Google Scholar
  51. 50.
    Semba RD, Miotti PG, Chiphangwi JD, Liomba G, Yang LP, Saah AJ, Dallabetta GA, Hoover DR. Infant mortality and maternal vitamin A deficiency during human immunodeficiency virus infection. Clin Infect Dis 1995; 21:966–972.CrossRefGoogle Scholar
  52. 51.
    Bloem MW, Wedel M, van Agtmaal EJ, et al. Vitamin A intervention: short-term effects of a single, oral, massive dose on iron metabolism. Am J Clin Nutr 1990; 51:469–478.Google Scholar
  53. 52.
    Suharno D, West CE, Muhilal, Karyadi D, Hautvast JGAJ. Supplementation with vitamin A and iron for nutritional anaemia in pregnant women in West Java, Indonesia. Lancet 1993; 342:1325–1328.CrossRefGoogle Scholar
  54. 53.
    Sommer A. Field Guide to the Detection and Control of Xerophthalmia. Geneva: World Health Organization; 1982; 1–58.Google Scholar
  55. 54.
    Sommer A, Tarwotjo I, Hussaini G, Susanto D, Soegiharto T. Incidence, prevalence, and scale of blinding malnutrition. Lancet 1981; ii:1407–1408.Google Scholar
  56. 55.
    Muhilal, Tarwotjo I, Kodyat B, et al. Changing prevalence of xerophthalmia in Indonesia, 1977 to 1992. Eur J Clin Nutr 1995; 48:708–714.Google Scholar
  57. 56.
    Semba RD, Susatio B, Muhilal, Natadisastra G. The decline of admissions for xerophthalmia at Cicendo Eye Hospital, Indonesia, 1981–1992. Int Ophthal 1995; 19:39–42.CrossRefGoogle Scholar
  58. 57.
    Underwood BA. Methods for assessment of vitamin A status. J Nutr 1990; 120:1459–1463.Google Scholar
  59. 58.
    Pilch SM. Analysis of vitamin A data from the health and nutrition examination surveys. J Nutr 1987; 117:636–640.Google Scholar
  60. 59.
    Keenum DG, Semba RD, Wirasasmita S, et al. Assessment of vitamin A status by a disk applicator for conjunctival impression cytology. Arch Ophthalmol 1990; 108:1436–1441.CrossRefGoogle Scholar
  61. 60.
    Edmund C. Some methods of testing dark-vision. Acta Ophthalmol 1926; 3:153–169.Google Scholar
  62. 61.
    Flores H, Campos F, Araújo CRC, Underwood BA. Assessment of marginal vitamin A deficiency in Brazilian children using the relative dose response procedure. Am J Clin Nutr 1987; 46:91–94.Google Scholar
  63. 62.
    Tanumihardjo SA, Muhilal, Yuniar Y, et al. Vitamin A status in preschool-age Indonesian children as assessed by the modifiied relative dose response (MRDR) assay. Am J Clin Nutr 1990; 52:1068–1072.Google Scholar
  64. 63.
    Congdon N, Sommer A, Sevems M, et al. Pupillary and visual thresholds in young children as an index of population vitamin A status. Am J Clin Nutr 1995; 61:1076–1082.Google Scholar
  65. 64.
    Ellison JB. Intensive vitamin therapy in measles. Br Med J 1932; 2:708–711.CrossRefGoogle Scholar
  66. 65.
    Sommer A, Tarwotjo I, Djunaedi E, et al. Impact of vitamin A supplementation on childhood mortality: a randomised controlled community trial. Lancet 1986; 1:1169–1173.CrossRefGoogle Scholar
  67. 66.
    Vijayaraghavan K, Radhaiah G, Prakasam BS, et al. Effect of massive dose vitamin A on morbidity and mortality in Indian children. Lancet 1990; 336:1342–1345.CrossRefGoogle Scholar
  68. 67.
    Rahmathullah L, Underwood BA, Thulasiraj RD, et al. Reduced mortality among children in southern India receiving a small weekly dose of vitamin A. New Engl J Med 1990; 323:929–935.CrossRefGoogle Scholar
  69. 68.
    West KP Jr, Pokhrel RP, Katz J, et al. Efficacy of vitamin A in reducing preschool child mortality in Nepal. Lancet 1991; 338:67–71.CrossRefGoogle Scholar
  70. 69.
    Kothari G. The effect of vitamin A prophylaxis on morbidity and mortality among children in urban slums in Bombay. J Trop Pediatr 1991; 37:141.CrossRefGoogle Scholar
  71. 70.
    Daulaire NMP, Starbuck ES, Houston RM, et al. Childhood mortality after a high dose of vitamin A in a high risk population. Br Med J 1992; 304:207–210.CrossRefGoogle Scholar
  72. 71.
    Herrera MG, Nestel P, El Amin A, et al. Vitamin A supplementation and child survival. Lancet 1992; 340:267–271.CrossRefGoogle Scholar
  73. 72.
    Ghana VAST Study Team. Vitamin A supplementation in northern Ghana: effects on clinic attendances, hospital admissions, and child mortality. Lancet 1993; 342:7–12.CrossRefGoogle Scholar
  74. 73.
    Barclay AJG, Foster A, SommerA. Vitamin A supplements and mortality related to measles: a randomised clinical trial. Br J Med 1987; 294:294–296.CrossRefGoogle Scholar
  75. 74.
    Hussey GD, Klein M. A randomized, controlled trial of vitamin A in children with severe measles. New Engl J Med 1990; 323:160–164.CrossRefGoogle Scholar
  76. 75.
    Coutsoudis A, Broughton M, Coovadia HM. Vitamin A supplementation reduces measles morbidity in young African children: a randomized, placebo-controlled, double-blind trial. Am J Clin Nutr 1991; 54:890–895.Google Scholar
  77. 76.
    Ogaro FO, Orinda VA, Onyango FE, Black RE. Effect of vitamin A on diarrheal and respiratory complications of measles. Trop Geogr Med 1993; 45:283–286.Google Scholar
  78. 77.
    Barreto ML, Santos LMP, Assis AMO, et al. Effect of vitamin A supplementation on diarrhea and acute lower-respiratory-tract infections in young children in Brazil. Lancet 1994; 344:228–231.CrossRefGoogle Scholar
  79. 78.
    WHO/UNICEF/IVACG Task Force. Vitamin A supplements. A guide to their use in the treatment and prevention of vitamin A deficiency and xerophthalmia. World Health Organization, Geneva, Switzerland, 1988; 1–24.Google Scholar
  80. 79.
    International Vitamin A Consultative Group. Guidelines for the eradication of vitamin A deficiency and xerophthalmia. Washington, DC: Nutrition Foundation, 1988; I1–IV7.Google Scholar
  81. 80.
    Schaumberg DA, Linehan M, Hawley G, et al. Vitamin A deficiency in the South Pacific. Public Health 1995; 109:311–317.CrossRefGoogle Scholar

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© Springer Science+Business Media New York 1997

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  • Richard D. Semba

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