Review of the safety and efficacy of vitamin A supplementation in the treatment of children with severe acute malnutritionReportar como inadecuado

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Nutrition Journal

, 12:125

First Online: 12 September 2013Received: 06 March 2013Accepted: 21 August 2013


BackgroundWorld Health Organization WHO guidelines recommend for children with severe acute malnutrition SAM, high-dose vitamin A VA supplements be given on day 1 of admission, and on days 2 and 14 in the case of clinical signs of vitamin A deficiency VAD. Daily low-dose VA follows, delivered in a premix added to F-75 and F-100. This study aimed to systematically review the evidence for safety and effectiveness of high-dose VA supplementation VAS in treatment of children with SAM.

MethodsA comprehensive literature review was undertaken for all relevant randomized controlled trials RCT and observational studies from 1950 to 2012. Studies identified for full review were evaluated using the Grading of Recommendations, Assessment, Development and Evaluation GRADE methodology using a set of pre-defined criteria: indirectness; inconsistency; imprecision; and study limitations. A quality rating of high, moderate, or low was then assigned to each study, and only those attaining moderate to high were considered in making recommendations.

ResultsOf the 2072 abstracts screened, 38 met criteria for full review, and 20 were rated moderate to high quality. Only one study replicated the WHO VA protocol in children with SAM. Indirectness was a critical limitation, as studies were not exclusive to children with SAM. There was inconsistency across trials for definitions of malnutrition, morbidities, and ages studied; and imprecision arising from sub-group analyses and small sample sizes. Evidence showed improved outcomes associated with low-dose compared to high-dose VAS, except in cases presenting with signs of VAD, measles, and severe diarrhea or shigellosis. Adverse outcomes related to respiratory infection, diarrhea, and growth were associated with high-dose VAS in children who were predominantly adequately nourished. No adverse effects of the high dose were found in children with SAM in the trial that replicated the WHO VA guideline.

ConclusionThis is the first systematic review of the safety and efficacy of high-dose VAS in treatment of SAM. We recommend a low-dose VAS regimen for children with SAM, except in cases presenting with measles, severe diarrhea shigellosis, and any indication of VAD. Further research is needed in exclusively malnourished children and to explore alternate delivery strategies.

KeywordsGRADE Vitamin A supplementation Severe acute malnutrition Systematic review AbbreviationsALRIAcute lower respiratory infection

GRADEGrading of recommendations assessment development and evaluation

MUACMid-upper arm circumference

RCTRandomized controlled trial

RUTFReady-to-use therapeutic food

SAMSevere acute malnutrition

VAVitamin A

VADVitamin A deficiency

VASVitamin A supplementation

WAZWeight-for-age Z score

WHZWeight-for-height Z score.

Electronic supplementary materialThe online version of this article doi:10.1186-1475-2891-12-125 contains supplementary material, which is available to authorized users.

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Autor: Lora L Iannotti - Indi Trehan - Mark J Manary


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