Introduction: Decreased vitamin A (Vit A) intake and low serum levels of retinal binding protein (RBP) have been associated with an increased incidence of some cancers and a shorter time before the recurrence of breast tumours respectively. Children in developing countries often have low Vit A serum levels and this has been associated with increased morbidity and susceptibility to respiratory and gastrointestinal infections.

Aim: To evaluate and compare in children with cancer the morbidity and mortality associated with decreased and normal Vit A and RBP serum levels.

Methods: Forty nine consecutive children treated for cancer were evaluated for nutritional status including Vit A and RBP at diagnosis as well as 3 weeks and 4 months after diagnosis. All the children were treated with standard treatment protocols, received no planned dietary intervention, and were followed up until death or for at least 5 years.

Results: There was no significant difference in the number of children with low of normal levels of Vit A (28 vs 21 respectively) and RBP(20 vs 29 respectively) who died or survived. Mean and median levels of Vit A and RBP did not differ in survivors and non survivors at diagnosis, after 3 weeks or after 4 months. There was no difference in the 5 year survival rate(SR) of children with low (SR 63%) or normal (SR 57%) Vit A levels. Children with decreased Vit A levels at diagnosis suffered more febrile episodes (48 vs 17, p 0.02) during induction treatment than those with normal levels.

Conclusion: Children with cancer and low serum levels of Vit A are more susceptible to infections during periods of treatment related neutropenia. Survival in children with cancer does not appear to be influenced by Vit A or RBP levels. Routine Vit A administration at diagnosis to decrease morbidity is recommended.