Abstract
Objective: To assess the effects of multi-micronutrient supplementation and multi-helminth chemotherapy on serum retinol concentration, using schools as a health delivery system.
Study area and population: From 19 primary schools in Bondo District, western Kenya, 977 children between 9 and 18 y were included in the trial. The 644 (65.9%) children on whom baseline serum retinol was available were included in this study.
Design: A randomised, placebo-controlled, double-blind, two-by-two factorial trial on the effects of multi-micronutrient supplementation and multi-helminth chemotherapy on serum retinol after 8 months.
Intervention: Single treatment with albendazole (600 mg) and praziquantel (40 mg/kg of body weight) and daily multi-micronutrient supplementation with tablet containing 1000 µg vitamin A.
Results: Micronutrient supplementation (0.08 µmol/l, 95% CI 0.01, 0.14; P=0.025), but not treatment (0.03 µmol/l, 95% CI −0.04, 0.10; P=0.38), increased serum retinol. However, treatment did increase serum retinol in S. mansoni-infected (0.09, 95% CI 0.02, 0.16; P=0.009), but not in uninfected children (−0.07, 95% CI −0.18, 0.03; P=0.18; interaction, P=0.01). Similarly, reduction in egg output of S. mansoni, but none of the geohelminth, was a predictor, corresponding to a 0.008 µmol/l (95% CI 0.00002, 0.02; P=0.049) increase in serum retinol per 100 epg reduction. Interestingly, interactions were found between age and sex (P=0.046), and malaria parasitaemia and sickle cell phenotype (P=0.04).
Conclusion: Multi-micronutrient supplementation and reduction in S. mansoni egg output increased serum retinol, irrespective of initial serum retinol.
Sponsorship: The Danish International Development Assistance.
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References
Ahmed F, Mohiduzzaman M, Jackson AA . 1993 Vitamin A absorption in children with ascariasis Br. J. Nutr. 69: 817–825
Ash D, Tatala SR, Latham MC, Ndossi GD . 1997 A micronutrient fortified beverage supplement to combat vitamin A deficiency International Vitamin A Consultative Group Meeting, Cairo
Bundy DAP, Guyatt H . 1996 Schools for health: focus on health, education and the school-age child Parasitol. Today 12: 1–16
Curtale F, Vaidya Y, Muhilal, Tilden RL . 1994 Ascariasis, hookworm infection and serum retinol amongst children in Nepal Panminerva. Med. 36: 19–21
Fawzi WW, Chalmers TC, Herrera MG, Mosteller F . 1993 Vitamin A supplementation and child mortality. A meta-analysis J.A.M.A. 269: 898–903
Friis H, Mwaniki D, Omondi B, Muniu E, Magnussen P, Geissler W, Thiong'o F, Michaelsen KF . 1997 Serum retinol concentrations and Schistosoma mansoni, intestinal helminths, and malarial parasitemia: a cross-sectional study in Kenyan preschool and primary school children Am. J. Clin. Nutr. 66: 665–671
Friis H, Ndhlovu P, Kaondera K, Sandstrom B, Michaelsen KF, Vennervald BJ, Christensen NO . 1996 Serum concentration of micronutrients in relation to schistosomiasis and indicators of infection: a cross-sectional study among rural Zimbabwean schoolchildren Eur. J. Clin. Nutr 50: 386–391
Friis H, Gomo E, Kæstel P, Ndhlovu P, Nyazema N, Krarup H, Michaelsen KF . 2001 HIV and other predictors of serum β-carotene and retinol in pregnancy: a cross-sectional study in Zimbabwe Am. J. Clin. Nutr. 73: 1058–1065
Jalal F, Nesheim MC, Agus Z, Sanjur D, Habicht JP . 1998 Serum retinol concentrations in children are affected by food sources of beta-carotene, fat intake, and anthelmintic drug treatment Am. J. Clin. Nutr. 68: 623–629
Kaestel P, Lewis FJ, Willingham AL, Bogh HO, Eriksen L, Michaelsen KF, Sandstrom B, Hoy CE, Friis H . 1999 Schistosoma japonicum infection and serum and tissue concentrations of retinol and zinc in pigs Ann. Trop. Med. Parasitol. 93: 489–499
Krakower C, Hoffman WA, Axtmayer JH . 1940 The fate of schistosomes (S. mansoni) in experimental infections of normal and vitamin A deficient white rats Puerto Rico J. Publ. Health Trop. Med. 16: 269–345
Mahalanabis D, Jalan KN, Maitra TK, Agarwal SK . 1976 Vitamin A absorption in ascariasis Am. J. Clin. Nutr. 29: 1372–1375
McLaren DS . 1993 Vitamin A In Human Nutrition and Dietetics eds. JS Garrow and WPT James, Vol 9: pp 208–217 Edinburgh: Churchill Livingstone
Mikhail MM, Mansour MM . 1982 Complications of human schistosomiasis and their effect on levels of plasma copper, zinc and serum vitamin A Hum. Nutr. Clin. Nutr. 36: 289–296
Mitra AK, Alvarez JO, Guay-Woodford L, Fuchs GJ, Wahed MA, Stephensen CB . 1998 Urinary retinol excretion and kidney function in children with shigellosis Am. J. Clin. Nutr. 68: 1095–1103
Olsen A . 1998 The proportion of helminth infections in a community in western Kenya which would be treated by mass chemotherapy of schoolchildren Trans. R. Soc. Trop. Med. Hyg. 92: 144–148
Parent G, Rousseaux-Prevost R, Carlier Y, Capron A . 1984 Influence of vitamin A on the immune response of Schistosoma mansoni-infected rats Trans. R. Soc. Trop. Med. Hyg. 78: 380–383
Rosales FJ, Ritter SJ, Zolfaghari R, Smith JE, Ross AC . 1996 Effects of acute inflammation on plasma retinol, retinol-binding protein, and its mRNA in the liver and kidneys of vitamin A-sufficient rats J. Lipid Res. 37: 962–971
Semba RD . 1994 Vitamin A, immunity, and infection Clin. Infect. Dis. 19: 489–499
Sivakumar B, Reddy V . 1975 Absorption of vitamin A in children with ascariasis J. Trop. Med. Hyg. 78: 114–145
Sommer A, Katz J, Tarwotjo I . 1984 Increased risk of respiratory disease and diarrhea in children with preexisting mild vitamin A deficiency Am. J. Clin. Nutr. 40: 1090–1095
Stephensen CB, Alvarez JO, Kohatsu J, Hardmeier R, Kennedy JI Jr, Gammon RB Jr . 1994 Vitamin A is excreted in the urine during acute infection Am. J. Clin. Nutr. 60: 388–392
Sturchler D, Holzer B, Hanck A, Degremont A . 1983 The influence of schistosomiasis on the serum concentrations of retinol and retinol binding protein of a rural population in Liberia Acta Trop. 40: 261–269
Tanumihardjo SA, Permaesih D, Muherdiyantiningsih, Rustan E, Rusmil K, Fatah AC, Wilbur S, Muhilal, Karyadi D, Olson JA . 1996 Vitamin A status of Indonesian children infected with Ascaris lumbricoides after dosing with vitamin A supplements and albendazole J. Nutr. 126: 451–457
Taren DL, Nesheim MC, Crompton DW, Holland CV, Barbeau I, Rivera G, Sanjur D, Tiffany J, Tucker K . 1987 Contributions of ascariasis to poor nutritional status in children from Chiriqui Province, Republic of Panama Parasitology 95: 603–613
Thurnham DI, Singkamani R . 1991 The acute phase response and vitamin A status in malaria Trans. R. Soc. Trop. Med. Hyg. 85: 194–199
Tripathy K, Duque E, Bolanos O, Lotero H, Mayoral LG . 1972 Malabsorption syndrome in ascariasis Am. J. Clin. Nutr. 25: 1276–1281
West KP Jr, Katz J, Khatry SK, LeClerq SC, Pradhan EK, Shrestha SR, Connor PB, Dali SM, Christian P, Pokhrel RP, Sommer A . 1999 Double blind, cluster randomised trial of low dose supplementation with vitamin A or beta carotene on mortality related to pregnancy in Nepal. The NNIPS-2 Study Group Br. Med. J. 318: 570–575
Willingham AL, Hurst M . 1996 The pig as a unique host model for Schistosoma japonicum infection Parasitol. Today 12: 132–134
World Bank. 1993 World Development Report: Investing in Health Oxford: Oxford University Press
World Health Organization. 1991 Basic Laboratory Methods in Medical Parasitology Geneva: WHO
Yassai MB, Malek F . 1989 Newborns vitamin A in relation to sex and birth weight J. Trop. Pediatr. 35: 247–249
Acknowledgements
The study was financed by the Danish International Development Assistance. Technical and logistical support was provided by Ministry of Health, Kenya Medical Research Institute (KEMRI) and the participating schools. We gratefully acknowledge support from local education authorities and in particular Education Officer, Mrs C Otieno. We are grateful to Dr W Watkins, Director of Wellcome Trust Laboratories in Nairobi for facilitating training our technicians and in the set up for vitamin A assays. Also thanks to Director of the Centre for Microbiology Research of KEMRI for availing a HPLC for use in the assays. We are indebted to the children, their teachers and the local community for their participation and cooperation. We also gratefully acknowledge the commitment of our technical staff and field workers. Finally, we would like to thank the Kenyan and the Danish KEDAHR Director for facilitating the research activities. This work is published with permission from the Director of Medical Services, Kenya, and the Director of KEMRI.
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Mwaniki, D., Omondi, B., Muniu, E. et al. Effects on serum retinol of multi-micronutrient supplementation and multi-helminth chemotherapy: a randomised, controlled trial in Kenyan school children. Eur J Clin Nutr 56, 666–673 (2002). https://doi.org/10.1038/sj.ejcn.1601376
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DOI: https://doi.org/10.1038/sj.ejcn.1601376
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