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Antioxidant vitamins E and C as adjunct therapy of severe acute lower-respiratory infection in infants and young children: a randomized controlled trial

European Journal of Clinical Nutrition volume 60, pages 673–680 (2006)Cite this article

Abstract

Objective:

To evaluate the effect of antioxidant Vitamins E and C as adjunct therapy of severe acute lower respiratory infection (ALRI) in children.

Design:

Randomized double-blind placebo-controlled clinical trial.

Setting:

A large childrens' hospital serving the urban poor in Kolkata, India.

Subjects:

Children aged 2–35 months admitted with severe ALRI.

Intervention:

In total, 174 children were randomly assigned to receive α-tocopherol 200 mg and ascorbic acid 100 mg twice daily or placebo for 5 days. All children received standard treatment for severe ALRI. Outcome measures were: time taken to recover from a very ill status, fever, tachypnoea, and feeding difficulty; and improvement in oxidative stress and immune response indicated by thiobarbituric acid reacting substances (TBARS) and response to skin antigens, respectively.

Results:

Recovery rate ratios (95% CI) using proportional hazards model were 0.89 (0.64–1.25), 1.01 (0.72–1.41), 0.86 (0.57–1.29), and 1.12 (0.77–1.64) for very ill status, feeding difficulty, fever, and tachypnoea, respectively. TBARS values were high and similar in the two groups at admission, discharge, and at 2 weeks follow-up. Serum α-tocopherol significantly increased in treated group at discharge. Immune response to skin antigens were very poor at admission and after 2 weeks, in both groups.

Conclusion:

Infants with severe ALRI failed to benefit from two antioxidant nutrients as adjunct therapy. Severe ALRI in infants may cause cell-mediated immune dysfunction. We need a better understanding of oxidative processes in growing infants to help us better design interventions with antioxidant therapy.

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Acknowledgements

The study was supported by a research Grant from Nestle Foundation, Switzerland. We thank Dr Mrinal Kanti Chatterjee (Superintendent), the doctors and healthcare workers of BC Roy Memorial Hospital for Children and ML Chakrabarti of Kothari Medical Research Centre, Kolkata, for their assistance in conduct of the study. We thank Mr Jakir Hossain for computer data management and analysis, and Mr Subodh Karmakar for typing and editing the manuscript.

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Authors and Affiliations

  1. Society for Applied Studies, Kolkata, WB, India

    D Mahalanabis, S Gupta & S Shaikh

  2. BC Roy Memorial Hospital for Children, Kolkata, WB, India

    M Basak & D Paul

  3. ICDDR-B, Dhaka, Bangladesh

    M A Wahed

  4. University of Alabama at Birmingham, USA

    M A Khaled

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  1. D Mahalanabis
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  2. M Basak
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  3. D Paul
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  4. S Gupta
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  5. S Shaikh
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  6. M A Wahed
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  7. M A Khaled
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Corresponding author

Correspondence to D Mahalanabis.

Additional information

Guarantor: D Mahalanabis.

Contributors: DM was responsible for study design, data analysis and writing the manuscript. MB, DP and SG took part in case management and evaluation, skin antigen tests and data collection, and assisted in writing the manuscript. SS and MAW took part in laboratory tests and interpretation and assisted in the writing of the manuscript. MAK took part in the study design, in establishing and standardizing TBARS procedures and interpreting the results, and in writing the manuscript.

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Mahalanabis, D., Basak, M., Paul, D. et al. Antioxidant vitamins E and C as adjunct therapy of severe acute lower-respiratory infection in infants and young children: a randomized controlled trial. Eur J Clin Nutr 60, 673–680 (2006). https://doi.org/10.1038/sj.ejcn.1602368

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