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The Importance of Vitamin A Supplementation Dose, Frequency and Duration On All‐Cause Mortality in Children under 5 Years
Author(s) -
Pimpin Laura,
Kranz Sarah,
Fawzi Wafaie,
Duggan Christopher,
Mozaffarian Dariush
Publication year - 2016
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.30.1_supplement.671.6
Subject(s) - medicine , vitamin , randomization , meta analysis , pediatrics , randomized controlled trial
BACKGROUND Prior meta‐analyses indicated that Vitamin A supplementation reduces child mortality, but the influence of dose, frequency and duration are unclear. OBJECTIVE To investigate the effect of Vitamin A supplementation dose, frequency and duration on all‐cause mortality in children up to 5 years. METHODS We identified and extracted de novo information on all individual publications included in the most recent and relevant meta‐analysis. We included any study using the standard WHO Vitamin A dose (50,000 International Unit (IU) < 6 months old, 100,000 IU 6–11 months, 200,000 IU >12 months). We extracted information on study identifiers, dose and frequency of vitamin A supplementation, number of participants, and numbers of deaths, as well as the original estimate of effects and associated uncertainty. We conducted univariate and multi‐variate meta‐regression on frequency of doses (per year), duration of supplementation (years) and total age‐standardized dose (IU). We conducted sensitivity analyses with and without one large controversial trial (DEVTA). RESULTS We identified 16 trials including 204,494 children aged 33 months (SD 14.5) on average at randomization. Frequency of supplementation ranged from 4 times a year to once in 2 years. Duration of supplementation ranged from 5 months to 5 years (mean=18.5; SD 13.8). Total age‐standardized cumulative dose ranged from 200,000 to 1,400,000 IU. Overall, vitamin A compared to none reduced mortality by 26% (95%CI 13, 37); P=0.001. Increasing frequency of supplementation, per dose per year OR=1.04 95%CI=0.95, 1.14; P=0.368 did not affect the protective effect of Vitamin A on mortality. Similarly, neither did increasing the duration of supplementation (per year) OR=1.01 95%CI=0.66, 1.54; P=0.951 nor the total age‐adjusted cumulative dose (total IU) OR=1.00 95%CI=0.99, 1.00; P=0.368.Multivariate analyses showed similar results. The inclusion or exclusion of the DEVTA trial to the analyses did not affect the overall results. CONCLUSION The results confirmed beneficial effect of vitamin A supplementation in children less than 5 years, without significant influence of dose frequency, duration of dosing or age‐standardized total dose within these ranges. These novel findings can help inform the development and efficiency of Vitamin A supplementation policies. Support or Funding Information Bill & Melinda Gates Foundation