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A double-blind, randomized, clinical trial of the effect of vitamin A and zinc supplementation on diarrheal disease and respiratory tract infections in children in Mexico City, Mexico^1,2,3

¹ From the Departments of Nutrition (KZL) and Epidemiology (EH), Harvard School of Public Health, Boston MA; the Center for Childhood and Adolescent Health, Secretary of Health, Mexico City, Mexico (YM); the Hospital Infantil de Mexico "Federico Gomez", Mexico City, Mexico (JIS); the School of Natural Sciences, Universidad Autónoma de Queretero, Queretero, Mexico (JLR)

Background: The efficacy of micronutrient supplementation in improving childhood health and survival in developing countries may be specific to the micronutrient used and health outcome measured.

Objective: We evaluated the effect of vitamin A and zinc supplementation on overall rates of childhood diarrheal disease and respiratory tract infections and rates stratified by household and personal characteristics.

Design: A double-blind, randomized, placebo-controlled trial was carried out in which 736 children aged 6–15 mo living in a periurban area of Mexico City were assigned to receive vitamin A every 2 mo, zinc daily, vitamin A and zinc together, or placebo. Children were followed for 12 mo to determine overall counts of diarrheal episodes and respiratory tract infections.

Results: Vitamin A supplementation was associated with a 27% increase in diarrheal disease [risk ratio (RR): 1.27; 95% CI: 1.10, 1.45; P < 0.001] and a 23% increase in cough with fever (RR: 1.23; 95% CI: 1.02, 1.47; P = 0.02), whereas zinc had no effect on these outcomes. Vitamin A supplementation decreased diarrhea in children from households with dirt floors but increased diarrhea in children from households with nondirt floors, piped water, and indoor bathrooms. Zinc supplementation decreased diarrhea in children from households with dirt floors and whose mothers were more educated. Vitamin A supplementation increased cough with fever in children from less-crowded households that lacked indoor bathrooms and in children of less-educated mothers.

Conclusions: Vitamin A increases diarrheal disease and respiratory tract infections in young children in periurban areas of Mexico City. Vitamin A and zinc have more heterogeneous effects in different subgroups of children.

Key Words: Vitamin A supplementation • zinc supplementation • diarrhea • respiratory tract infection • Mexico

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