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Effect of vitamin A supplementation with BCG vaccine at birth on vitamin A status at 6 wk and 4 mo of age ^1,2,3

¹ From the Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau (ABF, AR, and PA); the Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark (PA and CSB); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (ABF); the Department of Pathology, Herlev University Hospital, Copenhagen, Denmark (IML); the Department of Biostatistics, University of Aarhus, Aarhus, Denmark (BMB); and SEAMEO, Regional Center for Community Nutrition, University of Indonesia, Jakarta, Indonesia (JGE)

Background: The effect of vitamin A supplementation (VAS) at birth on subsequent vitamin A status has not been studied.

Objective: The objective was to study the effect of 50 000 IU vitamin A administered with BCG vaccine at birth on vitamin A status in both sexes.

Design: Within a randomized placebo-controlled trial of VAS, we obtained blood from 614 children at 6 wk of age and from 369 mother-infant pairs at 4 mo of age. We assessed vitamin A status on the basis of serum retinol-binding protein (RBP) and measured serum C-reactive protein to monitor for concurrent infections.

Results: RBP concentrations indicated vitamin A deficiency in 32% of the children at age 6 wk and in 16% at age 4 mo. VAS was not associated with higher RBP concentrations overall or in either sex. However, the effect of VAS varied with maternal education (P for interaction = 0.004): At age 6 wk, VAS was associated with higher (9%; 95% CI: 2, 17%) RBP concentrations in children of noneducated mothers but not in children of educated mothers. Overall, RBP concentrations increased between 6 wk and 4 mo of age. The increase correlated inversely with the number of diphtheria-tetanus-pertussis (DTP) vaccines received in the interval (P = 0.009), particularly in girls (P for interaction = 0.01) and in vitamin A recipients (P = 0.01).

Conclusions: Overall, VAS at birth had no effect on vitamin A status. However VAS may temporarily improve vitamin A status in the subgroup of children of noneducated mothers. In vitamin A recipients, subsequent DTP vaccines affected vitamin A status negatively. The main trial was registered at clinicaltrials.gov as NCT00168597.

Key Words: Vitamin A supplementation • BCG vaccine • retinol-binding-protein • acute phase reaction • sex differences • diphtheria-tetanus-pertussis vaccine

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