Human and Clinical Nutrition
@ @
RICHARD D. SEMBA,2 MUHILAL, ALAN L. SCOT1 GANTIRA NATADISASTRA, 1@ SOPA ND! WIRASASM1TA, 1@ LISA MELE, END! RIDWAN, KEiTH P. WEST, JR. AND ALFRED SOMMER
@
Dana Center for Preventive Ophthalmology, and Public Health, Baltimore, MD 21205,
Wilmer Institute and the Johns Hopkins School of Hygiene Research and Development Centre@Ministry of Health,
Government oflndonesia, Bogor,Indonesia and tCicendo Eye Hospital, Bandung, Indonesia demonstrated in vitamin A-deficient animals. The spe cific role that vitamin A may have in immune respon siveness in vitamin A—deficienthumans is unclear. The
ABSTRACT A randomized, double-masked, placebo controlled clinical trial was conducted with 236 pre
school children,age 3—6 y, in Indonesiato assess immunestatus in mildvitaminA deficiency.The Im mune response to tetanus Immunizationwas used as a measureof immunecompetence.Cilnicallynormal
purpose of our study was to determine whether there is a difference in immunity between children who were supplemented to normal vitamin A status and children
children (n - 118) and children with mild xerophthal @
mia (n
1 18) were randomly
vitamin A (60,000
assigned
to receive
with clinical or subclinical vitamin A deficiency, and we reporthere the results of a randomizedclinical trial
oral
@tg retinol equivalent) or placebo
investigating the humoral immune response to tetanus.
treatmentfora total of fourstudygroups.Twoweeks after treatment, children were immunized with diphthe
nia-pertussis-tetanusvaccine.The Immunoglobulin G (IgG) responses
to tetanus
at baseline and 3 wk
SUBJECTS AND METHODS
following immunization were measured by ELISA.
After adjustingfor previous tetanus Immunization, clinicallynormalandxerophthalmicchildrenreceiving vitamin
A had a significantly
greater
IgG response
Study design. A double-masked, randomized, pla
to
cebo-controlled, clinical trial involving 236 preschool
tetanus than dllnicallynormal and xerophthalmic chil dren receiving
placebo
(P < 0.05).
children, age 3—6 y, was carried out at the outpatient
These results sug
clinic of the Cicendo Eye Hospital in Bandung, West Java, Indonesia. Children with mild xerophthalmia (night blindness and/or Bitot's spots) and clinically
gest that childrenwithmildvitaminA deficiencyhave a relativeimmunedepressioncomparedwithchildren who have been supplementedto normalvitaminA levels. J. Nutr.122: 101—107, 1992. INDEXING
normal children were identified in a community-wide
KEY WORDS:
•vitamin A deficiency •xerophthalmia •immunodeficiency •tetanus •children
Vitamin
A deficiency
is a major cause of childhood
morbidity and mortality in the developing world (1—7). Children with vitamin A deficiency are more suscepti ble to diarrhea and respiratory disease (1, 2, 5, 6). Vita mm A supplementation has been shown to reduce
mortality by 30—50%or more in preschool children (3,
screening in Ciperay and Madjalaya, two rice-farming communities in West Java. Children were defined as clinically normal if they did not have any clinical signs or symptoms of vitamin A deficiency. Following in formed consent from the parent or guardian, children were brought to the Cicendo Eye Hospital for examina tion. Anthropometry, which included weight, height, mean upper arm circumference and triceps skinfold thickness, was conducted using equipment and proce
1This study was conducted under Cooperative Agreement DAN 0045-A-5094-00 between the Dana Center for Preventive Ophthal. mology, the Johns Hopkins University, and the Office of Nutrition, Bureau for Science and Technology, United States Agency for Inter natinal Development, with additional financial assistance from the National Institutes of Health grants K! 1 EY00286, RR-04060, and Task Force Sight and Life, Hoffmann-La Roche Laboratories. 2To whom correspondence should be addressed.
4, 7) and upwards of 50% in children with moderate to
severe measles (8). These clinical observations may be explained in part by the important role vitamin A seems to play in immune function (9, 10).Depressed humoral (1 1—14) and cellular immunity (15—19),and decreased resistance to experimental infections (20—23) have been
0022.3166/92 $3.00 ©1992 American Institute of Nutrition. Received 21 February 1991. Accepted 18 June 1991.
101
Downloaded from https://academic.oup.com/jn/article-abstract/122/1/101/4754799 by Tulane University Medical Library user on 02 December 2018
Depressed Immune Response to Tetanus in Children with Vitamin A Deficiency'
102
SEMBA ET AL
dures that have been described (24). Children
@ @
RICHARD D. SEMBA,2 MUHILAL, ALAN L. SCOT1 GANTIRA NATADISASTRA, 1@ SOPA ND! WIRASASM1TA, 1@ LISA MELE, END! RIDWAN, KEiTH P. WEST, JR. AND ALFRED SOMMER
@
Dana Center for Preventive Ophthalmology, and Public Health, Baltimore, MD 21205,
Wilmer Institute and the Johns Hopkins School of Hygiene Research and Development Centre@Ministry of Health,
Government oflndonesia, Bogor,Indonesia and tCicendo Eye Hospital, Bandung, Indonesia demonstrated in vitamin A-deficient animals. The spe cific role that vitamin A may have in immune respon siveness in vitamin A—deficienthumans is unclear. The
ABSTRACT A randomized, double-masked, placebo controlled clinical trial was conducted with 236 pre
school children,age 3—6 y, in Indonesiato assess immunestatus in mildvitaminA deficiency.The Im mune response to tetanus Immunizationwas used as a measureof immunecompetence.Cilnicallynormal
purpose of our study was to determine whether there is a difference in immunity between children who were supplemented to normal vitamin A status and children
children (n - 118) and children with mild xerophthal @
mia (n
1 18) were randomly
vitamin A (60,000
assigned
to receive
with clinical or subclinical vitamin A deficiency, and we reporthere the results of a randomizedclinical trial
oral
@tg retinol equivalent) or placebo
investigating the humoral immune response to tetanus.
treatmentfora total of fourstudygroups.Twoweeks after treatment, children were immunized with diphthe
nia-pertussis-tetanusvaccine.The Immunoglobulin G (IgG) responses
to tetanus
at baseline and 3 wk
SUBJECTS AND METHODS
following immunization were measured by ELISA.
After adjustingfor previous tetanus Immunization, clinicallynormalandxerophthalmicchildrenreceiving vitamin
A had a significantly
greater
IgG response
Study design. A double-masked, randomized, pla
to
cebo-controlled, clinical trial involving 236 preschool
tetanus than dllnicallynormal and xerophthalmic chil dren receiving
placebo
(P < 0.05).
children, age 3—6 y, was carried out at the outpatient
These results sug
clinic of the Cicendo Eye Hospital in Bandung, West Java, Indonesia. Children with mild xerophthalmia (night blindness and/or Bitot's spots) and clinically
gest that childrenwithmildvitaminA deficiencyhave a relativeimmunedepressioncomparedwithchildren who have been supplementedto normalvitaminA levels. J. Nutr.122: 101—107, 1992. INDEXING
normal children were identified in a community-wide
KEY WORDS:
•vitamin A deficiency •xerophthalmia •immunodeficiency •tetanus •children
Vitamin
A deficiency
is a major cause of childhood
morbidity and mortality in the developing world (1—7). Children with vitamin A deficiency are more suscepti ble to diarrhea and respiratory disease (1, 2, 5, 6). Vita mm A supplementation has been shown to reduce
mortality by 30—50%or more in preschool children (3,
screening in Ciperay and Madjalaya, two rice-farming communities in West Java. Children were defined as clinically normal if they did not have any clinical signs or symptoms of vitamin A deficiency. Following in formed consent from the parent or guardian, children were brought to the Cicendo Eye Hospital for examina tion. Anthropometry, which included weight, height, mean upper arm circumference and triceps skinfold thickness, was conducted using equipment and proce
1This study was conducted under Cooperative Agreement DAN 0045-A-5094-00 between the Dana Center for Preventive Ophthal. mology, the Johns Hopkins University, and the Office of Nutrition, Bureau for Science and Technology, United States Agency for Inter natinal Development, with additional financial assistance from the National Institutes of Health grants K! 1 EY00286, RR-04060, and Task Force Sight and Life, Hoffmann-La Roche Laboratories. 2To whom correspondence should be addressed.
4, 7) and upwards of 50% in children with moderate to
severe measles (8). These clinical observations may be explained in part by the important role vitamin A seems to play in immune function (9, 10).Depressed humoral (1 1—14) and cellular immunity (15—19),and decreased resistance to experimental infections (20—23) have been
0022.3166/92 $3.00 ©1992 American Institute of Nutrition. Received 21 February 1991. Accepted 18 June 1991.
101
Downloaded from https://academic.oup.com/jn/article-abstract/122/1/101/4754799 by Tulane University Medical Library user on 02 December 2018
Depressed Immune Response to Tetanus in Children with Vitamin A Deficiency'
102
SEMBA ET AL
dures that have been described (24). Children
