Effect of vitamin D supplementation in children with severe acute malnutrition in a nutritional rehabilitation centre: a randomized controlled trial

Abstract

Background: According to World Health Organization (2013) approximately 35% of the under-fivemortalities are due to nutrition related factors & 4.4% of deaths are due to severe wasting. It has been found that Vitamin D levels are low in children with malnourished and very sick children. Even the prevalence of vitamin D deficiency is very high in Indian subcontinent. In WHO recommendations for the management of severe acute malnutrition there is no role of vitamin D supplementation. Objective: To study the effect of vitamin D supplementation on severe acute malnourished children admitted in nutritional rehabilitation Centre. Design: Single blinded Randomized controlled, parallel group trial. Setting: Nutritional Rehabilitation Centre (NRC) of a tertiary care hospital. Participants: 70 severe acute malnourished children aged 6 months to 59 months admitted in the NRC were randomized by computer generated random table. Intervention: 6 lakhs IU vitamin D was given intramuscularly on day one of therapy after an informed consent to the study group and other group was given only management of SAM. Main Outcome measure: outcome indicators of NRC i.e. cure rate, death rate, non-responders, relapse rate. Results: There was no significant difference in the outcome indicators of NRC i.e cured, death, non-response and relapse rate (p=0.32) and average weight gain (p= 0.38) and length of stay (p=0.42) between the two groups at discharge but wasting (p=0.02 on first, p=0.008 on third and p=0.04 on fourth follow ups respectively) improved significantly on follow ups. Conclusions: vitamin D supplementation does not have any significant improvement in the outcome indicators at discharge but significantly improves wasting on follow up.

Effect of Vitamin D Supplementation in Children with Severe Acute Malnutrition

“…Other complications are severe anemia, different stages of dermatitis, etc. Maurya et al, showed Acute gastroenteritis and pneumonia were the most common complication affecting 33.3% and 12.5% children [18]. In our study 46% children were exclusively breast fed, only 20% children had timely initiation of complimentary feeding.…”

“…The difference was not statistically significant (p>0.05) among groups. Maurya et al, (2018) observed a slight male preponderance Male: Female 1.91:1 in control group and 1.69:1 in case group [18]. Nahida et al, (2017) study found male preponderance in severe acute malnourished children with 56.7% male and 43.3% female [20].…”

“…The mean difference was not statistically significant (p>0.05) among two groups. Maurya et al, (2018) the mean age was found 16.44±9.97 months in control group and 17.52±9.48 months in case group [18]. Javeria et al, (2018) reported the mean age was found 15.0±9.6 months in placebo group and 15.7±10.8 months in Vitamin D group [19].…”

“…The difference was not statistically significant (p>0.05) between groups. Maurya et al, (2018) reported that their mean weight on admission was 6.23±1.58 kg, mean height was 69.53±7.48 cm, MUAC was 106.05±12.08 cm [18]. Javeria et al, reported Mean weight was 5.5kg, Mean MUAC was 10.2 cm and Mean weight for height z score -3.9.…”

Correlation Between Nutritional Status and Serum Vitamin D Level in Children

“…This causes a tendency to decrease serum vitamin D levels due to impaired synthesis. 9 Research on the relationship between serum vitamin D levels in malnourished children in Indonesia has not been conducted. In a state of malnutrition, there is a decrease in the concentration of vitamin D receptors.…”