Low serum vitamin A is prevalent in underfive children with severe malaria and is associated with increased risk of death

Abstract

Introduction: Micronutrient deficiencies are prevalent in developing countries and may influence vulnerability to diseases particularly malaria and its severity. This study investigated serum vitamin A profile of under-five children with severe malaria (SM) in South-western, Nigeria and to determine its association with degree of malaria parasitaemia, types of SM and eventual outcome.
 Methodology: Using HPLC, serum vitamin A concentrations of 170 under-five children with SM and 170 age- and gender-matched controls were determined. Parasite species identification and density were also determined. Association between serum vitamin A levels and the degree of parasitaemia, type of SM and patients’ outcome were examined by both bivariate and logistic regression analyses.
 Results: Thirty-five (20.6%) of the children with SM compared with 3 (1.8%) of the controls had hypovitaminosis A, p <0.001, OR = 14.4, 95% Confidence Interval = 4.4 – 47.8. The mean serum vitamin A concentration was also lower in the patients (45.23µg/dL vs. 87.28µg/dL; p <0.001). There was inverse correlation between serum vitamin A levels and malaria parasite density (r = - 0.103, p = 0.027). Higher proportions of children with SM and hypovitaminosis A presented with metabolic acidosis and cerebral malaria (p <0.001 and 0.032 respectively). Children with SM and hypovitaminosis A were 9.1 times more likely to die compared to those without low serum vitamin A levels, OR = 9.1, 95% Confidence Interval = 2.2–38.1, p = 0.002.
 Conclusion: Children with SM had reduced serum vitamin A and significantly contributed to increased morbidity and mortality.

Impact of malaria on glutathione peroxidase levels: a systematic review and meta-analysis

“…The relationship between oxidative stress and antioxidant levels is an essential host-related factor as depletion of antioxidants, such as reduced glutathione (GSH), antioxidant vitamins (A, C, and E), and superoxide dismutase (SOD), leads to increased severity of malaria 10 – 14 . Glutathione peroxidase (GPx) is a member of the oxidoreductase family that catalyzes the conversion of hydrogen peroxide and organic hydroperoxides into water or related alcohols 15 .…”

Evidence to Underpin Vitamin A Requirements and Upper Limits in Children Aged 0 to 48 Months: A Scoping Review

“…Alongside these we noted 12 recent cohort or case–control studies, 15 earlier studies, nine recent cross-sectional studies, 25 older studies, and nine non-systematic reviews. For studies assessing the relationship between vitamin A status and health, growth or development outcomes we identified no systematic reviews, two recent RCTs (with additional data extraction), 39 older RCTs, 17 recent observational studies of which eight appeared particularly relevant [ 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ], 42 earlier cohort or case–control studies, 19 recent cross-sectional studies, 56 earlier cross-sectional studies and eight potentially relevant non-systematic reviews.…”

“…As expected from the nature of the question, most of the studies available to address the relationship between vitamin A status and health outcomes were observational, assessing relationships between markers of vitamin A status and autism spectrum disorders [ 39 ], acute or recurrent respiratory infection [ 40 , 43 , 44 , 46 ], asthma [ 42 ], malaria [ 41 ], infectious diseases generally [ 45 ] and mortality [ 41 ] (Excel sheet 2C Status Outcome) .…”

Oxidative Stress in Malaria: Potential Benefits of Antioxidant Therapy

“…A study of preschool children showed that the levels of antioxidants A, C, and E in children infected by Plasmodium were low, and that the more severe the infection, the lower the levels of these antioxidants [ 150 ]. Recent studies show that vitamin deficiency can significantly contribute to the increase in disease morbidity and mortality [ 151 , 152 ].…”