Published online October 1, 2007
PEDIATRICS Vol. 120 No. 4 October 2007, pp. e846-e855 (doi:10.1542/10.1542/peds.2006-2187)
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ARTICLE

Effect of Vitamin A and Zinc Supplementation on Gastrointestinal Parasitic Infections Among Mexican Children

Kurt Z. Long, PhDa, Jorge L. Rosado, PhDb, Yura Montoya, MDc, Maria de Lourdes Solano, BSd, Ellen Hertzmark, MAe, Herbert L. DuPont, MDf and Jose Ignacio Santos, MDg

a Departments of Nutrition
e Epidemiology, Harvard School of Public Health, Boston, Massachusetts
b Department of Nutrition, School of Natural Sciences, Universidad Autónoma de Querétaro, Querétaro, Mexico
c Center for Childhood and Adolescent Health, Secretary of Health, Mexico City, Mexico
d Department of Animal Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubiran," Mexico City, Mexico
f Center for Infectious Diseases, School of Public Health and University of Texas Medical School, Houston, Texas
g Office of Director General, Hospital Infantil de Mexico "Federico Gomez," Mexico City, Mexico

OBJECTIVE. Gastrointestinal parasites continue to be an important cause of morbidity and stunting among children in developing countries. We evaluated the effect of vitamin A and zinc supplementation on infections by Giardia lamblia, Ascaris lumbricoides, and Entamoeba histolytica.

METHODS. A randomized, double-blind, placebo-controlled trial was conducted among 707 children who were 6 to 15 months of age and from periurban areas of Mexico City, Mexico, between January 2000 and May 2002. Children, who were assigned to receive either vitamin A every 2 months, a daily zinc supplement, a combined vitamin A and zinc supplement, or a placebo, were followed for 1 year. The primary end points were the 12-month rates and durations of infection for the 3 parasites and rates of parasite-associated diarrheal disease as determined in stools collected once a month and after diarrheal episodes.

RESULTS. G lamblia infections were reduced and A lumbricoides infections increased among children in the combined vitamin A and zinc group or the zinc alone group, respectively. Durations of Giardia infections were reduced among children in all 3 treatment arms, whereas Ascaris infections were reduced in the vitamin A and zinc group. In contrast, E histolytica infection durations were longer among zinc-supplemented children. Finally, E histolytica–and A lumbricoides–associated diarrheal episodes were reduced among children who received zinc alone or a combined vitamin A and zinc supplement, respectively.

CONCLUSIONS. We found that vitamin A and zinc supplementation was associated with distinct parasite-specific health outcomes. Vitamin A plus zinc reduces G lamblia incidence, whereas zinc supplementation increases A lumbricoides incidence but decreases E histolytica–associated diarrhea.

Key Words: vitamin A • zinc • G lamblia • A lumbricoides • E histolytica • diarrhea

Abbreviations: Th2—T-helper type 2 • Th1—T-helper type 1 • IgA—immunoglobulin A • RR—rate ratio • CI—confidence interval

Accepted Feb 6, 2007.


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