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Sinopoli A, Caminada S, Isonne C, Santoro MM, Baccolini V. What Are the Effects of Vitamin A Oral Supplementation in the Prevention and Management of Viral Infections? A Systematic Review of Randomized Clinical Trials. Nutrients 2022; 14:4081. [PMID: 36235733 PMCID: PMC9572963 DOI: 10.3390/nu14194081] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 12/21/2022] Open
Abstract
Vitamin A (VA) deficiency is associated with increased host susceptibility to infections, but evidence on its role in the prevention and management of viral infections is still lacking. This review aimed at summarizing the effects of VA supplementation against viral infections to support clinicians in evaluating supplemental treatments. PubMed, Scopus, and Web of Science were searched. Randomized clinical trials comparing the direct effects of VA oral supplementation in any form vs. placebo or standard of care in the prevention and/or management of confirmed viral infections in people of any age were included. A narrative synthesis of the results was performed. The revised Cochrane Risk-Of-Bias tool was used to assess quality. Overall, 40 articles of heterogeneous quality were included. We found data on infections sustained by Retroviridae (n = 17), Caliciviradae (n = 2), Flaviviridae (n = 1), Papillomaviridae (n = 3), Pneumoviridae (n = 4), and Paramyxoviridae (n = 13). Studies were published between 1987 and 2017 and mostly conducted in Africa. The findings were heterogeneous across and within viral families regarding virological, immunological, and biological response, and no meaningful results were found in the prevention of viral infections. For a few diseases, VA-supplemented individuals had a better prognosis and improved outcomes, including clearance of HPV lesions or reduction in some measles-related complications. The effects of VA oral supplementation seem encouraging in relation to the management of a few viral infections. Difference in populations considered, variety in recruitment and treatment protocols might explain the heterogeneity of the results. Further investigations are needed to better identify the benefits of VA administration.
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Affiliation(s)
- Alessandra Sinopoli
- Department of Prevention, Local Health Authority Roma 1, 00193 Rome, Italy
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Susanna Caminada
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Claudia Isonne
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Maria Mercedes Santoro
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Valentina Baccolini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
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Vitamin A and Viral Infection in Critical Care. JORJANI BIOMEDICINE JOURNAL 2022. [DOI: 10.52547/jorjanibiomedj.10.1.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Exploring the Immune-Boosting Functions of Vitamins and Minerals as Nutritional Food Bioactive Compounds: A Comprehensive Review. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27020555. [PMID: 35056870 PMCID: PMC8779769 DOI: 10.3390/molecules27020555] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 02/06/2023]
Abstract
Food components have long been recognized to play a fundamental role in the growth and development of the human body, conferring protective functionalities against foreign matter that can be severe public health problems. Micronutrients such as vitamins and minerals are essential to the human body, and individuals must meet their daily requirements through dietary sources. Micronutrients act as immunomodulators and protect the host immune response, thus preventing immune evasion by pathogenic organisms. Several experimental investigations have been undertaken to appraise the immunomodulatory functions of vitamins and minerals. Based on these experimental findings, this review describes the immune-boosting functionalities of micronutrients and the mechanisms of action through which these functions are mediated. Deficiencies of vitamins and minerals in plasma concentrations can lead to a reduction in the performance of the immune system functioning, representing a key contributor to unfavorable immunological states. This review provides a descriptive overview of the characteristics of the immune system and the utilization of micronutrients (vitamins and minerals) in preventative strategies designed to reduce morbidity and mortality among patients suffering from immune invasions or autoimmune disorders.
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Gannon BM, Jones C, Mehta S. Vitamin A Requirements in Pregnancy and Lactation. Curr Dev Nutr 2020; 4:nzaa142. [PMID: 32999954 PMCID: PMC7513584 DOI: 10.1093/cdn/nzaa142] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/06/2020] [Accepted: 08/20/2020] [Indexed: 02/06/2023] Open
Abstract
Pregnancy and lactation are critical life stages with unique nutritional requirements, including for vitamin A (VA). Current DRIs for VA were published in 2001. The objective of this review was to identify and categorize evidence related to VA requirements in pregnancy and lactation since these DRIs were formulated. We searched MEDLINE and included articles according to an analytic framework of maternal VA exposure on status and health outcomes in the mother-child dyad. Intermediate and indirect evidence supports that maternal VA intakes can impact the mother's VA status, breastmilk, and health outcomes, as well as the child's VA status and select health outcomes. Food-based approaches can lead to more sustained, sufficient VA status in mothers and children. Research needs include further study linking maternal VA intakes on maternal and child VA status, and further associations with outcomes to determine intake requirements to optimize health.
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Affiliation(s)
- Bryan M Gannon
- Division of Nutritional Sciences, and Institute for Nutritional Sciences, Global Health, and Technology (INSiGHT), Cornell University, Ithaca, NY, USA
| | - Camille Jones
- Division of Nutritional Sciences, and Institute for Nutritional Sciences, Global Health, and Technology (INSiGHT), Cornell University, Ithaca, NY, USA
| | - Saurabh Mehta
- Division of Nutritional Sciences, and Institute for Nutritional Sciences, Global Health, and Technology (INSiGHT), Cornell University, Ithaca, NY, USA
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Gebremedhin S. Postpartum vitamin A supplementation for HIV-positive women is not associated with mortality and morbidity of their breastfed infants: evidence from multiple national surveys in sub-Saharan Africa. BMC Pediatr 2020; 20:214. [PMID: 32404193 PMCID: PMC7218630 DOI: 10.1186/s12887-020-02131-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 05/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vitamin A supplementation (VAS) in the postpartum period improves the vitamin A concentration of breast milk and vitamin A status is an important predictor of childhood survival. It is also known that Vitamin A Deficiency (VAD) is more prevalent in HIV-infected women. This study investigated the association between vitamin A supplements provided to HIV-positive women in the postpartum period and mortality and morbidity of their breastfed infants in sub-Saharan Africa (SSA) where the prevalence of VAD and HIV is high. METHODS This cross-sectional study was conducted based on the secondary data of 838 HIV-positive women (309 vitamin A supplement and 529 non-supplemented) extracted from the datasets of 43 Demographic and Health Surveys (DHS) conducted in 26 SSA countries between 2003 and 2015. The data of HIV-positive women who gave a live birth in the preceding 6 months of the survey and who were breastfeeding their infants at the time of the survey or who breastfed their deceased infants until the time of death, were included in the analysis. The association of postpartum VAS with early infant mortality (death in the first 6 months of birth) and morbidity secondary to fever, diarrhoea and cough with respiratory difficulties in the preceding 2 weeks was assessed by mixed-effects logistic regression model and interpreted using adjusted odds ratio (AOR) with the 95% confidence intervals (CI). RESULTS About one-third (36.9%) of the HIV-positive women received VAS soon after the recent delivery. The early infant mortality rate per 1000 live births in vitamin A supplemented group was 100 (95% CI: 67-133) and the corresponding level for non-supplemented group was 125 (95% CI: 97-154). Yet, in the multivariable model adjusted for seven potential confounders, the association was not significant (AOR = 1.10: 95% CI, 0.57-2.13). Similarly, postpartum VAS was not significantly associated with the occurrence of cough with difficult breathing (AOR = 0.65: 95% CI, 0.39-1.10), diarrhoea (AOR = 0.89: 95% CI, 0.50-1.58) and fever (AOR = 1.19: 95% CI 0.78-1.82) in their breastfed infants. CONCLUSION VAS provided to HIV-positive women in the immediate postpartum period does not have significant association with the mortality and morbidity of their breastfed infants.
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Hombali AS, Solon JA, Venkatesh BT, Nair NS, Peña‐Rosas JP. Fortification of staple foods with vitamin A for vitamin A deficiency. Cochrane Database Syst Rev 2019; 5:CD010068. [PMID: 31074495 PMCID: PMC6509778 DOI: 10.1002/14651858.cd010068.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Vitamin A deficiency is a significant public health problem in many low- and middle-income countries, especially affecting young children, women of reproductive age, and pregnant women. Fortification of staple foods with vitamin A has been used to increase vitamin A consumption among these groups. OBJECTIVES To assess the effects of fortifying staple foods with vitamin A for reducing vitamin A deficiency and improving health-related outcomes in the general population older than two years of age. SEARCH METHODS We searched the following international databases with no language or date restrictions: Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 6) in the Cochrane Library; MEDLINE and MEDLINE In Process OVID; Embase OVID; CINAHL Ebsco; Web of Science (ISI) SCI, SSCI, CPCI-exp and CPCI-SSH; BIOSIS (ISI); POPLINE; Bibliomap; TRoPHI; ASSIA (Proquest); IBECS; SCIELO; Global Index Medicus - AFRO and EMRO; LILACS; PAHO; WHOLIS; WPRO; IMSEAR; IndMED; and Native Health Research Database. We also searched clinicaltrials.gov and the International Clinical Trials Registry Platform to identify ongoing and unpublished studies. The date of the last search was 19 July 2018. SELECTION CRITERIA We included individually or cluster-randomised controlled trials (RCTs) in this review. The intervention included fortification of staple foods (sugar, edible oils, edible fats, maize flour or corn meal, wheat flour, milk and dairy products, and condiments and seasonings) with vitamin A alone or in combination with other vitamins and minerals. We included the general population older than two years of age (including pregnant and lactating women) from any country. DATA COLLECTION AND ANALYSIS Two authors independently screened and assessed eligibility of studies for inclusion, extracted data from included studies and assessed their risk of bias. We used standard Cochrane methodology to carry out the review. MAIN RESULTS We included 10 randomised controlled trials involving 4455 participants. All the studies were conducted in low- and upper-middle income countries where vitamin A deficiency was a public health issue. One of the included trials did not contribute data to the outcomes of interest.Three trials compared provision of staple foods fortified with vitamin A versus unfortified staple food, five trials compared provision of staple foods fortified with vitamin A plus other micronutrients versus unfortified staple foods, and two trials compared provision of staple foods fortified with vitamin A plus other micronutrients versus no intervention. No studies compared staple foods fortified with vitamin A alone versus no intervention.The duration of interventions ranged from three to nine months. We assessed six studies at high risk of bias overall. Government organisations, non-governmental organisations, the private sector, and academic institutions funded the included studies; funding source does not appear to have distorted the results.Staple food fortified with vitamin A versus unfortified staple food We are uncertain whether fortifying staple foods with vitamin A alone makes little or no difference for serum retinol concentration (mean difference (MD) 0.03 μmol/L, 95% CI -0.06 to 0.12; 3 studies, 1829 participants; I² = 90%, very low-certainty evidence). It is uncertain whether vitamin A alone reduces the risk of subclinical vitamin A deficiency (risk ratio (RR) 0.45, 95% CI 0.19 to 1.05; 2 studies; 993 participants; I² = 33%, very low-certainty evidence). The certainty of the evidence was mainly affected by risk of bias, imprecision and inconsistency.It is uncertain whether vitamin A fortification reduces clinical vitamin A deficiency, defined as night blindness (RR 0.11, 95% CI 0.01 to 1.98; 1 study, 581 participants, very low-certainty evidence). The certainty of the evidence was mainly affected by imprecision, inconsistency, and risk of bias.Staple foods fortified with vitamin A versus no intervention No studies provided data for this comparison.Staple foods fortified with vitamin A plus other micronutrients versus same unfortified staple foods Fortifying staple foods with vitamin A plus other micronutrients may not increase the serum retinol concentration (MD 0.08 μmol/L, 95% CI -0.06 to 0.22; 4 studies; 1009 participants; I² = 95%, low-certainty evidence). The certainty of the evidence was mainly affected by serious inconsistency and risk of bias.In comparison to unfortified staple foods, fortification with vitamin A plus other micronutrients probably reduces the risk of subclinical vitamin A deficiency (RR 0.27, 95% CI 0.16 to 0.49; 3 studies; 923 participants; I² = 0%; moderate-certainty evidence). The certainty of the evidence was mainly affected by serious risk of bias.Staple foods fortified with vitamin A plus other micronutrients versus no interventionFortification of staple foods with vitamin A plus other micronutrients may increase serum retinol concentration (MD 0.22 μmol/L, 95% CI 0.15 to 0.30; 2 studies; 318 participants; I² = 0%; low-certainty evidence). When compared to no intervention, it is uncertain whether the intervention reduces the risk of subclinical vitamin A deficiency (RR 0.71, 95% CI 0.52 to 0.98; 2 studies; 318 participants; I² = 0%; very low-certainty evidence) . The certainty of the evidence was affected mainly by serious imprecision and risk of bias.No trials reported on the outcomes of all-cause morbidity, all-cause mortality, adverse effects, food intake, congenital anomalies (for pregnant women), or breast milk concentration (for lactating women). AUTHORS' CONCLUSIONS Fortifying staple foods with vitamin A alone may make little or no difference to serum retinol concentrations or the risk of subclinical vitamin A deficiency. In comparison with provision of unfortified foods, provision of staple foods fortified with vitamin A plus other micronutrients may not increase serum retinol concentration but probably reduces the risk of subclinical vitamin A deficiency.Compared to no intervention, staple foods fortified with vitamin A plus other micronutrients may increase serum retinol concentration, although it is uncertain whether the intervention reduces the risk of subclinical vitamin A deficiency as the certainty of the evidence has been assessed as very low.It was not possible to estimate the effect of staple food fortification on outcomes such as mortality, morbidity, adverse effects, congenital anomalies, or breast milk vitamin A, as no trials included these outcomes.The type of funding source for the studies did not appear to distort the results from the analysis.
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Affiliation(s)
- Aditi S Hombali
- Institute of Mental HealthDepartment of ResearchBlock 7, Buangkok View, Buangkok Green Medical ParkSingaporeSingapore539747
| | | | - Bhumika T Venkatesh
- Prasanna School of Public Health, Manipal Academy of Higher EducationPublic Health Evidence South Asia (PHESA)ManipalUdupiIndia
| | - N Sreekumaran Nair
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) (Institution of National Importance Under Ministry of Health and Family Welfare, Government of India)Department of Medical Biometrics & Informatics (Biostatistics)4th Floor, Administrative BlockDhanvantri NagarPuducherryIndia605006
| | - Juan Pablo Peña‐Rosas
- World Health OrganizationEvidence and Programme Guidance, Department of Nutrition for Health and Development20 Avenue AppiaGenevaGESwitzerland1211
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Bastos Maia S, Rolland Souza AS, Costa Caminha MDF, Lins da Silva S, Callou Cruz RDSBL, Carvalho Dos Santos C, Batista Filho M. Vitamin A and Pregnancy: A Narrative Review. Nutrients 2019; 11:nu11030681. [PMID: 30909386 PMCID: PMC6470929 DOI: 10.3390/nu11030681] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 12/13/2022] Open
Abstract
Vitamin A is a crucial micronutrient for pregnant women and their fetuses. In addition to being essential for morphological and functional development and for ocular integrity, vitamin A exerts systemic effects on several fetal organs and on the fetal skeleton. Vitamin A requirements during pregnancy are therefore greater. Vitamin A deficiency (VAD) remains the leading cause of preventable blindness in the world. VAD in pregnant women is a public health issue in most developing countries. In contrast, in some developed countries, excessive vitamin A intake during pregnancy can be a concern since, when in excess, this micronutrient may exert teratogenic effects in the first 60 days following conception. Routine prenatal vitamin A supplementation for the prevention of maternal and infant morbidity and mortality is not recommended; however, in regions where VAD is a public health issue, vitamin A supplementation is recommended to prevent night blindness. Given the importance of this topic and the lack of a complete, up-to-date review on vitamin A and pregnancy, an extensive review of the literature was conducted to identify conflicting or incomplete data on the topic as well as any gaps in existing data.
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Affiliation(s)
- Sabina Bastos Maia
- Maternal and Child Healthcare Postgraduate Program, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife 50070-550, Pernambuco, Brazil.
- Department of Obstetrics and Gynecology, Lauro Wanderley University Hospital, Federal University of Paraíba (UFPB), João Pessoa 58059-900, Paraíba, Brazil.
| | - Alex Sandro Rolland Souza
- Maternal and Child Healthcare Postgraduate Program, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife 50070-550, Pernambuco, Brazil.
- Department of Maternal and Child Healthcare, Federal University of Pernambuco (UFPE), Recife 50670-901, Pernambuco, Brazil.
- Biological and Health Sciences Center, Catholic University of Pernambuco (UNICAP), Recife 50050-900, Pernambuco, Brazil.
| | - Maria de Fátima Costa Caminha
- Maternal and Child Healthcare Postgraduate Program, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife 50070-550, Pernambuco, Brazil.
- Coordination of the Nursing Mentoring Program, Faculdade Pernambucana de Saúde (FPS), Recife 51180-001, Pernambuco, Brazil.
| | - Suzana Lins da Silva
- Maternal and Child Healthcare Postgraduate Program, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife 50070-550, Pernambuco, Brazil.
- Coordination of the Nursing Mentoring Program, Faculdade Pernambucana de Saúde (FPS), Recife 51180-001, Pernambuco, Brazil.
| | | | | | - Malaquias Batista Filho
- Maternal and Child Healthcare Postgraduate Program, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife 50070-550, Pernambuco, Brazil.
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Medley N, Vogel JP, Care A, Alfirevic Z. Interventions during pregnancy to prevent preterm birth: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev 2018; 11:CD012505. [PMID: 30480756 PMCID: PMC6516886 DOI: 10.1002/14651858.cd012505.pub2] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Preterm birth (PTB) is a major factor contributing to global rates of neonatal death and to longer-term health problems for surviving infants. Both the World Health Organization and the United Nations consider prevention of PTB as central to improving health care for pregnant women and newborn babies. Current preventative clinical strategies show varied efficacy in different populations of pregnant women, frustrating women and health providers alike, while researchers call for better understanding of the underlying mechanisms that lead to PTB. OBJECTIVES We aimed to summarise all evidence for interventions relevant to the prevention of PTB as reported in Cochrane systematic reviews (SRs). We intended to highlight promising interventions and to identify SRs in need of an update. METHODS We searched the Cochrane Database of Systematic Reviews (2 November 2017) with key words to capture any Cochrane SR that prespecified or reported a PTB outcome. Inclusion criteria focused on pregnant women without signs of preterm labour or ruptured amniotic membranes. We included reviews of interventions for pregnant women irrespective of their risk status. We followed standard Cochrane methods.We applied GRADE criteria to evaluate the quality of SR evidence. We assigned graphic icons to classify the effectiveness of interventions as: clear evidence of benefit; clear evidence of harm; clear evidence of no effect or equivalence; possible benefit; possible harm; or unknown benefit or harm. We defined clear evidence of benefit and clear evidence of harm to be GRADE moderate- or high-quality evidence with a confidence interval (CI) that does not cross the line of no effect. Clear evidence of no effect or equivalence is GRADE moderate- or high-quality evidence with a narrow CI crossing the line of no effect. Possible benefit and possible harm refer to GRADE low-quality evidence with a clear effect (CI does not cross the line of no effect) or GRADE moderate- or high-quality evidence with a wide CI. Unknown harm or benefit refers to GRADE low- or very low-quality evidence with a wide CI. MAIN RESULTS We included 83 SRs; 70 had outcome data. Below we highlight key results from a subset of 36 SRs of interventions intended to prevent PTB. OUTCOME preterm birthClear evidence of benefitFour SRs reported clear evidence of benefit to prevent specific populations of pregnant women from giving birth early, including midwife-led continuity models of care versus other models of care for all women; screening for lower genital tract infections for pregnant women less than 37 weeks' gestation and without signs of labour, bleeding or infection; and zinc supplementation for pregnant women without systemic illness. Cervical cerclage showed clear benefit for women with singleton pregnancy and high risk of PTB only.Clear evidence of harmNo included SR reported clear evidence of harm.No effect or equivalenceFor pregnant women at high risk of PTB, bedrest for women with singleton pregnancy and antibiotic prophylaxis during the second and third trimester were of no effect or equivalent to a comparator.Possible benefitFour SRs found possible benefit in: group antenatal care for all pregnant women; antibiotics for pregnant women with asymptomatic bacteriuria; pharmacological interventions for smoking cessation for pregnant women who smoke; and vitamin D supplements alone for women without pre-existing conditions such as diabetes.Possible harmOne SR reported possible harm (increased risk of PTB) with intramuscular progesterone, but this finding is only relevant to women with multiple pregnancy and high risk of PTB. Another review found possible harm with vitamin D, calcium and other minerals for pregnant women without pre-existing conditions. OUTCOME perinatal deathClear evidence of benefitTwo SRs reported clear evidence of benefit to reduce pregnant women's risk of perinatal death: midwife-led continuity models of care for all pregnant women; and fetal and umbilical Doppler for high-risk pregnant women.Clear evidence of harmNo included SR reported clear evidence of harm.No effect or equivalenceFor pregnant women at high risk of PTB, antibiotic prophylaxis during the second and third trimester was of no effect or equivalent to a comparator.Possible benefitOne SR reported possible benefit with cervical cerclage for women with singleton pregnancy and high risk of PTB.Possible harmOne SR reported possible harm associated with a reduced schedule of antenatal visits for pregnant women at low risk of pregnancy complications; importantly, these women already received antenatal care in settings with limited resources. OUTCOMES preterm birth and perinatal deathUnknown benefit or harmFor pregnant women at high risk of PTB for any reason including multiple pregnancy, home uterine monitoring was of unknown benefit or harm. For pregnant women at high risk due to multiple pregnancy: bedrest, prophylactic oral betamimetics, vaginal progesterone and cervical cerclage were all of unknown benefit or harm. AUTHORS' CONCLUSIONS Implications for practiceThe overview serves as a map and guide to all current evidence relevant to PTB prevention published in the Cochrane Library. Of 70 SRs with outcome data, we identified 36 reviews of interventions with the aim of preventing PTB. Just four of these SRs had evidence of clear benefit to women, with an additional four SRs reporting possible benefit. No SR reported clear harm, which is an important finding for women and health providers alike.The overview summarises no evidence for the clinically important interventions of cervical pessary, cervical length assessment and vaginal progesterone because these Cochrane Reviews were not current. These are active areas for PTB research.The graphic icons we assigned to SR effect estimates do not constitute clinical guidance or an endorsement of specific interventions for pregnant women. It remains critical for pregnant women and their healthcare providers to carefully consider whether specific strategies to prevent PTB will be of benefit for individual women, or for specific populations of women.Implications for researchFormal consensus work is needed to establish standard language for overviews of reviews and to define the limits of their interpretation.Clinicians, researchers and funders must address the lack of evidence for interventions relevant to women at high risk of PTB due to multiple pregnancy.
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Affiliation(s)
- Nancy Medley
- The University of LiverpoolCochrane Pregnancy and Childbirth Group, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
| | - Joshua P Vogel
- Burnet InstituteMaternal and Child Health85 Commercial RoadMelbourneAustralia
| | - Angharad Care
- The University of LiverpoolDepartment of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
| | - Zarko Alfirevic
- The University of LiverpoolDepartment of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
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Huang Z, Liu Y, Qi G, Brand D, Zheng SG. Role of Vitamin A in the Immune System. J Clin Med 2018; 7:E258. [PMID: 30200565 PMCID: PMC6162863 DOI: 10.3390/jcm7090258] [Citation(s) in RCA: 245] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 08/23/2018] [Accepted: 08/31/2018] [Indexed: 12/20/2022] Open
Abstract
Vitamin A (VitA) is a micronutrient that is crucial for maintaining vision, promoting growth and development, and protecting epithelium and mucus integrity in the body. VitA is known as an anti-inflammation vitamin because of its critical role in enhancing immune function. VitA is involved in the development of the immune system and plays regulatory roles in cellular immune responses and humoral immune processes. VitA has demonstrated a therapeutic effect in the treatment of various infectious diseases. To better understand the relationship between nutrition and the immune system, the authors review recent literature about VitA in immunity research and briefly introduce the clinical application of VitA in the treatment of several infectious diseases.
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Affiliation(s)
- Zhiyi Huang
- Department of Pathology and Physiopathology, Guilin Medical University, Guilin 541004, Guangxi, China.
- Laboratory of Tumor Immunology and Microenvironmental Regulation, Guilin Medical University, Guilin 541004, Guangxi, China.
| | - Yu Liu
- Department of Pathology and Physiopathology, Guilin Medical University, Guilin 541004, Guangxi, China.
- Laboratory of Tumor Immunology and Microenvironmental Regulation, Guilin Medical University, Guilin 541004, Guangxi, China.
| | - Guangying Qi
- Department of Pathology and Physiopathology, Guilin Medical University, Guilin 541004, Guangxi, China.
- Laboratory of Tumor Immunology and Microenvironmental Regulation, Guilin Medical University, Guilin 541004, Guangxi, China.
| | - David Brand
- Research Service, VA Medical Center, Memphis, TN 38104, USA.
| | - Song Guo Zheng
- Department of Medicine, Division of Rheumatology, Milton S. Hershey Medical Center at Penn State University, Hershey, PA 17033, USA.
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