Impact of vitamin A on childhood mortality

Heterologous and sex differential effects of administering vitamin A supplementation with vaccines

WHO recommends high-dose vitamin A supplementation (VAS) to children from 6 months to 5 years of age in low-income countries, in order to prevent and treat vitamin A deficiency-associated morbidity and mortality. The current policy does not discriminate this recommendation either by sex or vaccination status of the child. There is accumulating evidence that the effects of VAS on morbidity, mortality and immunological parameters depend on concomitant vaccination status. Moreover, these interactions may manifest differently in males and females. Certain vaccines administered through the Expanded Program on Immunization have been shown to alter all-cause mortality from infections other than the vaccine-targeted disease. This review summarizes the evidence from observational studies and randomized-controlled trials of the effects of VAS on these so-called heterologous or non-specific effects of vaccines, with a focus on sex differences. In general, VAS seems to enhance the heterologous effects of vaccines, particularly for diphtheria-tetanus-pertussis and live measles vaccines, where some studies, although not unanimously, show a stronger interaction between VAS and vaccination in females. We suggest that vaccination status and sex should be considered when evaluating the effects of VAS in early life.

Compartmental models of vitamin A and beta-carotene metabolism in women

We have developed compartmental models of vitamin A and beta-carotene (beta C) metabolism in women living under controlled conditions on diets with known concentrations of vitamins and carotenoids. Fourteen healthy adult women were given either retinyl-d4 acetate, or beta C-d8 before breakfast. Natural and stable-isotopes of retinol and beta C were collected in serum for up to 95 days or 20 days, respectively. Stable isotopes were separated from other components and measured by GC-MS or HPLC-UV. Preformed retinyl-d4 acetate metabolism in all women tested can be accurately described by a simple four-compartment model. However, the model did not fit one women initially, when she had marginal vitamin A status. We tested the hypothesis that dietary changes of beta C intake have important roles on the kinetics of vitamin A metabolism. Dietary changes of beta C intake did not influence the turnover rate of retinol in any compartment. However, it did result in changes in steady-state masses and residence times of retinol in several compartments. A working compartmental model for beta C metabolism was developed. The kinetics of retinol-d4 formed from beta C is more complicated than the pre-formed retinol-d4. Results suggest that beta C-d8 readily converts into retinol-d4 with high inter-individual variability.