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2X improved development by severely malnourished children with 2 loading doses of vitamin D – RCT May 2018

High-dose vitamin D3 in the treatment of severe acute malnutrition: a multicenter double-blind randomized controlled trial.

Am J Clin Nutr. 2018 May 1;107(5):725-733. doi: 10.1093/ajcn/nqy027.
Saleem J1,2, Zakar R1, Zakar MZ1, Belay M2, Rowe M3, Timms PM3, Scragg R4, Martineau AR2.

VitaminDWiki

Children (6-58 months) with severe acute malnutrition
Randomized Controlled Trial gave 2 doses of 200,000 IU of Vitamin D3 (@ week 2 and week 4)
It is amazing how much improvement results from just $2 worth of Vitamin D by week 8

Can expect even better results (including weight gain) if:

  • The Vitamin D levels were adjusted for infant weight
    • i.e. children who weigh 2X more are given 2X larger doses
  • Used a Vitamin D which is gut friendly (Suspect that many malnurished infants had poor guts)
  • The results were checked months, not weeks later - when the body had a chance to make use of the Vitamin D

Missed opportunity: Give vitamin D to malnurished infants might prevent them from becoming malnurished children

Author said that he decided on the trial because vitamin D was being added locally and he wanted to see if it actually was helping


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BACKGROUND:
Vitamin D deficiency is common in children with severe acute malnutrition, in whom it is associated with severe wasting. Ready-to-use therapeutic food (the standard treatment) contains modest amounts of vitamin D that do not reliably correct deficiency.

OBJECTIVE:
The aim of this study was to determine whether high-dose oral vitamin D3 enhances weight gain and development in children with uncomplicated severe acute malnutrition.

DESIGN:
We conducted a randomized placebo-controlled trial of high-dose vitamin D3 supplementation in children aged 6-58 mo with uncomplicated severe acute malnutrition in Pakistan. Participants were randomly assigned to receive 2 oral doses of 200,000 IU vitamin D3 or placebo at 2 and 4 wk after starting ready-to-use therapeutic food. The primary outcome was the proportion of participants gaining >15% of baseline weight at 8 wk after starting ready-to-use therapeutic food (the end of the study). Secondary outcomes were mean weight-for-height or -length z score and the proportion of participants with delayed development at the end of the study (assessed with the Denver Development Screening Tool II), adjusted for baseline values.

RESULTS:
Of the 194 randomly assigned children who started the study, 185 completed the follow-up and were included in the analysis (93 assigned to intervention, 92 to control). High-dose vitamin D3 did not influence the proportion of children gaining >15% of baseline weight at the end of the study (RR: 1.04; 95% CI: 0.94,1.15, P = 0.47), but it did increase the weight-for-height or -length z score (adjusted mean difference: 1.07; 95% CI: 0.49,1.65, P < 0.001) and
reduce the proportion of participants with

  • delayed global development (adjusted RR (aRR): 0.49; 95% CI: 0.31, 0.77, P = 0.002),
  • delayed gross motor development (aRR: 0.29; 95% CI: 0.13, 0.64, P = 0.002),
  • delayed fine motor development (aRR: 0.59; 95% CI: 0.38, 0.91, P = 0.018), and
  • delayed language development (aRR: 0.57; 95% CI: 0.34, 0.96, P = 0.036).

CONCLUSIONS:
High-dose vitamin D3 improved the mean weight-for-height or -length z score and developmental indexes in children receiving standard therapy for uncomplicated severe acute malnutrition in Pakistan.
This trial was registered at clinicaltrials.gov as NCT03170479.


Created by admin. Last Modification: Sunday July 19, 2020 15:02:47 GMT-0000 by admin. (Version 5)

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12369 Malnutrition.jpg admin 19 Jul, 2019 97.26 Kb 1054
12368 Malnutrtition 2018.pdf admin 19 Jul, 2019 629.78 Kb 580