A Study Of The Relationship Between Vitamin A And Persistent Diarrhea In Children

Object To understand the serum vitamin a(VA) levels and status ofVA in children with persistent diarrhea(PD).And to explore the relationshipbetween VA and PD in children.Methods We chose119chiliden who were admitted into Chirdren’shospital of ChongQing Medical University for PD between May2012andJanuary2013.They were assigned to one of four intervention groups bycomepletely randomized digital table.Group A:took2000IU VA orally oncea day for14days;Group B:took10mg Zinc(Zn) orally for less than6monthsold children,20mg Zn for more than6months old children,once a day for14days;Group C:took both VA and Zn orally once a day for14days;GroupD:no supplementation.The serum VA and Zn levels were respectivelymeasured by High performance liquid chromatography(HPLC) and Atomicabsorption spectrometry(ASS) in four groups before intervention.We chose65children with acute diarrhea(AD) as control group，who were admittedinto the same hospital during the same time with the intervention groups.The serum VA levels in control group were measured by HPLC. Results1. Most of children with PD were less than1year old.Children with PDless than6months of age,6months to1year of age,1year to5years of age,more than5years of age,respectively accounted for31.98%(38/119),49.58%(59/119),14.29%(17/119) and4.2%(5/119).2. The serum VA levels in children with PD and AD,were respectively(0.72±0.31)umol/L and (0.73±0.30)umol/L.There was no significantdifference(P＞0.05).3.Insufficient vitamin a (IVA) of children with PD and AD,respectively accounted for84.87%(101/119),87.69%(57/65). VAD ofchildren with PD and AD children,respectively accounted for60.5%(72/119),50.77%(33/65).Marginal vitamin a deficiency (MVAD) ofchildren with PD and AD,respectively accounted for24.37%(29/119),36.92%(24/65).Normal vitamin a(NVA) of children with PD andAD,respectively accounted for15.13%(18/119),12.1%(8/65). The VAstatus of children with PD and AD were not significantly different(P＞0.05),but most of them were in the status of Vitamin a deficiency (VAD).4.The serum VA levels of Children with PD,who were less than6months old,6months to1year old,1year to5years old and more than5years old,were (0.76±0.30)umol/L,(0.71±0.33)umol/L,(0.73±0.32)umol/Land (0.58±0.27)umol/L,respectively.The serum VA levels among PDchildren of the four different ages were not significantly different(P＞0.05).5.Effect observation: （1）Effect observation of72hours:there were significant differencesin effect among4intervention groups(P＜0.05), and total effective rate wasnot significantly different among them(P＞0.05).There were significantdifferences in effect between group B and A,group B and D(P＜0.05).Theeffect of group B was significantly better than group A and group D.Theeffect among other intervention groups was not significantly different(P＞0.05).（2）Effectobservationof5days:therewasnosignificantdifferenceineffect among4intervention groups(P＞0.05),and total effective rate wassignificantly different among them(P＜0.05). There were significantdifferences in total effective rate between group B and D,group C and D(P＜0.05).The total effective rate of group B and C was significantly higherthan group D.The total effective rate among other intervention groups wasnot significantly different(P＞0.05).（3）Effect observation of7days: there were significant differences ineffect among4intervention groups(P＜0.05),and total effective rate was notsignificantly different among them(P＞0.05).There were significantdifferences in effect between group B and D,group C and D(P＜0.05).Theeffect of group B and C was significantly better than group D.The effectamong other intervention groups was not significantly different(P＞0.05).(4) Effect observation of10days: there were significant differences ineffect among4intervention groups(P＜0.05),and total effective rate was not significantly different among them(P＞0.05).There were significantdifferences in effect between group C and D (P＜0.05).The effect of group Cwas significantly better than group D.The effect among other interventiongroups was not significantly different(P＞0.05).6.Causes of PD:allergic diarrhea (39/119,32.77%),intestinal infection(53/119,44.54%),lactose intolerance (16/119,13.45%) andantibiotic-associated diarrhea (19/119,15.97%) were the main causes ofPD.Unclear causes accounted for27.73%(33/119).Clear causes accountedfor72.27%(86/119),in which only38cases were single-factor(44.19%),and48cases were multi-factors(55.81%).The common multi-factors wereallergic diarrhea with intestinal infection, intestinal infection with lactoseintolerance,and antibiotic-associated diarrhea with intestinal infection.Theserum VA and Zn levels were not significantly different in four main causesof PD children(P＞0.05).7.119cases of children with PD in this study,29cases weremalnourished(24.37%),of which20cases existed VAD(68.97%).90caseswere non-malnourished(75.63%),of which57cases existedVAD(63.33%).The serum VA levels of PD children with malnourished andnon-malnourished were (0.72±0.31)umol/L,(0.75±0.35)umol/L.And therewas no significant difference between them(P＞0.05).Conclusions1.Most of children with PD were less than1year old.The serum VA levels among children who were less than6months old,6months to1yearold,1year to5years old and more than5years old,were not significantlydifferent(P＞0.05).2.There was no direct relationship between the courses of diarrhea andthe serum VA levels.3.The serum VA levels decreased in most children with PD andAD.VAD was the main VA status in children with PD and AD.4.The effect of VA on PD in children was uncertain.With the increaseof intervention courses,VA could have the synergistic effect on Zntreatment for PD in children.5.The causes of PD were the multi-factors mostly which werecomplicated.Etiological diagnosis and treatment of PD was difficult. Theserum VA levels were not significantly different in the main causes of PDchildren(P＞0.05).6.Malnutrition children with PD mostly existed VAD.The VAsupplementation during diarrhea could play a role of nutritional support.