The Relationship Of Vitamins A,D And E With Acute Bronchiolitis In Infants And Younger Children

BackgroundAcute Bronchiolitis is one of the most common respiratory diseases in infants and young children around the world.Many risk factors are thought to influence its incidence in children and are increasing every year which is a major health concern for parents and health care providers.Vitamins A,D and E have an important role in maintaining the biological functions in the body.A deficiency of these vitamins can lead to various illnesses amongst are respiratory tract infections as they are closely linked with their immuno regulatory effect.In this study we compared and contrasted different parameters and their association with vitamins A,D and E thought to have an impact on Acute Bronchiolitis in infants and young children in an attempt to provide significant predictive value for clinicians worldwide.The benefit of this study will make us understand the role of vitamins A,D and E which were found to be correlated to Acute Bronchiolitis and its risk factors,hence providing a broader approach towards its management and prevention by supplementation of deficient vitamins in these children.Purpose In this study,we carried out analysis on multiple risk factors associated with acute bronchiolitis in children aged 6 months to 3 years of age based on gender,history of breast feeding,history of preterm birth,seasons and their individual relationships with levels of vitamins A,D and E.This research shall provide some relevance to physicians for reducing the incidence of acute bronchiolitis and realize early prevention by considering supplementation of deficient vitamins in these patients.Materials and methodsWe analysed the data collected from 115 cases(Bronchiolitis Group,with no other significant underlying disease)and 114 cases that have not been infected with Bronchiolitis or other respiratory diseases(Control Group,with no significant underlying disease)in paediatric inpatient and outpatient department of First Affiliated Hospital of Dalian Medical University from January 2015 to January 2017,in an attempt to compare vitamin A,D and E level in these patients and risk factors for acute bronchiolitis for statistical significance.IBM-SPSS software,version 21,was used for the statistical analysis.Continuous variables were described by mean and standard derivation,while categorical variables were described by percentages.One sided t test was conducted to compare continuous variables of two independent groups.We computed ?2 analysis to compare the categorical variables.Analysis of variance(ANOVA)was employed to compare seasons and serum vitamins A,D and E level.Furthermore,multiple comparisons were conducted to obtain the statistical significance of serum vitamin D levels among the given seasons from post hoc test.Linear multiple regression analysis was employed to assess the association of serum levels of vitamins A,D and E and associated risk factors of bronchiolitis(Gestation,Breast Feeding duration and Seasons)along with age and gender among case and control groups separately.A p value of 0.05 was considered statistically significant.Results:1.Comparison between Bronchiolitis Group and Non Bronchiolitis Groupa)The mean serum vitamin concentration was 0.29 ± 0.15 mg/L for vitamin A,19.77±5.80 ng/L for vitamin D and 6.30 ± 1.89 mg/L for vitamin E.There was a significant difference in season(?2= 5.344;p<0.001),breast feeding(?2= 4.262;p=0.039)and gestation(?2= 7.316;p=0.007)between case group(Bronchiolitis)and the control group(Non Bronchiolitis).Also,this study revealed that there was statistically significant differences in serum vitamin A(t=-6.683;p=0.000)and vitamin D(t= 3.388;p=0.001)levels between the two groups.However,there was no significant difference in serum vitamin E levels between the two groups(t=-1.015;p=0.311).2.Analysis of Single Risk Factor with vitamins A,D and Ea)Serum vitamin A level was significantly lower(t=5.344;p=0.000)in those who had less than 6 months history of breast feeding compared to those who reported breastfeeding for more than 6 months with acute bronchiolitis.The control group had higher serum retinol level than their counter parts(bronchiolitis group)with no significant difference between breastfeeding durations(t=1.399;p=0.165).b)Serum vitamin D level was found to be affected by seasons only in bronchiolitis patients(?2= 12.736;p=0.001).There was a statistically difference in the disease groups based on the 4 seasons.The result from our study showed that acute bronchiolitis was higher during winter(45.2%)and spring(25.2%)than in autumn(17.4%)and summer(12.2%)in the case group only.There was no statistically significant difference in the control group.c)The result from our study showed that there was no statistically significant difference in serum vitamin E level in gender,season,and breast feeding in both groups.3.Comparison of Multiple Risk Factors with Vitamins A,D and Ea)In case group,only breast feeding duration less than 6 months(? =-0.500;p< 0.001)was found to be significantly associated with serum vitamin A.Age,gender,gestation,breast feeding and seasons were not found to associate with serum vitamin A concentration in control group.b)Seasons(? = 0.419;p< 0.05)was found to associate significantly with the serum concentration of vitamin D in case group.There was no statistically significant association between serum vitamin D concentration and age,gender,gestation,seasons and breast feeding in control group.c)Gestation(? = 0.464;p=0.001)was found to associate significantly with the serum concentration of vitamin E in case group.There was no significant relationship observed between serum vitamin E concentration and age,gender,season,gestation and breast feeding in control group.Conclusion:1.Vitamins A and D have a significant relationship with Acute Bronchiolitis.2.Single risk factor analysis of Acute Bronchiolitis was found to be associated with Vitamin A and Vitamin D only.Multiple risk factor analysis showed that all three Vitamins(A,D,E)had an association with acute bronchiolitis.3.Supplementation of these vitamins can be considered in children less than 3 years old as a preventive measure against acute bronchiolitis.