Association Between Serum Vitamin A Levels and Recurrent Respiratory Tract Infections in Children.

Haitao Gao,Lili Zhang,Xinran Qi,Lin Wang,Xinyuan Bai,Chunhua Jin,Na Jin,Yue Zhang,Jianhong Wang,Xiaoyan Wang,Na Li,Wenhong Song,Xingming Li,Baojun Gao

doi:10.3389/fped.2021.756217

Abstract

To evaluate the association between serum vitamin A levels and the prevalence of recurrent respiratory tract infections (RRTIs) in children and adolescents and to provide evidence that would help decrease the prevalence of respiratory tract infections (RTIs) in children. This cross-sectional study included 8034 children and adolescents in Beijing aged 6 months to 17 years. RRTI and RTI symptoms were diagnosed according to the Clinical Concept and Management of Recurrent Respiratory Tract Infections in Children. Multivariate logistic regression models were used to evaluate the association between serum vitamin A levels and RRTIs after adjusting for potential confounders. Among the included children, 721 (8.97%) were diagnosed with vitamin A deficiency, whereas 3,073 (38.25%) were diagnosed with subclinical vitamin A deficiency. Only 28.8% (208/721) of children with vitamin A deficiency and 53.1% (1,631/3,073) of children with subclinical vitamin A deficiency had no RRTI and RTI symptoms, respectively. Compared with children with normal vitamin A levels, those with vitamin A deficiency and subclinical vitamin A deficiency had a greater risk for RRTIs, with an odds ratio (OR) of 6.924 [95% confidence interval (CI): 5.433–8.824] and 2.140 (95% CI: 1.825–2.510), respectively]. Vitamin A levels were also positively associated with RTI symptoms, with those having vitamin A deficiency and subclinical vitamin A deficiency showing an OR of 1.126 (95% CI: 0.773–1.640) and 1.216 (95% CI: 1.036–1.427), respectively. The present cross-sectional study found that low serum vitamin A levels were significantly associated with RRTI or RTI prevalence in children and adolescents.

Highlights

Respiratory tract infections (RTIs) are the most widespread infectious disease in children and adolescents and a serious public health concern promoting high morbidity and mortality that considerably threatens children’s health
After stratifying the patients according to location, the analysis revealed that the association between vitamin A levels and respiratory tract infections (RRTIs) risk was stronger among rural and migrant populations, with the odds ratio (OR) being 4.165 and 1.445 for urban children with vitamin A deficiency and subclinical vitamin A deficiency, 7.407 and 2.845 for migrant children with vitamin A deficiency and subclinical vitamin A deficiency, and 6.707 and 2.345 for rural children with vitamin A deficiency and subclinical vitamin A deficiency, respectively
After stratifying the patients according to body mass index (BMI), the analysis showed a stronger association between vitamin A deficiency and risk for RRTIs among children who were overweight/obese, with the ORs being 7.529 and 2.514 for children who were overweight/obese and had vitamin A deficiency and subclinical vitamin A deficiency, 4.345 and 1.512 for children with healthy weight with vitamin A deficiency and subclinical vitamin A deficiency, 3.204 and 1.028 for children who were underweight with vitamin A deficiency and subclinical vitamin A deficiency, respectively

Summary

Introduction

Respiratory tract infections (RTIs) are the most widespread infectious disease in children and adolescents and a serious public health concern promoting high morbidity and mortality that considerably threatens children’s health. Besides the traditional risk factors of RRTIs, including parental educational level, family medical history of respiratory diseases, parental smoking status, nutritional status, supplemental microelements, immune status, diet status, exercise, and environmental factors [4], previous evidence has suggested that low serum vitamin A levels are significantly associated with high morbidity of RRTIs and respiratory infections [5,6,7]. Consistent with these findings, it has been found that patients with chronic infectious diseases generally present with severe vitamin A deficiency [8]. A clinical trial on 100 children with RRTI without acute phase response demonstrated that vitamin A supplementation could decrease the morbidity of RRTIs [9]

Methods

Results

Conclusion