Abstract
Vitamin A deficiency contributes to the morbidity and mortality from some infectious diseases. Empirical observations and trials from the early twentieth century led to the paradigm that improvement of vitamin A status could reduce morbidity and mortality among women and children. Many seminal observations of vitamin A deficiency and infection were made in Scandinavia. International organizations in the 1930s and 1940s emphasized adequate vitamin A status to prevent morbidity and mortality. With improvement of nutrition and hygiene in Europe and the United States, vitamin A deficiency largely disappeared, and attention later turned towards developing countries. Over one hundred clinical trials have addressed the impact of vitamin A on infectious disease morbidity and mortality and show that adequate vitamin A status is important in measles and diarrheal disease but not in non-measles pneumonia. Current studies extend investigations of the role of vitamin A to malaria, tuberculosis, and human immunodeficiency virus infection. Key words: Immunity, infection, morbidity, mortality, vitamin A
Highlights
Towards the characterization of vitamin AThe existence of vitamin A was demonstrated through a long series of steps that spanned a period of over one hundred and thirty years
Vitamin A deficiency contributes to the morbidity and mortality from some infectious diseases
Clinical trials in the last fifteen years showed that improving vitamin A status of preschool children through supplementation or fortification can reduce morbidity and mortality, of diarrheal diseases but not acute lower respiratory disease [2,3]
Summary
The existence of vitamin A was demonstrated through a long series of steps that spanned a period of over one hundred and thirty years. Cornelis Pekelharing [11] and Frederick Hopkins [12] both conducted studies that suggested there was something essential in milk that supported growth and survival, and Hopkins believed these "accessory factors" were necessary for life. In 1911, Wilhelm Stepp extracted lipids from milk with alcohol-ether that appeared to contain the active substance [13,14] and in 1913at the University of Wisconsin, Elmer McCollum and Marguerite Davis extracted the lipids with ether from cod-liver oil, concluding "our observation ...strongly supports the belief that there are certain accessory articles in certain food-stuffs which are essential for normal growth for extended periods" [15]. At Yale University, Thomas Osborne and Lafayette Mendel made the seminal observation that infectious diseases in vitamin A-deficient animals were quickly alleviated by introduction of butter-fat in the diet [16,17]. Harry Steenbock and colleagues proposed in 1919 that there was a connection between yellow plant pigments ("carotin") and vitamin A, an observation suggested by the appearance of vitamin Adeficiency in a rat colony when white corn was substituted
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