Alfred Sommer: The Risk Of Child Death Is Directly Related To The Risk Of Vit A Deficiency

Discussion in 'A' started by burtlancast, Mar 15, 2019.

  1. burtlancast

    burtlancast Member

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    "The Indonesian study showed that malnourished children with adequate vitamin A were less likely to die
    than well-nourished children who were deficient in vitamin A."

    "Vitamin A capsules were given every six months to approximately 20,000 young children in 450 randomly
    chosen villages. The result was a one-third reduction in death rates, compared with villages where
    there had been no intervention."

    Impact of vitamin A supplementation on childhood mortality. A randomised controlled community trial. - PubMed - NCBI


    A bridge too near
    By Alfred Sommer
    Dr. Alfred Sommer is Professor and Dean at the School of Hygiene and Public Health, Johns
    Hopkins University, Baltimore. He has been in the forefront of research into vitamin A deficiency
    for almost 20 years, and led the two major Indonesian studies described in this article.
    For almost a decade, medical science ignored or rejected the evidence that vitamin A could reduce
    child deaths by between a quarter and a third in many countries of the developing world.
    Today, the scepticism of the 1980s has been swept away by an avalanche of data. And as the tables
    on the following pages show, most nations are now moving to make this most cost-effective of all
    health interventions available to their children.
    If this effort succeeds, then we can expect to bring about a fall in child deaths of somewhere
    between 1 million and 3 million per annum.

    Discovered in 1913, vitamin A has taken almost a century to come into its own. It has long been
    known that the lack of this particular vitamin could cause stunting, infection, and blindness in
    animals. But it was 1974 before the first report was published (by WHO) on vitamin A deficiency as
    a major cause of blindness among the children of the developing world.

    Missing the point
    In that same year, a research project was launched in Indonesia to find out more about vitamin A
    deficiency, and particularly about what levels of deficiency were associated with xerophthalmia (the
    inflammation and drying of the eye that can result in permanent blindness). Over a period of a year
    and a half, 4,000 children were examined at three-month intervals.
    By 1981 much useful information had been gleaned. But in looking only for what we expected to
    see, we had missed what the data itself had revealed. Unlooked-for and unseen amid the mass of
    figures was a much more dramatic message.
    One December evening almost a year later, while a particular set of figures was being crosstabulated,
    it became apparent that many xerophthalmic children were missing from later crosstabulations.
    Running the computer analysis in the reverse direction revealed what the data had been
    waiting to tell us all along: children with even mild xerophthalmia were dying at a far greater rate.
    Any suggestion that the higher death rate was caused by malnutrition, of which the lack of vitamin
    A was merely a symptom, was quickly dispelled. Malnutrition clearly increases the risk of child
    death, but so does vitamin A deficiency - even among adequately nourished children. In fact the
    Indonesian study showed that malnourished children with adequate vitamin A were less likely to die than well-nourished children who were deficient in vitamin A.

    Preliminary calculations, soon to be revised upwards, showed that if xerophthalmia could be
    prevented, then the death rate among children aged one to six would fall by approximately 20%.
    Analysis also showed that the risk of death was directly related to the degree of deficiency.

    To test these extraordinary conclusions, a second Indonesian study was launched. This time, vitamin
    A capsules were given every six months to approximately 20,000 young children in 450 randomly chosen villages. The result was a one-third reduction in death rates, compared with villages where there had been no intervention.

    These findings were published in The Lancet and other medical journals. The response was the long
    silence of disbelief.

    With its vision fixed on the high-tech and high-cost frontiers of modern medical care, the medical
    and research establishment found it difficult to accept that something as simple and cheap as a 2-cent capsule of vitamin A could represent such a break-through for human life and health.
    Perhaps in some quarters, also, there was an innate and ideological dislike of `magic bullet' solutions to
    health problems which do not directly address the underlying problems of poverty.
    Whatever the reason, a discovery that seemed to promise so much had caused barely a ripple on the
    surface of medical interest.
    It was at this point that a wise colleague pointed out that this was the normal first reaction to any
    unexpected research finding. The next stage, he advised, was to "bury them in data."
    Knowing that measles often leads to vitamin A loss, we had begun to wonder if Africa's high death rates from measles might also be connected with vitamin A deficiency. To test this, children hospitalized with measles in Tanzania were given vitamin A capsules. The measles death rate fell by half. It was at this point that we discovered, to our astonishment, that a similar experiment had been conducted 50 years earlier in a London hospital - with the same results: medicine too has doors it did not enter, paths it did not take.
    WHO and UNICEF now acted quickly to make vitamin A supplementation a routine part of measles
    treatment. More broadly, the elimination of the deficiency became one of the goals adopted by the
    World Summit for Children held at UNICEF's instigation in the fall of 1990. The progress being
    made towards that goal is shown in the following tables.
    By 1992, the results were in from several large, community-based investigations into vitamin A deficiency. Ghana, India, Indonesia, and Nepal all yielded results in line with the one-third
    reduction in mortality rates revealed by the original research in Indonesia.

    At this point, the medical community accepted our conclusions as unanimously as it had dismissed
    them a decade earlier. A colleague who had earlier written a leader in The New England Journal of
    Medicine titled `Too good to be true', now published a paper under the heading `Too good not to be
    true'.
    With the scientific community in full agreement, ministries of health across the world have now
    given the green light to vitamin A supplementation. Unfortunately, official recommendations
    usually stress vitamin A supplementation only where there is evidence of severe deficiency, whereas the evidence suggests that supplementation can significantly reduce mortality even among populations with mild vitamin A deficiency
    . Further studies are now needed to quantify this effect.
    Three ways
    Increasing vitamin A intake can be achieved by three main methods - improving diets, fortifying
    common foods, and distributing vitamin A capsules.
    The politically correct method is dietary improvement through the addition of green leafy
    vegetables or carrots. Of course diets should be improved. But this is a slow and uncertain process,
    and there are doubts about whether it can provide sufficient vitamin A even where dietary change is
    indeed achieved. Certainly, more work is needed on the most effective dietary ways of beating
    vitamin A deficiency.
    Some countries, particularly in Central America, have fortified sugar with vitamin A (the problem
    was solved in the industrialized world by adding vitamin A to common foods such as milk, bread,
    and margarine). But in the developing world as a whole, food fortification is only beginning to be
    explored.
    In the meantime, at least two children are dying every minute for the lack of the protection that
    vitamin A can bring.
    The 2-cent capsules are therefore an essential weapon for the defence of children. And the outreach
    systems which have been built or strengthened by the immunization effort of the last decade have
    now made it possible to deliver that protection to the great majority of children at risk.
    There can be no excuse for further delay
     

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  2. AnonE

    AnonE Member

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    "In fact the
    Indonesian study showed that malnourished children with adequate vitamin A were less likely to die than well-nourished children who were deficient in vitamin A."

    Wow that really stuck out to me.

    Why is it specifically that they are A deficient in Indonesia? Not enough food in general, or lack of vegetables, or what?

    I imagine they do fine for vitamin D though, nice and sunny/warm. Opposite problems of that French Canadian guy who tried to eliminate Vit A from his diet lol.
     
  3. OP
    burtlancast

    burtlancast Member

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    Indeed.

    No wonder his 2 books hardly mention this professor's name.

    Also very telling: "children hospitalized with measles in Tanzania were given vitamin A capsules. The measles death rate fell by half"

    Not too bad for a poisonous substance...
     
  4. AnonE

    AnonE Member

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  5. schultz

    schultz Member

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    I am shocked, SHOCKED! that a poison had this effect... must be some kind of hormesis or something.

    But in all seriousness, this is very interesting. Thanks @burtlancast
     
  6. somuch4food

    somuch4food Member

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    Actually, vitamin A is quite useful against infections. The problem is that the western world and its lifestyle and hygiene practices reduce a lot of contact with pathogens which means that vit A doesn't get used up as fast and accumulates within to be ready when an infection happens.

    I'm thinking sporadic supplementation like in the experiment would be less harmful than fortification since the risk of toxicity is lower and the body doesn't have the burden of processing it every day.

    I'm low A, but I do think it has its usages, but that overdoing it can be quite dangerous especially from long term chronic exposure. Vitamin A toxicity is well documented.
     
  7. OP
    burtlancast

    burtlancast Member

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    These Indonesian studies totally contradict Genereux' thesis that Vit A isn't a vitamin at all. The undernourished children with sufficient Vit A outlived the well-nourished children with a deficiency of Vit A.
    Can't get better proof than that.

    My article documents that lack of Vit A causes premature death.
    Worldwide, the ratio of Vit A saving lives/ Vit A toxicity is in the thousands.
     
  8. somuch4food

    somuch4food Member

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    Yeah, I'm not 100% on the theory of it being a total poison, but I'm also unsure it's as important as purported generally. It has been shown to help, but it is also teratogenic in too high a dosage and generally too much is contraindicated during pregnancy which means it's not as safe as other vitamins.

    Application should be studied depending on the diet of people and their location and a generic application to large populations will be detrimental to some, while still helpng others.
     
  9. sugarbabe

    sugarbabe Member

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    What's more interesting to me is that measles is not something that most kids were dieing of in America. Yes some do die but for the majority it is a mild illness. So clearly America was getting plenty of vitamin A. When they say death rate for the measles they are most likely talking about sickly children. So yes this is a good therapy for sickly children.
     
  10. OP
    burtlancast

    burtlancast Member

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    What do you mean by this statement ?

    You consider it a vitamin or not ?

    A vitamin is something you die without.
     
  11. somuch4food

    somuch4food Member

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    I'm saying something along the line that it can save lives, but might not be necessary for life. That's an opinion from the information I have encountered.
     
  12. OP
    burtlancast

    burtlancast Member

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    Then if Vit A isn't really a Vitamin, meaning it's not essential for survival, why did the underfed children/Vit A sufficient outlive the well fed children/Vit A deficient ?....

    Was there some magic involved ...() ?