Role of Vitamin D Supplementation in the Treatment of Severe Acute Malnutrition

Author(s): Dr Shibani Datta*, Prof Dr Mujibul Hoque, Dr Suman Kanti Chowdhury, Dr Md. Shohidul Islam Khan, Dr Purabi Mazumder, Dr Naima Rahman

Background: Severe acute malnutrition (SAM) is one of the most common causes of morbidity in children and accounts for 4.4% of deaths worldwide due to severe wasting. It has been found that vitamin D levels are low in children with SAM and in very sick children. The WHO recommendations for the management of SAM include very modest amounts of vitamin D that do not reliably correct deficiency.

Aims of the study: The aims of this study were to determine the effects of vitamin D supplementation on children with severe acute malnutrition.

Methods: This randomized controlled trial was conducted in the Department of Paediatrics, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh, from January 2021 to December 2022. Seventy two children aged 6 to 59 months with SAM were randomized by lottery method and enrolled as Group A and Group B. Group A received six lakhs IU Vitamin D that was given intramuscularly on admission day along with conventional treatment of SAM, while Group B received only conventional management. Both groups were assessed for weight, height/ length, WHZ/WLZ scores, developmental indexes on admission and after eight weeks of intervention. Cure rate and hospital stay duration were also recorded.

Results: Among the 72 randomly assigned children, 67 participants completed the 8 weeks follow-up and were included in the analysis. Group A exhibited a significantly greater mean weight gain compared to Group B (1.76 ± 0.51 kg vs. 1.26 ± 0.82 kg; p=0.003), which was statistically significant. Although the mean height gain was higher in Group A (0.63 ± 0.59 cm) than in Group B (0.44 ± 0.62 cm), this difference was not statistically significant (p=0.204). Weight-for-height/length Z scores of Group A showed a significantly greater improvement (0.74 ± 1.04 vs. 0.09 ± 1.38; p<0.05) after 8 weeks. Proportion of cured participants (97.2% vs. 88.9%; p=0.16) and the length of hospital stay (8.69 ± 2.99 vs. 10.16 ± 3.78 days; p=0.081) in Group A and Group B were not statistically significant. Neurodevelopmental assessments using Denver Developmental Screening Tool II (DDST-II), revealed lower proportions of delayed gross motor, language and personal/social development in Group A (p<0.05) which were statistically significant. The mean of serum 25(OH)D concentration at the end of study were 77.03 ± 16.64 and 28.88 ± 7.44 ng/ml in Group A and Group B respectively. Serum 25(OH)D concentration exceeded 125 ng/ml in only 1 of 35 participants in Group A without any hypervitaminosis signs.

Conclusion: Vitamin D supplementation in addition to conventional treatment of SAM, significantly enhanced weight gain, improved the mean weight for height/length Z score and developmental indexes in children with uncomplicated severe acute malnutrition.