Severely Malnourished Children May Benefit From Vitamin D Supplement Interview with:
Dr Javeria Saleem PhD

Department of Public Health, Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry
Queen Mary University of London
London, United Kingdom What is the background for this study? What are the main findings?

Response: Severe acute malnutrition is the most extreme and visible form of undernutrition. Affected children have very low weight for their height and severe muscle wasting; they may also have swollen feet, face and limbs. Around 20 million children suffer from severe acute malnutrition worldwide of whom an estimated 1.4 million live in Pakistan. The condition is a major cause of death in children under 5 in Asia and Africa. The standard treatment is to give a high-energy, micronutrient enhanced paste called ready-to-use therapeutic food (RUTF).

Vitamin D deficiency has been reported to be a risk factor for severe wasting in children with severe acute malnutrition Ready-to-use therapeutic food contains relatively modest amounts of vitamin D. However, the effects of adding high-dose vitamin D to this standard treatment have not previously been evaluated.

We therefore did a clinical trial to assess whether high-dose vitamin D hastened recovery in 185 children aged 6-58 months who were receiving standard treatment for severe acute malnutrition in Southern Punjab, Pakistan. The 93 children in the active arm of the study received two doses of 5 mg vitamin D by mouth, while the 92 children in the control arm received placebo (a dummy medicine containing no vitamin D).

Our findings were very striking: after 2 months of treatment, the children who received high-dose vitamin D in addition to standard therapy had significantly better weight gain, and significantly better motor and language development, than those who received standard treatment alone. What should readers take away from your report?

Response: High-dose vitamin D significantly boosted weight gain in this group of malnourished children in Southern Punjab, Pakistan. Vitamin D supplementation also resulted in substantial improvements in motor development, language development and global development (i.e. reaching certain milestones such as learning to walk or talk). This could be a game-changer in the management of severe acute malnutrition; however, further research is needed before it can be incorporated into standard treatment protocols (see below). What recommendations do you have for future research as a result of this study?

Response: Further clinical trials are needed to see if our results can be reproduced in other countries where severe acute malnutrition is a problem. We are also planning a larger trial with longer follow-up in Pakistan to see if high-dose vitamin D could reduce mortality in children with the most severe form of acute malnutrition. Is there anything else you would like to add?

Response: We highlight that the dose of vitamin D that we gave was very large, and this should only be given by a doctor, with appropriate safety monitoring.

We have no disclosures or conflicts of interest to declare. This research was conducted by the University of the Punjab, Pakistan, in conjunction with Queen Mary University of London, UK. Thank you for your contribution to the community.


Javeria Saleem, Rubeena Zakar, Muhammad Z Zakar, Mulugeta Belay, Marion Rowe, Peter M Timms, Robert Scragg, Adrian R Martineau. High-dose vitamin D3 in the treatment of severe acute malnutrition: a multicenter double-blind randomized controlled trial. The American Journal of Clinical Nutrition, 2018; 107 (5): 725 DOI: 10.1093/ajcn/nqy027

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.


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Last Updated on May 4, 2018 by Marie Benz MD FAAD