Additional 1 Observational Studies Included in Systematic Review

Additional 1 Observational studies included in systematic review

Summary of Findings Quality Assessment Treatment Groups (sample size) Effect GRA

Study Relat DE Limitati Control ive Indirect Impreci Intervent Absol Ratin Ref Design Inconsistency ons Compar Risk ness sion ion Cases ute (risk of ison (95% g bias) CI) de Fátima Selection PEM Normal Costa Observati No VA Nutrition def: Small bias: age (n = 34) (n = 29) LOW- Caminha, and 2008 [15] onal interventio “normal” sample maternal MOD n WHZ > -1 schooling higher in (NCHS normal references [45]) group Pop: Confound Prevalence 24.1% Aim: hospitalize VAD def: low ing: after of low NS d children adjusting serum assess serum retinol (< for retinol (after and 0.70 μmol/L) gender, 41.2% adjust age, compare maternal ment serum schooling, family retinol income, concentra breastfeed ing tions in practices hospitaliz and residence, ed serum Brazilian retinol similar in children PEM and (< 60 mo) normal with protein- energy malnutriti on (PEM) Ashour, Observati No VA Selection Hospitalize Healthy 1999 [14] onal interventio No serious Small bias: d (n = 68) children LOW- n inclusion from inconsistency sample; criteria communit MOD sub- unclear y (n = 22) group analyses only possible for PEM arm Aim: Pop: 68% Controls KWO/MA p < 0.0 evaluate (46/68) matched R plasma 5 antioxida hospitalize on age A↓ mean nt status d children and sex; glutathione of with PEM; no SES peroxidase hospitaliz 38% with characteri ↓ plasma ed kwashiork stics E↓ plasma Egyptian or (KWO) reported C ↓ children and 29% ceruloplas (3 mo - with min↓ 3 yr) with marasmus copper↓ PEM (MAR) selenium↓ erythrocyte SOD ↑ plasma Zn↑ Baseline KWO Hb p < 0.0 nutrition: ↓plasma 5 HAZ, free Fe↑ WAZ, WHZ, BMI significan tly different Mitra, Observati No VA Nutrition def: Statistics: Potential S. Other p < 0.0 1998 [18] onal interventio NCHS independ confoundi dysenteria dysentery 001 LOW- n references ent ng: e (n = 49) (n = 24) associatio children Other MOD n of with S. Shigella WAZ and dysenteri (n = 14) infection ae had (S. higher dysenteri body ae) with temperatu low re, CRP, serum and AGP retinol concentra concentra tions tion demonstr ated in regressio n modeling Aim: Pop: only VAD def: serum Low serum p < 0.0 examine children retinol retinol: S. 001 relation with concentration; dysenteria of serum shigellosis deficient < 0.35 e CRP low retinol in ; µmol/L WAZ Banglade prevalence shi of PEM children not (5 mo - 5 reported, y) with although dysentery mean due to WAZ < -2 shigellosi in all s and groups other nutrition and illness severity indicators Serum p < 0.0 retinol 001 concentrati ons higher at discharge (0.36 ± 0.2 2) than at baseline (1.15 ± 0.5 0) without supplement ation (VAS) Donnen, Observati No VA VAD def: serum Statistics: No Total No 1996 [16] onal interventio retinol no control or sample comparis n concentration; regressio comparis (n = 415) on group deficient < 0.35 n on group µmol/L; relative modeling used dose response (RDR) Aim: Pop: all Nutrition def: Confound VAD: assess children < NCHS ing: no night VA status 6 yrs in 2 references adjustmen blindness among villages; ts for 0.7% low Zairian mean possible serum children WAZ confoundi retinol (< 6 yrs -2.24; ng 19.7% mean factors, in RDR in HAZ particular reduced LOW- -2.63; age sample MOD mean 7.6% WHZ -0.87 Other Low serum NS biases: retinol: intrahous WAZ, ehold HAZ, clustering MUAC not accounted for Low serum p < 0.0 retinol: 5 WHZ < -2 Mahalan- Observati No VA VAD def: No Selection Cases: Control abis, onal interventio xerophthalmia – serious bias: xerophthal (n = 2,62 LOW- 1991 [17] n Bitot’s spots, imprecisi surveillan mia 1) corneal lesions, on ce data (n = 66) MOD night blindness, used; or night urban blindness plus poor conjunctival household xerosis s likely with care- seeking behavior Aim: Pop: Nutrition def: Confound Breastfeedi AOR p < 0.0 determine children severe PEM (< ing: many ng 0.26 01 effect of entered in 60% reference covariates (0.14 - breastfee surveillanc median WAZ); considere 0.49) ding on e system NCHS d risk of from references xerophtha 1983-1985 lmia in aged 6-35 Banglade mo; shi prevalence children of PEM (6 - 35 not mo) reported Severe AOR p < 0.0 PEM 3.8 01 (1.8 - 8.0) Moderate AOR NS malnutritio 0.72 n (60-70% (0.28 - WAZ) 1.8) Prolonged AOR p < 0.0 diarrhea 5.3 01 (10 - (2.2 - 14 days) 12.5) Persistent AOR p < 0.0 diarrhea 3.5 01 (>14 days) (1.8 - 6.8) Other significant predictors: recent measles and poor SES

The table presents the included observational studies in the review by date of publication, from most recent to oldest. For each study, the design, aim, quality assessment by GRADE criteria, findings, and GRADE rating are provided.