Cod Liver Oil, the Ratio of Vitamins A and D, Frequent Respiratory Tract Infections, and Vitamin D Deficiency in Young Children in the United States.  Ann Otol Rhinol & Laryngol 2010;119:64-70.  By Linday LA, Umhau JC, Shindledecker RD, Dolitsky JN, Holick MF.

This paper is a response to "Cod liver oil, vitamin A toxicity, frequent respiratory infections, and the vitamin D deficiency epidemic."  Ann Otol Rhinol & Laryngol 2008;117:864-70.

Commentary on "Breastfeeding Does Not Protect Against Urinary Tract Infection in the First 3 Months of Life, but Vitamin D Supplementation Increases the Risk by 76%."  Clinical Pediatrics 2010;49:93-4.  By Linday LA, Shindledecker RD, Greer, FR, Holick MF.

Dr. Linday and colleagues disagree with the way the statistics were performed in the original paper, and they therefore disagree with the paper's conclusion.

Nutritional Supplements and Pediatric Upper Respiratory Tract Illnesses [letter].  J Allergy Clin Immunol 2006;117:953-4.  By Linday LA.

Upper respiratory tract illnesses are a common cause of exacerbations of asthma; Dr. Linday therefore suggests that evaluation of the study dietary supplements for children with asthma is warranted.

Plasma 25-hydroxyvitamin D levels in young children undergoing placement of tympanostomy tubes. Ann Otol Rhinol Laryngol 2008;117:740-744.

By Linday LA, Shindledecker RD, Dolitsky JN, Chen TC, Holick MF.

ABSTRACT

Objective:  To report plasma 25-hydroxyvitamin D [25(OH)D] levels of 16 young children undergoing ambulatory surgery for placement of tympanostomy tubes.

Methods:  We previously obtained blood samples from young children undergoing ambulatory surgery, and reported that they had lower blood levels than adults of eicosapentaenoic acid (an omega-3 fatty acid), vitamin A, and selenium. Plasma frozen continuously at -80º was available from 16 subjects undergoing placement of tympanostomy tubes.

Results:  Mean age = 3.7 years (± 1.6 SD); median = 2.9 years; range = 1.9-7.4 years. 62% were male; half were white and half Hispanic; 62% were private patients; parents reported half were taking vitamin supplements; none had a history of rickets. None had 25(OH)D levels <10 ng/mL; 50% had 25(OH)D levels < 20 ng/mL (deficient in adults); another 31% had levels from 21-29 ng/mL (insufficient in adults).

Conclusion:  Vitamin D is essential for the production of endogenous anti-microbial peptides, and has been linked to seasonal, epidemic influenza A. However, the level of 25(OH)D needed to prevent infection with various human pathogens has not been defined. In view of increasing bacterial resistance and emerging new pathogens, further research on the relationship of infection to 25(OH)D and other nutritional factors is warranted.

 

Note:  In October 2010, Dr. Linday will be an invited speaker at the American College of Nutrition (ACN) 51st Annual Symposium on Advances in Clinical Nutrition, to be held at the New York Academy of Medicine in New York City. 

Dr. Linday's INTERNATIONAL presentations at the Vth IAPO (Interamerican Association of Pediatric Otorhinolaryngology) International Symposium on Pediatric Infectious Diseases in Ear, Nose and Throat; São Paulo, Brazil, October 19-21, 2007.

March 8, 2006: Sam Brooke Visiting Professor in Dietary Supplements at Wake Forest University Medical School in Winston-Salem, North Carolina.

Dr. Linday’s chapter, "Nutritional supplements and upper respiratory tract illnesses in young children living in the U.S.A.," has been published in "Preventive Nutrition: The Comprehensive Guide for Health Professionals, Third Edition, edited by A. Bendich and RJ Deckelbaum, Humana Press Inc., Totowa NJ, 2005.

Dr. Linday wrote to the United States Department Agriculture (USDA) on December 15, 2003 and proposed that the supplements used in these studies be made available through WIC (Special Supplemental Nutrition Program for Women, Infants, and Children). Click the following link to read her letter (you will need Adobe Acrobat Reader to access this information):  WIC Comments

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TITLE: Nutritional supplements as adjunctive therapy for children with chronic/recurrent sinusitis: Pilot research.

AUTHORS: Linday LA, Dolitsky JN, Shindledecker RD

JOURNAL: International Journal of Pediatric Otorhinolaryngology 2004, Volume 68, Number 6 (June), pages 785-793

OBJECTIVE: Inflammation and edema of the sinonasal mucosa are important in the pathophysiology of sinusitis. Based on the similarities between otitis media (OM) and sinusitis, and our previous research on OM, we hypothesized that nutritional supplements would be effective adjunctive therapy for the treatment of children with chronic/recurrent sinusitis. METHODS: We performed a 4 month, open-label, dose-titration study; subjects were enrolled from late January to early March 2003. Each subject served as his own control. Study supplements were a lemon-flavored cod liver oil and a children's multivitamin-mineral with selenium, prescribed in escalating doses; at higher doses, fish oil was substituted for cod liver oil. Subjects were private pediatric otolaryngology outpatients with a clinical diagnosis of chronic/recurrent sinusitis, whose symptoms were refractory to treatment with antibiotics. RESULTS: Our four subjects were Caucasian males, ranging in age from 4.2 to 9.8 years, with chronic/recurrent sinusitis for at least 3 years prior to entry in the study. Three subjects had a positive response; one subject dropped out for administrative reasons. Four, six, and eight weeks after beginning study supplements, the responders had decreased sinus symptoms, fewer episodes of acute sinusitis, and fewer doctor visits for acute illnesses. Their parents reported that they had begun to recover from upper respiratory illnesses without complications, which was unusual for these children, as was improvement in springtime; their improvement had previously been limited to the summer months or periods of home-schooling. CONCLUSIONS: Use of flavored cod liver oil and a multivitamin-mineral with selenium as adjunctive therapy for children with chronic/recurrent sinusitis is an inexpensive, non-invasive intervention that clinicians can use for selected patients, pending the performance of definitive, large, well-controlled studies.

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TITLE: Lemon-flavored cod liver oil and a multi-vitamin/mineral supplement for the secondary prevention of otitis media in young children: Pilot research

AUTHORS: Linday LA, Dolitsky J, Shindledecker R, Pippenger CE

JOURNAL: Annals of Otology, Rhinology & Laryngology 2002, Volume 111, Number 7 (July), pages 642-652

We measured blood levels of fatty acids, vitamin A, and trace metals in children undergoing ambulatory surgery for placement of tympanostomy tubes and a comparison group of children having other ambulatory surgical procedures; we then performed a small, outpatient, secondary prevention study using nutritional supplements chosen on the basis of these blood levels. Study subjects had lower levels of red blood cell eicosapentaenoic acid (EPA) than adult controls. Consistent with previous reports, levels of vitamin A were  £ 40 mg/dL for 69% of our subjects, and plasma selenium values for children were lower than published values for adults. We then studied one otitis media (OM) season; 8 children (0.8 to 4.4 years of age), received one teaspoon of lemon-flavored cod liver oil (containing both EPA and vitamin A) and 1/2 tablet of a selenium-containing children's chewable multi-vitamin/mineral tablet, per day. During this OM season, study subjects received antibiotics for OM for 12.3% ± 13.4 (p<0.05; mean ± SD) fewer days during supplementation than before supplementation. Larger, controlled trials are warranted to assess the utility of cod liver oil (of acceptable purity and taste) and a children's multi-vitamin/mineral preparation containing selenium, both for the prevention of OM and for the acceptance of delayed prescription of antibiotics for this disorder.

Objectives: Part I: Measure blood levels of fatty acids, vitamin A and trace metals in children undergoing ambulatory surgery for placement of tympanostomy tubes (TT) and a comparison group (COMP) having other ambulatory surgical procedures. Part II: Perform a small, out-patient, secondary prevention study using nutritional supplements chosen on the basis of the results of Part I. Study design: Part I: Perform the above blood level analyses. Part II: Setting: Out-patients in a private pediatric group practice. Eligibility: Children with at least one episode of otitis media (OM) from 9/1 to 11/30/2000. Determine whether the daily administration of one teaspoon of lemon-flavored cod liver oil and 1/2 tablet of a selenium-containing children's chewable multi-vitamin/mineral preparation would decrease the percentage of days antibiotics were prescribed for OM from 9/1/2000-3/31/2001. Results: Part I: Fatty Acids: Study subjects had lower levels of red blood cell (RBC) eicosapentaenoic acid (EPA) than adult controls. Mean RBC EPA values were: 1) TT=0.31% ± 0.02% (SE), (n=16); 2) COMP=0.31% ± 0.04% (SE), (n=5); and 3) Adult Controls=0.48% ± 0.4% (SE), (n=6); (p=0.007, Kruskal-Wallis ANOVA by Ranks). Vitamin A: Consistent with previous reports, levels for 69% of our subjects (27/39) were £ 40 m g/dL, the level needed for normal dark adaptation; 15% (6/39) had sub-optimal levels (£ 30 m g/dL, >20 m g/dL). Selenium: There was no statistically significant difference between the mean plasma selenium for study subjects (TT=110 ng/ml ± 16.3 SD; n=39) and the published values for children; children had lower levels than published values for adults (p<0.005, ANOVA). Part II: Eight children, 0.8-4.4 years of age, entered the secondary prevention study. One could not tolerate the taste of cod liver oil; the remaining 7 children received antibiotics for OM for 12.3% ± 13.4 (SD) fewer days during supplementation than before (p<0.05, Wilcoxon Matched Pairs Test). 5/7 subjects had no additional episodes of OM during supplementation, although it had no apparent effect on established serous middle ear effusions in two children. Conclusion: Larger, controlled trials are warranted to assess the utility of cod liver oil (of acceptable purity and taste) and a children's multi-vitamin/mineral preparation containing selenium, both for the prevention of otitis media and the acceptability of delayed prescription of antibiotics for this disorder.

RESEARCH REVIEW:

This research was reviewed and approved by the Institutional Review Board of The New York Eye and Ear Infirmary. Written, informed consent was obtained from at least one parent before a child entered either study; assent was obtained from children over 6 years of age.

RESEARCH SUPPORT:

This work was supported in part by the Department of Otolaryngology of The New York Eye and Ear Infirmary (New York, NY). MedToxÒ Scientific, Inc. (St. Paul, MN) donated the vitamin and trace metal analyses, performed while Dr. Pippenger (a co-author) was a consultant. J. R. Carlson Laboratories, Inc. (Arlington Heights, IL) donated the nutritional supplements used in the supplementation studies, but had no other role in the design or conduct of the studies.

DISCLAIMER:

The information on this web site is provided for educational purposes only; it is a general reference for healthcare consumers and providers; it is not a prescription for any individual person. It is important that you consult your child’s qualified healthcare provider before implementing any of the research discussed on this web site.

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Updated June 24, 2010