Vitamin A and iron supplementation is as efficient as hormonal therapy in constitutionally delayed children


Zvi Zadik MD, Pediatric Endocrine Unit, Kaplan Medical Center, Rehovot, Israel, 76100. Tel: 972-8-9441276; Fax: 972-8-9419112; E-mail:


objective  To assess the effect of nutritional supplementation on growth and puberty in constitutionally delayed children.

patients  One hundred and two boys, 13·6–15·5 years of age, who were referred because of short stature and delayed puberty.

methods  The boys were randomly allocated to one of the following treatment groups: oxandrolone therapy, 5 mg/day for 6 months (n = 15), testosterone depot, 100 mg monthly for 3 months (n = 15) or for 6 months (n = 20), nutritional programme (n = 17), oxandrolone and nutritional programme (n = 15) or passive observation (n = 20). Boys in the nutritional programmes received 12 mg/day iron and 6000 IU/week of vitamin A. Outcome measurements were of height, weight, pubertal signs, dietary intake, serum vitamin A, iron, GH and IGF-1.

results  Six months of vitamin A supplementation induced growth acceleration similar to that seen in the oxandrolone- and testosterone-treated children, and significantly greater than in the observation group (9·3 ± 2·9 vs. 4·0 ± 0·9 crn/yr, P < 0·001). Whereas in the vitamin A-supplemented group, puberty (increase in testicular volume ≥ 12 ml) was induced within 12 months. In all testosterone-treated patients, pubic hair was noted within 3 months and a testicular volume of ≥ 12 ml was observed 9–12 months after the initiation of therapy. No pubertal signs were noted in the observation group during this time.

conclusions  Subnormal vitamin A intake is one of the aetiological factors in delayed pubertal maturation. Supplementation of both vitamin A and iron to normal constitutionally delayed children with subnormal vitamin A intake is as efficacious as hormonal therapy in the induction of growth and puberty.