ABSTRACT 

Background: Giardia duodenalis remain as common intestinal protozoan parasitic infection all over the world. Therefore, current study was purposed to explore the association of serum vitamin A concentrations with infection of Giardia duodenalis in children.
Methods: This comparative case control study was done on 50 children aged 5 to 10 years, and was conducted on 25 G. duodenalis infected children and 25 apparently healthy children as control in Al-Muthanna and Al-Diwaniyah (Iraq). The stool samples were assessed microscopically for incidence of G. duodenalis cysts and trophozoites. Blood samples were collected and serum was separated to measure vitamin A concentrations.
Results: The serum vitamin A level in Giardia-infected group was less (20.48 ± 9.91 µg/dL) compared to control (31.48 ± 6.19 µg/dL) group. The variation between groups was notably significant (p < 0.001). The median vitamin A concentration was (16 µg/dL) in infected children and (32 µg/dL) in controls. Serum vitamin A concentrations ranged from (11 to 45µg/dL) in infected group and from (20 to 44µg/dL) in control group. Sixteen infected children (64.0%) had vitamin A concentrations of ( ≤20 µg/dL), compared with only two children (8.0%) in the control group. The difference in frequency of low vitamin A concentrations between two groups was remarkable significant (p < 0.001).
Conclusion: Children infected with G. duodenalis had significantly lower serum vitamin A level than children in control group. The high proportion of infected children with low vitamin A concentrations supports a significant association between giardiasis and impaired vitamin A status. This relationship may be related to intestinal dysfunction, malabsorption, reduced dietary intake, or infection-associated alterations in vitamin A metabolism.

KEYWORDS

Giardia duodenalis, vitamin A, malabsorption, blood samples.

REFERENCES

1) Adam, R. D. (2021). Giardia duodenalis: biology and pathogenesis. Clinical microbiology reviews, 34(4), e00024-19.‏
2) Savioli, L., Smith, H., & Thompson, A. (2006). Giardia and Cryptosporidium join the neglected diseases initiative. Trends in Parasitology, 22(5), 203–208.
3) Faubert, G. (2000). Immune response to Giardia duodenalis. Clinical microbiology reviews, 13(1), 35-54.‏
4) Silva, R. K., Pacheco, F. T., Martins, A. S., Menezes, J. F., Costa-Ribeiro, H., Ribeiro, T. C., et al. (2016). Performance of microscopy and ELISA for diagnosing Giardia duodenalis infection in different pediatric groups. Parasitology International, 65(6), 635–640.
5) Cernikova, L., Faso, C., & Hehl, A. B. (2018). Five facts about Giardia lamblia. PLoS Pathogens, 14(9), e1007250.
6) Ali QA, Ghareeb OA. Drinking Water Quality and Its Impact on Public Health: Review. Academia Repository, Sep. 11, 2023; 4(9): 48-64.
7) Bhise, M. P., Padhi, A., Chaudhary, A., Rajyaguru, B., Chauhan, K., Meena, P., & Agrawal, A. (2025). Giardiasis in pediatric populations: A case series highlighting nutritional and growth impacts. Journal of Family Medicine and Primary Care, 14(11), 4883.‏
8) Belkessa, S., Ait-Salem, E., Laatamna, A., Houali, K., Sönksen, U. W., Hakem, A., … & Stensvold, C. R. (2021). Prevalence and clinical manifestations of Giardia intestinalis and other intestinal parasites in children and adults in Algeria. The American journal of tropical medicine and hygiene, 104(3), 910.‏
9) Barasa, E., Indusa, W., & Were, T. (2025). Giardia duodenalis in human health: A comprehensive review of its epidemiology, transmission, pathophysiology, diagnostics, and control strategies. Afro-Egyptian Journal of Infectious and Endemic Diseases, 15(2), 109-126.
10) Trelis, M., Taroncher-Ferrer, S., Gozalbo, M., Ortiz, V., Soriano, J. M., Osuna, A., & Merino-Torres, J. F. (2019). Giardia intestinalis and fructose malabsorption: a frequent association. Nutrients, 11(12), 2973.
11) Awasthi, S., & Awasthi, A. (2020). Role of vitamin A in child health and nutrition. Clinical Epidemiology and Global Health, 8(4), 1039–1042.
12) Kundu, S., Rai, B., & Shukla, A. (2021). Prevalence and determinants of Vitamin A deficiency among children in India: Findings from a national cross-sectional survey. Clinical Epidemiology and Global Health, 11, 100768
13) Rao, S., Li, T., Li, X., Hou, L., & Sun, W. (2025). Vitamin A and its related diseases. Food Science & Nutrition, 13(7), e70630.‏
14) Bastos Maia, S., Costa Caminha, M. D. F., Lins da Silva, S., Rolland Souza, A. S., Carvalho dos Santos, C., & Batista Filho, M. (2018). The prevalence of vitamin A deficiency and associated factors in pregnant women receiving prenatal care at a reference maternity hospital in Northeastern Brazil. Nutrients, 10(9), 1271.
15) Quihui-Cota, Astiazarán-García, Valencia, Morales-Figueroa, Lopez-Mata, & Ortiz, V. (2008). Impact of Giardia intestinalis on vitamin A status in schoolchildren from northwest Mexico. International journal for vitamin and nutrition research, 78(2), 51-56.‏
16) Fauziah, N., Aviani, J. K., Agrianfanny, Y. N., & Fatimah, S. N. (2022). Intestinal parasitic infection and nutritional status in children under five years old: a systematic review. Tropical medicine and infectious disease, 7(11), 371.
17) Solaymani-Mohammadi, S. (2022). Mucosal defense against giardia at the intestinal epithelial cell interface. Frontiers in immunology, 13, 817468.
18) Roshidi, N., Hassan, N. H. M., Hadi, A. A., & Arifin, N. (2021). Current state of infection and prevalence of giardiasis in Malaysia: a review of 20 years of research. PeerJ, 9, e12483.
19) Lima, A. A., Soares, A. M., Lima, N. L., Mota, R. M., Maciel, B. L., Kvalsund, M. P., … & Guerrant, R. L. (2010). Effects of vitamin A supplementation on intestinal barrier function, growth, total parasitic, and specific Giardia spp infections in Brazilian children: a prospective randomized, double‐blind, placebo‐controlled trial. Journal of pediatric gastroenterology and nutrition, 50(3), 309-315.
20) De Medeiros, P. H. Q., Pinto, D. V., De Almeida, J. Z., Rêgo, J. M., Rodrigues, F. A., Lima, A. Â. M., … & Oriá, R. B. (2018). Modulation of intestinal immune and barrier functions by vitamin A: implications for current understanding of malnutrition and enteric infections in children. Nutrients, 10(9), 1128.
21) Astiazaran-Garcia, H., Lopez-Teros, V., Valencia, M. E., Vazquez-Ortiz, F., Sotelo-Cruz, N., & Quihui-Cota, L. (2011). Giardia lamblia infection and its implications for vitamin A liver stores in school children. Annals of Nutrition and Metabolism, 57(3-4), 228-233.‏
22) Ghareeb OA, Ali QA, Abed QJ. Iodine: a micronutrient essential for human development and survival. Disease and Health Research developments. BP International. 2024 Dec 18:18-31.
23) Prabakaran, M., Weible, L. J., Champlain, J. D., Jiang, R. Y., Biondi, K., Weil, A. A., … & Ojo, K. K. (2023). The gut-wrenching effects of cryptosporidiosis and giardiasis in children. Microorganisms, 11(9), 2323.
24) Rogawski, E. T., Bartelt, L. A., Platts-Mills, J. A., Seidman, J. C., Samie, A., Havt, A., … & MAL-ED Network Investigators. (2017). Determinants and impact of Giardia infection in the first 2 years of life in the MAL-ED birth cohort. Journal of the Pediatric Infectious Diseases Society, 6(2), 153-160.
25) Fauziah, N., Aviani, J. K., Agrianfanny, Y. N., & Fatimah, S. N. (2022). Intestinal parasitic infection and nutritional status in children under five years old: a systematic review. Tropical medicine and infectious disease, 7(11), 371.
26) Kleinert, M., Górski, M., Kwiatkowski, A., Lepich, T., & Polaniak, R. (2026). Gastrointestinal disorders due to parasites–a narrative review of the literature. Pomeranian Journal of Life Sciences, 72(2).

Cite this article

AL-Ghazzi, M. H. D., Al-Rishawi, K. M., & Raheem, A. M. (2026). Association of Giardia Duodenalis Infection with Serum Vitamin a Status in Children: A Comparative Case Control Study. INTERNATIONAL JOURNAL OF HEALTH & MEDICAL RESEARCH, 5(9), 923-928. https://doi.org/10.58806/ijhmr.2026.v5i9n10