Vitamin A is a fat-soluble vitamin that has a primary role in vision. It is also required for proper functioning of the immune system along with overall growth and development. Vitamin A deficiency occurs when the body lacks sufficient amounts of Vitamin A.
The primary cause of Vitamin A deficiency is insufficient dietary intake. Children and pregnant women are more prone to this deficiency due to the more requirements. The symptoms include impaired sensitivity of the eye to light, vision problems, dry skin, growth retardation (in children) and fatigue.
Vitamin A deficiency can be easily corrected through diet and supplementation. Rich sources of Vitamin A include green leafy vegetables, eggs, milk, cheese, tomatoes, mango, papaya, sweet potato and chicken.
Individuals with chronic liver cirrhosis requiring transplantation have 70% chance of Vitamin A deficiency.
Adults also need vaccination just like kids. Here is a complete guide on the types of adult vaccines, why you need adult vaccines, and when you should get them.
Children between 36–47 months of age
Both men and women but more common in women
Eyes
Skin
Hair
Immune system
India: 17.54% (2021)
Retinitis pigmentosa
Retinal dystrophies
Niacin (Vitamin B3) deficiency
Pinguecula
Pterygium
Cataracts
Myopia
Serum retinol
Serum retinol-binding protein study
Retinol binding protein
Zinc level
Iron panel
Complete blood count
Electrolyte evaluation
Radiography
Dark-adaptation threshold (DAT)
Vitamin A supplementation
Zinc supplementation
Vitamin A deficiency can lead to following symptoms:
Impaired sensitivity of the eye to light
Impaired vision in the dark
Vision loss
Blindness
Dryness in the eyes, skin, nails, and lips
Growth retardation
Thickened tongue
Fatigue
Repeated occurrence of infections
Inflammation of the eyelids, surrounding, and even eyes
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Severe Vitamin A deficiency can cause xerophthalmia which can lead to the following symptoms:
Night blindness: Impaired sensitivity of the eye to light
Conjunctival xerosis: Dull, dry, thick, wrinkled appearance of the conjunctiva (thin, clear membrane that protects the eye)
Bitot spots: Whitish, foamy, opaque deposits on the conjunctiva
Corneal xerosis: Dull, dry, and hazy in appearance of cornea (transparent front part of the eye)
Keratomalacia (presence of ulcers and softening of the cornea)
Corneal scars (scarring of the cornea)
Xerophthalmic fundus (structural changes in the back interior of the eye, visible on ophthalmoscopy)
Vitamin A is a fat-soluble vitamin that is required for:
Normal vision
Proper functioning of the immune system
Reproduction
Growth and development
The major function of Vitamin A is maintenance of normal vision. Eyes need certain pigments to see the full spectrum of light. The synthesis of these pigments is halted by a deficiency of Vitamin A. Severe Vitamin A deficiency also leads to improper moisturization of the eye.
Low intake of dietary sources of Vitamin A can be attributed by:
Insufficient dietary intake
Long term alcoholism
Highly selective eating
Difficulty in swallowing
Mental illness
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The absorption of Vitamin A majorly takes place in the upper part of the small intestine. The presence of any diseases affecting the intestine can cause insufficient absorption of Vitamin A and lead to its deficiency.
The reduced storage of Vitamin A can also be a cause of its deficiency
Liver diseases
Cystic fibrosis (inherited disorder that mainly affects lungs and digestive system)
The following factors increase the risk of Vitamin A deficiency:
Pre-school children are more prone to develop a deficiency of Vitamin A. Studies suggest that the highest prevalence of Vitamin A deficiency is seen in children between 36 to 47 months of age.
Here are 6 tips to prevent nutritional deficiency in children.
Malnourished individuals and those who follow a severely restricted diet can have multiple vitamin deficiencies including Vitamin A deficiency.
Vitamin A is transported throughout the body with the help of zinc. The deficiency of zinc makes the individual more prone to develop Vitamin A deficiency as well.
Pregnant women are at higher risk of developing Vitamin A deficiency due to the increases in demand.
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Bariatric surgery, a type of weight loss surgery increases the risk of developing a deficiency of Vitamin A. This is due to the malabsorption of certain vitamins and minerals.
Here is a complete guide on bariatric surgery!
The medical conditions that impair the ability of the intestine to absorb fat along with some infections make the person more likely to develop Vitamin A deficiency.
Such conditions include:
Chronic diarrhea
Celiac disease
Cystic fibrosis
Blockage of bile duct
The diagnosis is made through medical history and physical examination and confirmed by response to vitamin A supplementation.
The various tests used to determine Vitamin A deficiency include:
1. Serum retinol: Retinol is the circulating form of Vitamin A. The test measures the amount of retinol in the blood. Blood concentrations of retinol do not reflect exact amounts of Vitamin A. This is due to the maintenance of circulating retinol levels by the liver stores.
However, this test is used to assess subclinical deficiency of Vitamin A. The level less than <0.70 μmol/L indicates subclinical vitamin A deficiency.
2. Serum retinol-binding protein study
Retinol-binding protein (RBP) is a protein that transports retinol (vitamin A) in the body. This test measures the amount of RBP in the blood using immunological methods, such as immunoturbidimetry or enzyme-linked immunosorbent assay (ELISA).
The estimation of zinc is useful since its deficiency is also associated with Vitamin A deficiency.
Individuals with confirmed Vitamin A deficiency are also suggested to detect the level of iron. This is because the deficiency of iron can also affect the metabolism of vitamin A.
A complete blood count (CBC) is recommended if there is a possibility of anemia, infection, or sepsis.
Here’s more on what you must know about the CBC test and its various parameters.
An electrolyte evaluation and liver function studies should be performed to evaluate for nutritional and volume status.
1. X-rays
The radiography of bones is mostly recommended in children for the evaluation of their growth as a result of Vitamin A deficiency.
2. Dark-adaptation threshold (DAT)
It is a vision test that measures the adjustment of the eye after exposing it to the dark.
It is very necessary to get Vitamin A deficiency at the right time to avoid complications. Seek immediate medical consult in case of the following symptoms:
Impaired sensitivity to light
Impaired vision in the dark
Dry eyes
Fatigue
The specialty of doctors that may help include:
General physician
General Medicine specialist
Nutritionist
Ophthalmologist
Dermatologist
Gastroenterologist
Bariatric surgeon
Transplant surgeon
A general physician and general medicine specialist can help in the diagnosis and treatment of Vitamin A deficiency.
A nutritionist can help in developing a personalized meal plan to ensure adequate intake of Vitamin A.
An ophthalmologist helps in managing eye-related disorders such as cataracts and dry eyes that may manifest as a result of this deficiency.
A dermatologist helps in treating the symptoms related to skin, hair, and nails that generally occur in case of severe Vitamin A deficiency.
A gastroenterologist helps in dealing with Vitamin A deficient individuals due to its malabsorption.
Bariatric surgeons and transplant surgeons can help post-bariatric surgery patients and liver cirrhosis patients, respectively.
The deficiency of Vitamin A can be prevented by the following measures:
Newborns are generally born with very low levels of Vitamin A. Breast milk serves as an excellent source of Vitamin A, especially during the initial six months of life. It is seen that children who get exclusively breast milk for the first 6 months have lesser chances of developing Vitamin A deficiency later in life.
Postpartum women should take Vitamin A-rich foods or supplements if needed. It proves to be beneficial to have a good content of Vitamin A in breast milk.
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The best way to prevent Vitamin A deficiency is to take an adequate amount of Vitamin A. It can be done by eating a healthy balanced diet rich in Vitamin A food sources such as carrots, milk, fish, eggs, green vegetables, yams, and sweet potatoes.
People who are on restrictive diets or facing some issues in getting adequate amounts of Vitamin A should take the recommended dose of Vitamin A supplements.
Appropriate intake of Vitamin A is also very important during pregnancy and lactation to build stores in the liver.
The chances of Vitamin A deficiency increase in the presence of certain diseases such as respiratory tract infections, tuberculosis, diarrhea, and worm infestations. Proper sanitation of the living environment helps in reducing the prevalence of these diseases.
Here are 5 simple tips to maintain hygiene at the workplace.
Certain vaccine-preventable diseases such as measles serve as a precipitating factor for Vitamin A deficiency. Immunization helps in the elimination of such factors and may help in preventing this deficiency.
The primary treatment approach includes the consumption of Vitamin A–rich foods, such as liver, beef, chicken, eggs, fortified milk, carrots, mangoes, sweet potatoes, and leafy green vegetables.
In severe cases, the following approaches are considered.
It includes the intake of vitamin A supplements. A serum retinol concentration below 20 micrograms/dL (approximately 0.70 micromol/L) is considered a threshold for vitamin A deficiency at the population level. The dosing of vitamin A is based upon the severity of symptoms.
Intramuscular injections of vitamin A are recommended in individuals having malabsorption.
The recommended daily intake of vitamin A varies with age and life stage. The table below provides the recommended dietary allowance (RDA) for different age groups.
Babies (birth to 12 months): 400–500 mcg RAE per day
Children (1–8 years): 300–400 mcg RAE per day
Children and teenagers (9–18 years): 600–900 mcg RAE per day, depending on age and sex
Adults (19 years and older): 700–900 mcg RAE per day, depending on sex and age
Pregnant or breastfeeding women: 750–770 mcg RAE per day during pregnancy and 1,200–1,300 mcg RAE per day while breastfeeding, depending on age
*RAE stands for retinol activity equivalents
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In most of the cases, zinc supplements are also given along with Vitamin A supplements.
Vitamin A can be easily corrected through the right diet and supplementation. However, severe Vitamin A deficiency can lead to:
Increased susceptibility to infections
Impaired immune function
Difficulty in conceiving
Infertility
Permanent vision loss
Blindness
It is very important to add rich sources of Vitamin A in the diet. The foods rich in Vitamin A include:
Fruits: Mango, papaya, and tomatoes
Tuber crops: Sweet potato
Leafy vegetables: Coriander, spinach, curry leaves, mint, and radish leaves
Non-vegetarian sources: Eggs, chicken, and beef
Dairy products: Milk and cheese
Eat at least 5 servings of any of these foods in a day in order to maintain a good level of Vitamin A.
Market is flooded with a variety of foods such as breakfast cereals, pastries, breads, crackers, and cereal grain bars. Try to include such foods in the diet. They are also helpful in maintaining a good level of Vitamin A.
Consuming a large amount of vitamin A over a short period of time can cause vitamin A toxicity (hypervitaminosis A). It is advised to consume supplements as per the recommended dose. The signs and symptoms of Vitamin A toxicity include:
