Vitamin A deficiency  in Indians

Vitamin A deficiency was, and arguably still is, a major public health problem in India. But the level of deficiency has declined significantly.

Government of India runs a Vitamin A supplementation program for children six months to 6 years of age. But low blood levels are still reported by NNMB in all age groups, especially in children and pregnant women

Symptoms of vitamin A deficiency

  • Vitamin A is essential for normal eyesight, for maintaining the integrity of epithelial tissues (skin and lining of mouth, eyes etc.), for immune system, reproduction and cellular level communication
  • Severe deficiency of vitamin A manifests as night blindness, eye lesions (Bitot’s spots, xerophthalmia and blindness)
  • Subclinical forms of VAD (Vitamin A Deficiency) may not cause any symptoms, but the risk of developing respiratory infections and diarrhea increases and growth rate and bone development slow down. It may give rise to infertility  due to low production of sperms in men and spontaneous abortion in women

People at risk of vitamin A deficiency

  1. Women in reproductive age group
  2. Infants and young children
  3. Premature infants
  4. Vegetarians who do not eat enough vegetables and milk
  5. People with cystic fibrosis
  6. People on weight loss drug orlistat

Test for vitamin A deficiency

Plasma retinol levels (a blood test, requiring fasting) can tell about adequacy status of vitamin A, but  this test is not commonly used. Instead, doctors advise to ensure adequate intake from rich dietary sources and safe supplements

However in people with night blindness and eye signs (Bitot’s spot etc.), your doctor may advise the test

Rich dietary sources (vitamin A foods)

Food provides Vitamin A in one of the two forms:

  1. Animal sources such as milk, butter, egg and fish provide active vitamin A
  2. Leafy vegetables and yellow and orange-coloured fruits and vegetables provide carotenoids, especially carotene
  3. Fortification of food stuff (breakfast cereals, cooking oils) with carotenoids or retinol is catching up in India, but as of now is in nascent state

The activity levels of different forms of vitamin A are different. So you would need more of vitamin A  if you get it from plant sources . The unit of comparison is Retinol Equivalent

1 Retinol Equivalent (RE)=1 mcg of retinol (Vitamin A from animal sources)= 8-12 mcg of beta-carotene from food of plant origin= 2 mcg of beta-carotene from fortified food (breakfast cereals/oils )

Vitamin A Supplements

  • Vitamin A supplements have to be taken with caution
    • Supplements in active form (retinol or retinyl esters) taken in high dosage can cause Vitamin A toxicity
    • Carotenoid forms are generally safe, but long term supplements can cause some problems in smokers
    • To know about the UL of safe intake, the RDA values and toxicity signs/symptoms of vitamin A , go to ‘Supplements: what are precautions to be taken?’
  • For mild deficiency (VAD syndrome), supplementation with Vitamin A at doses near Upper Limits (UL) is adequate. But for severe deficiency (night blindness, eye changes etc.), one needs to take high doses under supervision of a doctor

CHECK OUT: Our references for recommendations on diet