I C R O N U T R I E N T

Vitamin A
Ashwini Kalantri
 Vitamins
• Essential Nutrients
• Types
– Fat soluble – A, D, E, K
– Water soluble – B group, C

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 Vitamin A
• Per-formed vitamin – Retinol
• Pro-vitamin – β-carotene
• 1IU = 0.3µg retinol (0.55µg of retinol palmitate)
• Retinol Equivalent (RE)
– 1µg retinol = 1 RE
– 1µg β–carotene = 0.167 RE
– 1RE = 3.333 IU of Vitamin A
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 Functions
• Normal Vision
– Retinal pigmentation  vision in low light
• Integrity and function of glandular and epithelial
tissue of Respiratory System, Urinary Tract, Skin
and Eyes
• Skeletal Growth
• Anti-infective
• Protective against some epithelial cancers 4
 Sources
• Animal Foods: liver, eggs, butter, cheese, milk,
fish, meat
• Plant Foods: green leafy vegetables – spinach.
Yellow and green fruits – papaya, mango,
pumpkin. Roots – carrots.
• Fortified Foods: vanaspati, margarine, milk.
Liver stores Vitamin A as retinol palmitate.
Reserves for 6-9 months 5
 Deficiency
Xerophthalmia
• XN Night blindness
• X1A Conjunctival xerosis
• X1B Bitot spot
• X2 Corneal xerosis
• X3A Corneal ulceration, less than 1/3
• X3B Corneal ulceration, more than 1/3
• XS Corneal scar
• XF Xerophthalmic fundus
6
Singh, K. "Modified classification of xerophthalmia." Indian Journal of Ophthalmology 39.3 (1991): 105.
 Deficiency
Extra-ocular
• Folicular Hyperkeratosis
• Anorexia
• Growth retardation
• Mortality and morbidity due to respiratory
and intestinal infections.

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 Prevention
• Improvement of diet
• Reducing the severity of the contributory
factors
– PEM, respiratory tract infection, diarrhea,
measles.
• 6 monthly massive dose administration
– 1,00,000 IU (6 months – 1 year)
– 2,00,000 IU (1 year – 6 years)
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 Treatment
• Urgent treatment
• Early stages of Xerophthalmia  Massive
dose of Vitamin A (2,00,000 IU) orally.
Repeat after 4 weeks.
• All children with corneal ulcers

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 Assessment
• Population surveys - clinical and biochemical
• Per-school children (6 months – 6 years)
Criteria Prevalence in population at risk
(6 Months – 6 Years)
Night blindness > 1%
Bitot’s spots > 0.5%
Corneal xerosis/corneal
> 0.01%
ulceration/keratomalacia
Corneal Ulcer > 0.05%
Serum retinol (less than 10 µg/dl) > 5%
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WHO TRS 672
 Recommended Dietary Allowance
Group Retinol (µg) β – carotene (µg)
Adults
Man 600 4800
Women 600 4800
Pregnancy 800 6400
Lactation 950 7600
Infants
0 – 6 months 350 -
6 – 12 months 350 2800
Children
1 – 6 years 400 3200
7 – 9 years 600 4800
Adolescents
10 – 17 years 600 4800
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ICMR. “Nutrient requirement and recommended dietary allowances for Indians, A report of the expert group of the ICMR” 2010
 Toxicity
• Retinol
– Nausea, vomiting, anorexia and sleep disorders
– Skin desquamation, enlarged liver, papillar
odema
• Carotene
– Colour skin and plasma, not dangerous
• Teratogenic effects of massive dose of
vitamin A
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