Vitamin A deficiency

Symptoms Of Vitamin A deficiency

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

• Urinary tract infection
  
  

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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 surface of the eye

Causes Of Vitamin A deficiency 

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. 

What can lead to Vitamin A deficiency?

1. Inadequate dietary intake of Vitamin A

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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2. Impaired absorption of Vitamin A 

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.  

3. Reduced storage of Vitamin A

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)

Risk Factors For Vitamin A deficiency

The following factors increase the risk of Vitamin A deficiency:

1. Age

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.

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2. Malnutrition or severely restricted diets

Malnourished individuals and those who follow a severely restricted diet can have multiple vitamin deficiencies including Vitamin A deficiency. 

3. Zinc 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. 

4. Pregnancy 

Pregnant women are at higher risk of developing Vitamin A deficiency due to the increases in demand.

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5. Bariatric surgery

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.

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6. Certain medical conditions

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

• Measles

Diagnosis Of Vitamin A deficiency

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:

I. Blood tests

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 is a protein through which retinol transports in the body. This test measures the quantity of this protein through an instrument called a fluorometer. 

3. Zinc level

The estimation of zinc is useful since its deficiency is also associated with Vitamin A deficiency. 

4. Iron 

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.

5. Complete blood cell count 

A complete blood count (CBC) is recommended if there is a possibility of anemia, infection, or sepsis.

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6. Electrolyte level 

An electrolyte evaluation and liver function studies should be performed to evaluate for nutritional and volume status.

II. Imaging tests

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. 

Specialist To Visit

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.

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Prevention Of Vitamin A deficiency

The deficiency of Vitamin A can be prevented by the following measures:

1. Encouraging breastfeeding

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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2. Consuming an adequate amount of Vitamin A

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. 

3. Maintaining environmental sanitation 

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.

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4. Ensuring proper vaccination

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. 

Treatment Of  Vitamin A 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. 

Vitamin A supplementation

It includes the intake of Vitamin A supplements. It is recommended in individuals having serum retinol concentrations less than 20 micrograms/dL. The dosing of Vitamin A is based on the severity of symptoms. 

Intramuscular injections of Vitamin A are recommended in individuals having malabsorption. 

The recommended level of Vitamin A as per the age of the patient are: 

• Children aged 3 years or younger: 600 mcg (2000 IU)

• Children aged 4-8 years: 900 mcg (3000 IU)

• Children aged 9-13 years: 1700 mcg (5665 IU)

• Children aged 14-18 years: 2800 mcg (9335 IU)

• All adults: 3000 mcg (10,000 IU)

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Zinc supplementation

In most of the cases, zinc supplements are also given along with Vitamin A supplements.

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Complications Of Vitamin A deficiency

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

Living With Vitamin A deficiency

1. Dietary modifications

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. 

2. Look for fortified foods

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.

3. Be aware of toxicity

Consuming a large amount of Vitamin A over a short period of time can cause Vitamin A deficiency. It is advised to consume supplements as per the recommended dose. The signs and symptoms of Vitamin A toxicity include:

• Skin irritation

• Drowsiness

• Irritability

• Abdominal pain

• Nausea

• Vomiting