Vitamin A in Developing Countries

The importance of maintaining an adequate amount of Vitamin A in your diet cannot be
overstated!

However, in most of the countries we serve in here at Medical Missions Outreach,
it’s quite rare and/or difficult for the average patient we care for to be able to maintain the proper
intake of Vitamin A they need, due to limited resources and sustainable access to the
appropriate foods containing it. Without proper intake, serious harm and deterioration can occur.
That is why we can provide supplements to our patients when we are able to- especially those
with higher risks or increased intake needs.

So here we have comprised a brief overview of Vitamin A for you- what it is, where it’s found,
what’s the proper amount, and some special considerations regarding it!

What is Vitamin A?
Vitamin A is a conglomerate group of fat-soluble retinoids stored in the liver and fatty
tissue. It is used in several critical bodily functions including the immune system, reproduction,
vision, and organ development, and it plays a vital role in cellular growth, differentiation, and
transmission.
Vitamin A exists in 2 forms: preformed vitamin A and provitamin A. Preformed vitamin
A can be found greatly in animal products (meat, diary, fish, etc.) and provitamin A can be found
in plants (fruits and veggies).

Vitamin A in Developing Countries:
In many developing countries, there is little access to a balanced diet that would be
sufficient for an adequate intake of vitamin A. Having poor access to micronutrients such as
vitamin A can lead to chronic deficiencies and injury, and ultimately possibly death. According
to the US National Institute of Health:
“Vitamin A deficiency (VAD) is considered one of the most prevalent
micronutrient deficiencies worldwide, mainly affecting children in
developing countries. It is estimated that globally about 30% of children
<5 years of age are vitamin A deficient, and about 2% of all deaths are
attributable to VAD in this age group. VAD is also a major cause of
preventable childhood blindness. The transfer of VA in breast milk from
the mother to the child depends on the status of the mother, and thus VAD
often develops early in life, particularly in populations that consume diets
low in provitamin A.”
Combatting VAD has been a goal of the World Health Organization and UNICEF
for nearly two decades due to both the prevalence and detrimental nature of VAD. By
increasing to and maintaining an appropriate level of vitamin A in the body, many crucial
functions are improved such as immune health and vision.
The most common sign of VAD in children is xerophthalmia (abnormal dryness of
conjunctiva and cornea of the eye). Other signs and symptoms of VAD for all ages include blind
spots, dry skin, night blindness, delayed growth, throat/chest infections, increased acne
breakouts, and delayed wound healing.

Dose and form:
Vitamin A should primarily be gained in maintaining a consistent, balanced diet. Eating 5
servings of fruits and vegetables daily supports between 50% and 65% of the adult recommended
daily allowance.
Supplements of vitamin A most often come in dose or capsule form and should not be
crushed or chewed.

Daily recommended intake relies primarily on age. The NIH made changes to
measurement of how the dosage is presented- vitamin A is now measured in mcg retinol activity
equivalent (RAE), but it was previously measured in International Units (IUs).
The following table displays the recommended current dosages of vitamin A
determined by the Food and Nutrition Board at the Institute of Medicine of the
National Academies, used by the NIH:

The max 24hr dose for adults is 3,000 mcg RAE.

For children, the doses vary based on age:
Less than 600 mcg/day in children up to 3 years old.
Less than 900 mcg/day in children ages 4 to 8 years old.
Less than 1700 mcg/day in children ages 9 to 13 years old.
Less than 2800 mcg/day in children ages 14 to 18 years old.

Precautions and contraindications:
Taking multiple forms of supplements (especially when receiving an adequate amount
already through the diet) can lead to an overdosed intake of vitamin A.
Pregnant women should consult a physician before taking additional supplements.
Patients taking increased doses of vitamin A should avoid the intake of alcohol as it may
amplify harmful effects to the liver. Any liver disease or family history of liver disease should be
considered before increasing doses of vitamin A.
Several antibiotics contain doses of vitamin A, such as doxycycline and tetracycline.
Other medications that already have doses of vitamin A include birth control pills, orlistat, other
retinoid drugs, and herbal medications. Physicians should be consulted before supplements are
taken while on medication.

Side effects:
Several side effects of Vitamin A toxicity include fever, chills, N/V/D, confusion,
jaundice, gums bleeding, drowsiness, double vision, seizures, hair loss, and dry, peeling skin.

Pregnancy and breastfeeding:
There are no controlled data studies for human pregnancies. High doses of vitamin A
may result in teratogenic results. The US FDA has not assigned a pregnancy category class to
this drug.

We hope that this brief article has given more of an understanding to you regarding the
importance of Vitamin A- especially the need for an increased education regarding it in the
countries we get to serve in!

References


Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes for Vitamin A,
Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel,
Silicon, Vanadium, and Zinc . Washington, DC: National Academy Press; 2001

Johnson EJ, Russell RM. Beta-Carotene. In: Coates PM, Betz JM, Blackman MR, et al., eds.
Encyclopedia of Dietary Supplements. 2nd ed. London and New York: Informa Healthcare;
2010:115-20

Mayo-Wilson E, Imdad A, Herzer K, Yakoob MY, Bhutta ZA. Vitamin A supplements for
preventing mortality, illness, and blindness in children aged under 5: systematic review and
meta-analysis. BMJ 2011;343:d5094. [PubMed abstract]

National Institute of Health Office of Dietary Supplements: Vitamin A Fact Sheet for Healthcare
Professionals. https://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/ (Accessed 2021)

United States National Library of Medicine "Toxnet. Toxicology Data Network.
http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT. " (Accessed 2021)

U.S. Food and Drug Administration.
https://www.federalregister.gov/documents/2016/05/27/2016-11867/food-labeling-revision-
of-the-nutrition-and-supplement-facts-labels 2016. (Accessed 2021)