From the Guidelines
Vitamin A deficiency in childhood can lead to severe long-term consequences, including increased morbidity and mortality, and impaired quality of life, emphasizing the need for prompt supplementation and prevention strategies. The most significant impacts of vitamin A deficiency include permanent blindness due to xerophthalmia, stunted growth, and impaired development, as vitamin A plays a crucial role in cell differentiation and proper organ formation 1. Children with vitamin A deficiency may also experience compromised immune systems, leading to increased susceptibility to infections throughout life and higher mortality rates from common childhood illnesses like measles and diarrheal diseases. Cognitive development can be irreversibly affected, resulting in learning difficulties and reduced intellectual capacity.
Key considerations for vitamin A supplementation include:
- Dosage: According to the guidelines, preterm infants on parenteral nutrition should receive 700-1500 IU/kg/day of vitamin A, while term infants should receive 150-300 ug/kg/day, and older children 150 ug/day 1.
- Administration: Vitamin A should be given with lipid emulsion whenever possible to minimize losses due to adsorption onto tubing materials 1.
- Monitoring: Serum retinol and retinol-binding protein (RBP) levels can be used to assess vitamin A status, with concentrations below 200 mg/l indicating deficiency in premature infants 1.
Treatment involves immediate supplementation with vitamin A, typically 200,000 IU for children over 12 months (100,000 IU for younger infants) as an oral dose, repeated the next day and again in 2-4 weeks. For prevention, children in at-risk areas should receive 200,000 IU every 4-6 months. Dietary diversification is essential for long-term prevention, incorporating foods rich in vitamin A such as liver, eggs, dairy products, orange and yellow fruits and vegetables, and dark green leafy vegetables. Vitamin A is fat-soluble and critical for vision, epithelial tissue integrity, immune function, and cellular communication throughout the body, making adequate intake during childhood developmental periods absolutely essential 1.
From the Research
Long-term Consequences of Vitamin A Deficiency in Childhood
- Vitamin A deficiency can lead to a series of ocular symptoms, anemia, and weak resistance to infection, which can increase the severity of infectious diseases and the risk of death 2.
- Vitamin A deficiency disorders (VADD) include mild to severe systemic effects on innate and acquired mechanisms of host resistance to infection and growth, increased burden of infectious morbidity, mild to severe (blinding) stages of xerophthalmia, and increased risk of mortality 3.
- The vicious cycle of vitamin A deficiency can have progressive, negative effects on vital processes of the human body throughout the life cycle, including impaired tissue function, especially during developmental periods of infancy, childhood, pregnancy, and lactation 2.
Health Consequences
- Vitamin A deficiency is associated with increased rates of death from severe infections, especially in developing countries 2.
- Vitamin A deficiency can lead to impaired cell development, vision, growth, and normal metabolism 2.
- Vitamin A supplementation can reduce all-cause mortality by about 24% compared to no treatment, and can also reduce the incidence of diarrhoea and measles morbidity 4.
Prevention and Control
- Correcting the low vitamin A content of breast milk from malnourished mothers within the first four weeks of delivery by a high dose oral vitamin A supplement can be an effective short-term preventive strategy 5.
- Vitamin A supplementation is effective in reducing child mortality, and further placebo-controlled trials of vitamin A supplementation in children between 6 months and 5 years of age are not required 4.
- The World Health Organization (WHO) has a programme for the prevention and control of vitamin A deficiency, xerophthalmia, and nutritional blindness, which includes short, medium, and long-term steps 6.