1. Vitamin A Ashwini Kalantri MICRONUTRIENTS

2. Vitamins Essential Nutrients Types –Fat soluble – A, D, E, K –Water soluble – B group, C 2

3. 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 3

4. 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

5. 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

6. Deficiency Xerophthalmia XNNight blindness X1AConjunctival xerosis X1BBitot spot X2Corneal xerosis X3ACorneal ulceration, less than 1/3 X3BCorneal ulceration, more than 1/3 XSCorneal scar XFXerophthalmic fundus Singh, K. "Modified classification of xerophthalmia." Indian Journal of Ophthalmology 39.3 (1991): 105. 6

7. Deficiency Extra-ocular Folicular Hyperkeratosis Anorexia Growth retardation Mortality and morbidity due to respiratory and intestinal infections. 7

8. 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) 8

9. 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 9

10. Assessment Population surveys - clinical and biochemical Per-school children (6 months – 6 years) CriteriaPrevalence in population at risk (6 Months – 6 Years) Night blindness > 1% Bitot’s spots > 0.5% Corneal xerosis/corneal ulceration/keratomalacia > 0.01% Corneal Ulcer > 0.05% Serum retinol (less than 10 µg/dl) > 5% 10 WHO TRS 672

11. Recommended Dietary Allowance GroupRetinol (µg)β – carotene (µg) Adults Man6004800 Women6004800 Pregnancy8006400 Lactation9507600 Infants 0 – 6 months350- 6 – 12 months3502800 Children 1 – 6 years4003200 7 – 9 years6004800 Adolescents 10 – 17 years6004800 11 ICMR. “Nutrient requirement and recommended dietary allowances for Indians, A report of the expert group of the ICMR” 2010

12. 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 12