The document outlines the significance of vitamin A, its functions, sources, and the clinical manifestations of its deficiency. It emphasizes the health impacts, including night blindness and xerophthalmia, and discusses treatment strategies and preventive measures. Additionally, it provides recommended dietary allowances and assessment criteria for populations at risk.

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4. Vitamin A deficiency

5. Learning objectives
At the end of the class the students should be able to
 Define the functions of vitamin A
 List the sources of vitamin A
 Identify clinical manifestations of Vitamin A
deficiency
 To determine when it is a public health problem and
what preventive measures are to be taken
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6. Contents
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 Introduction
 Functions of Vitamin A
 Sources of Vitamin A
 Recommended Dietary Allowance
 Clinical manifestation of Vitamin A deficiency
 Assessment of Vitamin A deficiency

7. Contents
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 Treatment of Vitamin A deficiency
 Prevention & control of Vitamin A deficiency
 Summary
 Exercise

8. Introduction
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 Nutrition may be defined as the science of food and its
relationship to health
 Good nutrition means "maintaining a nutritional status
that enables us to grow well and enjoy good health”
 Nutrients are organic and inorganic complexes
contained in food.

9. Introduction
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NUTRIENTS
MACRONUTRIENTS
CARBOHYDRATES
PROTEINS
FATS
MICRONUTRIENTS
VITAMINS
WATER
SOLUBLE
FAT
SOLUBLE
MINERALS

10. Vitamin A
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 Belongs to category of micronutrients – required by
the body in small amounts
 Do not yield energy but enables the body to utilize
other nutrients
 Cannot be synthesized by our body & hence has to
provided by food
 Vitamin A includes both retinol & beta carotene

11. Functions
 For normal vision
 Necessary for maintaining the integrity and the normal
functioning of glandular and epithelial tissue
 Supports skeletal growth
 Anti-infective
 May protect against some epithelial cancers such as
bronchial cancers
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12. Sources
 ANIMAL FOODS : liver, eggs, butter, cheese, whole
milk, fish and meat.
 PLANT FOODS : green leafy vegetables - spinach and
amaranth. Also occurs in most green and yellow fruits
& vegetables. Ex papaya, mango, pumpkin, carrots etc
 FORTIFIED FOODS :Ex: vanaspati, margarine, milk
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13. Recommended allowances
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Group Retinol (mcg) B-carotene (mcg)
Adults
Man 600 4800
Woman 600 4800
Pregnancy 800 6400
Lactation 950 7600
Infants 0 -12
months
350 -
Children 1- 6 yrs 400 3200
7 - 12 yrs 600 4800
Adolescent 13 -19
yrs
600 4800

14. Deficiency
VITAMIN A DEFICIENCY
OCULAR
XEROPHTHALMIA
XN – Night blindness
X1A- Conjunctival xerosis
X1B- Bitot spots
X2 – Corneal xerosis
X3A – Keratomalacia <1/3rd of cornea
X3B – Keratomalacia >1/3rd of cornea
XS- Corneal scar
XF- Xerophthalmic fundus
EXTRA OCULAR
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15. Night blindness
 Inability to see in dim light.
 Due to impairment in dark adaptation.
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16. Conjunctival xerosis
 First clinical sign of vitamin A deficiency.
 Conjunctiva becomes dry and non-wettable
 Described as "emerging like sand banks at receding
tide”
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17. Bitot's spots
 Triangular, pearly-white or
yellowish, foamy spots on the
bulbar conjunctiva on either side
of the cornea, frequently bilateral.
 Indication of
 In young children
 In older individuals
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18. Corneal xerosis
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 Cornea appears dull, dry, non wettable & eventually
opaque.
 In more severe deficiency - corneal ulceration.
 Ulcer may heal leaving a corneal scar which can affect
vision.

19. Keratomalacia
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 Liquefaction of the cornea
 Is a grave medical emergency.
 The cornea may become soft and may burst open.
 If the eye collapses, vision is lost.
 It’s one of the major causes of blindness in India and is
frequently associated with protein energy malnutrition.

20. EXTRA-OCULAR MANIFESTATIONS
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 Comprise follicular hyperkeratosis, anorexia and
growth retardation which have long been recognised.
 They are non-specific and difficult to quantify.
 Even mild vitamin A deficiency causes an increase in
morbidity and mortality due to respiratory and
intestinal infection

21. Assessment of Vitamin A deficiency
 Population surveys employing both clinical &
biochemical criteria using prevalence criteria by WHO
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Criteria Prevalence in
population
at risk (6 months -6
years)
Night blindness >1 %
Bitot spots > 0.5%
Corneal xerosis > 0.01%
Corneal ulcer >0.05%
Serum retinol (< 10 > 5%

22. Treatment of Vitamin A deficiency
 Two doses of 2 lakh I.U of vitamin A are given 4
weeks apart according to the NPCB.
 However, WHO recommends another dose that should
be given on 2nd day after the first dose [so totally 3
doses are given]
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23. Prevention and control of Vitamin A
deficiency
 SHORT TERM ACTION: Vitamin A administration
according to Indian National Immunization Schedule
 MEDIUM TERM ACTION: Fortification of certain foods
with vitamin A. Ex: addition of Vit A to dalda
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At 9 months along with measles 1 lakh IU
At one and a half year with DPT
booster
2 lakh IU
1-5 yr 2 lakh IU every
6 monthly

24. Prevention and control of Vitamin A
deficiency contd….
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 LONG TERM ACTION:
 Improvement of people’s diet
 Promote breast feeding for as long as possible.
 Improvements in environmental health – ensuring safe &
adequate water supply; construction and maintenance of
sanitary latrines
 Immunization against infectious diseases such as measles

25. Summary
 Vitamin A is one of the fat soluble vitamins
 Has an important role in production of retinal pigments
 Richest source- carrots & halibut liver oil
 RDA
 Deficiency results in xerophthalmia
 Treatment
 Prevention & control
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26. References & Further reading
 Park K. Park’s Textbook of Preventive and Social
Medicine,22nd ed. Jabalpur: Banarsidas Bhanot;2013
 National program for control of blindness (NPCB)
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27. Exercise
 An epidemiological survey conducted among 500
children aged between 6 months to 6 years revealed
that 5 children had bitots spots, 10 children had
conjuctival xerosis, 20 had night blindness. What is
your inference and list the measures you will take
based on your inference.
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28. Thank you
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