Food-based initiatives through green leafy vegetables and fruits can meet daily vitamin A requirement, while not putting the children below five years at risk of excess intake. Hence, authorities concerned should consider a targeted state-based Vitamin A supplementation (VAS) programme, unlike the current nation-wide megadose VAS program in the country, say scientists of Indian Council of Medical Research (ICMR)-National Institute of Nutrition (NIN).
A joint research effort in association with researchers at St. John’s Research Institute, Bengaluru, and Sitaram Bhartia Institute of Science & Research, New Delhi, had found that Vitamin A Deficiencies (VAD) among children is not a public health problem anymore as the national prevalence of risk is below 20% in children.
In fact, the researchers warned of a possible risk of ‘hypervitaminosis’ caused by excess intake with food fortification and supplementation. Vitamin A (VA), essential for vision and many biological activities, must be provided in the diet as it cannot be synthesised by humans. VAD can lead to eye problems, from night blindness to more severe clinical conditions such as keratomalacia and corneal scars, among children.
VAD along with nutritional blindness was a major public health problem in 1950s and 60s, in 1970, the National Prophylaxis Program Against Nutritional Blindness was initiated by providing mega doses of Vitamin A with children below five years administered the same once in six months in tune with the WHO/UNICEF recommendations. Now, with reduction of infant and child mortality rates, progress in immunisation coverage, underpinned by almost complete decline in clinical signs of VAD in children, scientists feel the need to revisit the programme.
“The study draws on the sample of the Comprehensive National Nutrition Survey 2016-2018. It showed VAD based on serum retinol levels was 15.7% among 1-5 years old children, lesser than the 20% mark that defines a serious public health problem,” said NIN director R. Hemalatha.
There were very few children (as low as 0.4%) with very low serum retinol values at which serious clinical problems are likely to manifest. There were no significant differences in serum retinol values between urban and rural children, and boys and girls. The study also derived the estimated average requirement (EAR) as 198 and 191 μg/d for boys and girls, respectively for assessing dietary adequacy of Vitamin A.
“We evaluated dietary vitamin A from data of National Sample Survey Office (NSSO) and National Nutrition Monitoring Bureau (NNMB). When dietary intake, food fortification and VAS are factored in, there is a risk of exceeding the upper limit of intake of Vitamin A in a proportion of children particularly from higher socio-economic status. We did not find any evidence of mortality benefit due to mega-dose administration throughout the country”, added lead author and senior scientist Bhanuprakash Reddy.
The study results were published recently in the American Journal of Clinical Nutrition.
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