The role of Vitamin A

Vitamin A plays an important role in the development of children. Vitamin A deficiency reduces growth, increases the risk of infectious diseases and increases the risk of death in children. Vitamin A deficiency leads to xerophthalmia which can result in permanent blindness. In Vietnam, subclinical vitamin A deficiency is still a public health problem for children under 5 years old. If a breastfeeding mother, especially in the first 6 months, is deficient in vitamin A, the vitamin A content in breast milk will be low, so even though the child is breastfed, the child is still at risk of vitamin A deficiency, which negatively affects the child's growth.

Causes of vitamin A deficiency

• Due to a lack of vitamin A in the diet: a diet high in carbohydrates, low in animal foods (foods high in vitamin A) such as liver, meat, fish, eggs, shrimp..., lack of fat reduces the absorption of vitamin A (vitamin A is soluble in oil and fat), eating few green vegetables and ripe fruits rich in Beta-carotene (malabar spinach, papaya, carrots, gac fruit). .Breast milk is an important source of vitamin A for young children. Children who are not breastfed are at high risk of vitamin A deficiency.
  
  
• Bacterial and viral infections, especially when children have measles, respiratory infections, and prolonged diarrhea, are important causes of vitamin A deficiency. Because children's need for vitamin A increases when they are sick, while their diet is not sufficient, it can easily lead to vitamin A deficiency. 
  
  
• Children with severe malnutrition (especially Kwashiokor) often have vitamin A deficiency. In addition, deficiencies of other micronutrients such as zinc also affect vitamin A metabolism in the body.
  
  

Risk factors that make children susceptible to vitamin A deficiency have also been studied, such as: children under 5 years old (especially children from 6 months to 1 year old); children not fed colostrum; children not breastfed; children who are weaned too early or have a poor diet lacking in nutrients; children with recurrent, long-term infections; children whose fathers and mothers have limited nutritional knowledge. 

Consequences of vitamin A deficiency in children 

Mild vitamin A deficiency reduces physical growth and increases the risk of infectious diseases, especially gastrointestinal infections (diarrhea) and respiratory infections (respiratory tract infections).

• Severe vitamin A deficiency not only reduces the body's resistance and stunts growth in children, but also causes eye damage. If these damages are not detected early and treated promptly, they can lead to permanent blindness.
  
  

Detection and treatment of dry eyes in children: Children with symptoms of dry eyes due to vitamin A deficiency need to be detected and treated quickly and promptly. All cases of diseases ranging from night blindness, conjunctival xerophthalmia, Bitot's spots to corneal xerophthalmia are urgently treated according to the World Health Organization's protocol as follows:

Immediately give 200,000IU (International Unit)

Next day take another 200,000 IU.

One week later, take the remaining 200,000 IU.

Children under 12 months use half the above dose (100,000 IU each time)

Measures to prevent vitamin A deficiency

Improve the quality of meals: The daily diet needs to provide enough vitamin A for children. Breastfeed because breast milk is the best source of vitamin A for young children, breastfeed early within the first hour after birth to take advantage of the precious colostrum, because colostrum is rich in vitamin A and antibodies that help children prevent pathogens, and breastfeed exclusively for the first 6 months. When 6 months old, children need to be supplemented with appropriate foods and continue to breastfeed until 24 months of age. Children's meals should pay attention to using animal foods rich in vitamin A. In 100 grams of edible foods, the vitamin content is as follows: chicken has 120 mcg of vitamin A; pork liver has 6000 mcg of vitamin A; catfish has 93 mcg of vitamin A; egg yolk has 960 mcg of vitamin A...). Children's meals need oil or fat to help absorb vitamin A well. Plant-based foods such as green vegetables, carrots, spinach, mango, watermelon, ripe papaya, tomatoes, gac fruit, etc. and ripe fruits with yellow, red, orange colors contain high levels of beta-carotene, etc. Carotene when entering the body will be converted into vitamin A.

High-dose vitamin A supplementation for children : Children from 6 to 36 months old are given high-dose vitamin A capsules twice a year. Children from 37 to 60 months old are given high-dose vitamin A capsules twice a year (in 22 disadvantaged provinces with high rates of malnutrition). The dosage for one dose is as follows:

Children < 6 months: take 50,000 IU (international units)/time

Children 6-12 months: take 100,000 IU/time

Children > 12 months: take 200,000 IU/time

In addition to the campaign, supplementary doses for children under 5 years old with diarrhea and respiratory infections should be given a high dose of vitamin A (according to the above dosage). On April 18, 2014, the Minister of Health issued Decision No. 1327/QD-BYT promulgating "Guidelines for diagnosis and treatment of measles" in which vitamin A supplementation is considered as supportive treatment for children with measles with the following specific doses:

Children < 6 months: take 50,000 IU (international units)/day x 2 consecutive days

Children 6 - 12 months: take 100,000 IU/day x 2 consecutive days

Children > 12 months and adults: take 200,000 IU/day x 2 consecutive days

In case of vitamin A deficiency: repeat the above dose after 4-6 weeks.

Vitamin A is a fat-soluble vitamin that, when in excess, accumulates and causes poisoning in the body with symptoms such as headache, fatigue, nausea, hair loss, menstrual disorders in adults; fatigue, slow weight gain, increased intracranial pressure (bulging fontanelle, hydrocephalus), bone pain... in children, so do not arbitrarily buy and use vitamin A.

Fortifying vitamin A in foods: Many countries in the world and in Asia have applied vitamin A fortification in some foods such as Margarine fat, skimmed milk powder, sugar, and wheat flour. In Vietnam, there are also some foods fortified with vitamin A such as sugar, cooking oil, biscuits, etc.