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May 1987, Volume 37, Issue 5

Editorial

VITAMIN ‘A’ AND INFECTION

Rakhshanda Baqai  ( PMRC Research Centre, Jinnah Postgraduate Medical Centre, Karachi. )

Vitamin ‘A’ a fat soluble vitamin is found in liver, poultry, meat and dairy products. It is also synthesised in the gut by the conversion of carotene present in green leafy vegetables, red palm oil and yellow fruits. Ninety percent of Vitamin ‘A’ is stored in the liver and it takes many months before signs and symptoms of deficiency appears. Plasma vitamin ‘A’ levels are a useful indicator of its levels within the body. Its deficiency can occur from either a deficient intake or an increase in metabohc demands.1 Complete exhaustion requires many months of severe malnutrition: In developed2 and develop­ing countries3-5 most of the children under 15 years of age have a low Vitamin ‘A’ level probably due to a deficient intake. According to IVACG6 criteria an intake of less than 200mcg/day results in severe vitamin ‘A’ deficiency. In Pakistan low levels (30mg%) of Vitamin ‘A’ have been reported in children under 15 years7-12 42 of age, similar results have been reported from other coun­tries.13,14 According to WHO and PAHO criteria these children are at risk of developing the compli­cations of Vitamin ‘A’ deficiency.15
Vitamin ‘A’ deficiency is one of the most important paediatric nutritional problem.16 Chil­then of low socioeconomic group are prone to suffer from diarrhoeal diseases and respiratory infections17 because of a deficient caloric plus Vit. ‘A’ intake. Repeated attacks may adversely affect Vitamin ‘A’ stores.18 Availability of stored Vitamin ‘A’ will also depend upon the nutritional status because a severely malnourished protein deficient child will synthesise rational binding protein at a reduced rate.
Diseased liver cannot store much Vitamin ‘A’ or make rational binding protein at a normal rate, but storage is enhanced with a high protein diet.19 In diarrhoeal disease due to parasitic in­festation (mainly giardiasis) absorption of this vitamin is impaired but marked improvement occurs after therapy.20-21 In infection Vitamin ‘A’ is excreted partly as such and partly in the form of degraded products. Experiments have shown that rats deficient in Vitamin ‘A’ were more susceptible to infection by Angiostrongylus cantonensis than controls, and more larvae penetrated the intestinal mucosa; because Vitamin ‘A’ which maintains the morphological and functional integrity of the mucosa was depleted22. Vitamin ‘A’ deficiency does not occur as an isolated problem but is almost invariably accompanied by protein calorie malnutrition (PCM) and infection. PCM may interfere with normal metabolism and transport of vitamin.23 Many aspects of immune response are depressed in experimental animals that have been made Vitamin ‘A’ deficient. In children with measles, Kerato conjunctivitis leading to blindness has been observed and in some cases Vitamin ‘A’ was recognized as a contri­butory factor. Frequent occurrence of a variety of common infection occurs in children with this disease.24 Xerophthalmia is the most widespread and serious nutritional disorder which occurs due to decreased supply of Vitamin ‘A’ to ocular tissues. Children with Xerophthalmia frequently have a recent history of diarrhoea, respiratory disease and passing of worms. Anaemia might also be associated with Vitamin ‘A’ deficiency but it is often masked by dehydration. Dehydrated children often have a very low liver reserves of Vitamin ‘A’25.
Diagnosis of Vitamin ‘A’ deficiency can be made by observing the deficiency signs and symptoms and plasma retinol concentration but the best criteria is the estimation of Vitamin ‘A’in liver.26
Vitamin ‘A’ deficiency can be prevented by introducing Vit. ‘A’ and carotene containing food stuffs to the diet. Distribution of Vitamin ‘A’ capsules may reduce overall child death rate among children above one year of age, hence increasing Vitamin ‘A’ intake may be the most practical and effective means for improving child survival. Children at risk of Vitamin ‘A’ deficiency should be given 200,000 IU of Vitamin ‘A’ capsules every three to six months28. In developing countries where diarrhoea ahd malnutrition are rampant prompt administration of .Vitamin ‘A’ is highly effective in preventing blindness.29 In addition to Vitamin ‘A’ supplement, immunization, ex­posure of mother to health education and a change in eating habits are necessary.

REFERENCES

1. Aron, H.C.S, Plasma vitamin A and its clinical significance; a review. Am. J. Dis, Child., 1949; 77:763.
2. Wilcox, F.B., Galloway, L.S., Wood, P. and Mangelson, F.L. Children with and without rheu­matic fever. III. Blood serum vitamin and phosphatase data. J. Am. Diet. Assoc., 1954; 30:1231.
3. Castenda, G. et al. Rev. Col. Med. Guatemala. 1955; 6:22. Cited from Oomen H.A.P.C. A global survey on xerophthalmia. Trop. Georg. Med., 1964; 16:271.
4. Susela, T.P. Studies on serum vitamin A level after a single massive oral dose. Indian J. Mcd. Res., 1969;57 : 2147.
5. Oomen, J.M.V. Xerophthalmia in northern Nigeria. Trop. Georg. Med., 1971;26:246.
6. Ibrahim, K. Plasma vitamin A and carotene levels in general population in Karachi. Karachi,Univer­ sity of Karachi, 1980 (M. Phil.Thesis).
7. WACG. Guidelines for the eradication of vitamin A deficiency and Xerophthalmia. Report of the international vitamin Aconsultant group. New York, Published with the assistance of Agency for International development of U.S.A to the Nutrition Foundation, 1976.
8. Kirmani, T.H. Incidence of preventable eye disease in school children of Karachi. Report presented at the Asia Pacific Academy of Ophthalmology Singapore, 1968.
9. Nutrition Survey of West Pakistan, Ministry of Health, Labour and Family Planning, Islamabad  Govt. of Pakistan’ 1970.
10. Undre, H.R., Siddiqui, A., Ibrahim, K., Maqsood, R., Khan, S.M., Ahmed, S., Masood, S. and Choudhry, A. A pilot study for the solution of nutritional problems of Pakistan. Pakistan J. Med. Res., 1972;11(3):50.
11. National Micro-Nutrient Survey Nutrition Cell, Planning and Development Division lslamabad, Govt. of Pakistan, 1977.
12. Malik, F.R., Haq, M.Y.I. and All, S.M. Some observations on the state of nutrition at Lahore school children. Pakistan J. Med. Res., 1968; 7:124. Academic Press, 1965.
13 McLaren, D.S. Malnutrition and eye. New York,
14. Periera, S.M. and Begum, A. Vitamin A deficiency in Indian children. World Rev. Nutr. Diet., 1976; 24:192.
15. Report of PAHO Technical group meeting. Hypovi­~aminosis A in Americal 1970.
16. Gopalan, C., Venkatachalam, P.S. and Bhavani, B. Studies of vitamin A deficiency in children. Am. J. Clin.Nutr., l960;8:83.
17. Sivakumar, B. and Reddy, V. Absorption of labelled vitamin A in children duiing infection. Br. J. Nutr., 1972; 27:299.
18. Popper, H., Steigmann, F., Dubin, A., Dyniewicz, H.A. and Hessuer, F.P. Significance of vitamin A alcohol and esler partitioning under normal and pathologic circumstances. Proc. Soc. Exp. Biol. Med., 1948;68:676.
19. Ahija, B.S., Wagle, D.S. The effect of dietary protein on the conversion of j3 carotene into vitamin A in rats, Indian J. Nutr. Diet., 1980; 17:123.
20. Ketsamples, C.P., McCoord, A.B. and Philips, W.A. Vitamin A absorption test in cases of giardiasis. Am. J. Dis. Child., 1944; 67:189.
21. Mahalanabis, D., Simpson, T.W., Chakraborty, M.L., Ganguli, C., Bhattacharjee, A.K. and Muk­herjee, K.L. Malabsorption of water miscible vitamin A in children with giardiasis and ascariasis. Am.J.Clin.Nutr.,1979;32 :313.
22. Darip, M.D., Sirisinha, S. and Lamb, A.J. Effect of vitamin A deficiency on susceptibility of rats to Angio-strongylus cantonensis. Proc. Soc. Exp. Biol. Med., 1979; 161:600.
23. Brown, K.H., Ghaffar, A. and Alamgir, S.M. Xerophthalmia, protein.caloric malnutrition, and infections in children. J. Pediatr., 1979; 95:651.
24. Oomen, H.A.P.C., McLaren, D.S. and Escapini, H. Epidemiology and public health aspects of hypovitaminosis A. A global survey on xeroph­thalmia. Trop. Georg. Med., 1964; 16:271.
25. Olson, J.A. Liver vitamin A reserve of neonates, preschool children and adults dying of variouscauses in Salvador Brazil. Arch. Latinoam Nutr., 1979; 29 :521.
26. Pitt, G.A.J. The assessment of vitamin A status. Proc. Nutr. Soc., 1981;40:173.
27. Devadas, R.P., Saroja, S. and Murthy, N.F. Availability of j3 carotene from papaya fruit and amaranth in preschool children. Indian J. Nutr. Diet., 1980; 17 :41.
28. Vitamin A deficiency and xerophthalmia. WHO Tech. Rep. Ser., 1976;590:51.
29. Molla, A., Islam, A., Molla, A.M. and Jahan, F. Change in serum vitamin A concentration after an oral dose in children with acute diarrhoea. J. Pediatr., 1983; 103 : 1000.

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