Bhutta ZA, Hurrell RF, Rosenberg IH (eds): Meeting Micronutrient Requirements for Health and Development. Nestlé Nutr Inst Workshop Ser, vol 70, pp 103–105, Nestec Ltd., Vevey/S. Karger AG., Basel, © 2012

Vitamin A deficiency (VAD) is a very common public health problem in more than half of the world, especially in Africa and Southeast Asia, with young children and pregnant women in low-income countries being hardest hit. The WHO estimates that 250 million preschool children have VAD and that a substantial proportion of pregnant women in VAD geographic areas is vitamin A deficient. Globally, between 1995 and 2005, ~5.2 million preschool children and ~9.7 million pregnant women were affected by night blindness. If retinol concentrations 6 months of age, vitamin A supplementation decreased all-cause and diarrhea-specific mortality in some studies, but not others.

Thus, for the continuum of vitamin A sufficiency, one would include breastfeeding for 6 months, appropriate timely vitamin A supplementation between 6 months and 6 years of age, and food fortification after that (Guatemala, for example, where sugar is fortified). For specific vulnerable populations, growing fruits and vegetables complements dietary diversity and food fortification. These three approaches combined with other public health initiatives to promote breastfeeding, oral rehydration therapy, vaccination and birth spacing can all lead to significant reductions in VAD and related morbidities. Jatinder Bhatia

References 5 Gogia S, Sachdev HS: Neonatal vitamin A supplementation for prevention of mortality and morbidity in infancy: systematic review of randomised controlled trials. BMJ 2009;338:b919. 6 WHO/CHD Immunisation-Linked Vitamin A Supplementation Study Group: Randomised trial to assess benefits and safety of vitamin A supplementation linked to immunisation in early infancy. Lancet 1998;352:1257–1263. 7 Arroyave G, Aguilar JR, Flores M, Guzmán MA: Evaluation of Sugar Fortification with Vitamin A at the National Level. Scientific publication 384. Washington, Pan American Health Organization, 1979. 8 World Health Organization, UNICEF, IVACG Task Force: Vitamin A Supplements: A Guide to Their Use in the Treatment of Vitamin A Deficiency and Xerophthalmia, ed 2. Geneva, World Health Organization, 1997. 9 Bhutta ZA, Ahmed T, Black RE, et al: What works? Interventions for maternal and child undernutrition and survival. Lancet 2008;371:417–440.

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1 West KP Jr, Katz J, Khatry SK, et al: Double blind, cluster randomised trial of low dose supplementation with vitamin A or beta carotene on mortality related to pregnancy in Nepal. The NNIPS-2 Study Group. BMJ 1999;318:570–575. 2 Supplementation with Multiple Micronutrients Intervention Trial (SUMMIT) Study Group, Shankar AH, Jahari AB, Sebayang SK, et al: Effect of maternal multiple micronutrient supplementation on fetal loss and infant death in Indonesia: a double-blind cluster-randomised trial. Lancet 2008;371:215–227. 3 Kirkwood BR, Hurt L, Amenga-Etego S, Tawiah C, et al: Effect of vitamin A supplementation in women of reproductive age on maternal survival in Ghana (ObaapaVitA): a cluster-randomised, placebo-controlled trial. Lancet 2010;375:1640–1649. 4 Imdad A, Herzer K, Mayo-Wilson E, et al: Vitamin A supplementation for preventing morbidity and mortality in children from 6 months to 5 years of age. Cochrane Database Syst Rev 2010;CD008524.

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