Coping up Vitamin A Deficiency in Older People: An Overview

Introduction:

Vitamins are essential nutrients required to be included in the diet for overall health and well-being. Adequate nutrition is required, especially in old age, due to the susceptibility to various infections and diseases and to maintain functional independence. The aging process causes various changes in the body, affecting the individual's health, quality of life, and lifestyle. Nutritional deficiencies can result in chronic diseases and may deteriorate health; hence nutrition deserves special attention, especially in old age.

What Is Vitamin A?

Vitamin A is a lipid-soluble (fat-soluble) vitamin essential for the immune system, vision, reproduction, gene expression, growth, and development. It is also required for the proper functioning of vital organs such as the heart, lungs, and other organs. Vitamin A is available in two forms: Preformed vitamin A (retinol) found in dairy products, eggs, fish, etc., and provitamin A (carotenoids) found in fruits, vegetables, and other plant-based products. Carotenoids are plant pigments that are converted into vitamin A in the intestine. Some vitamin A-rich foods include; carrots, mangoes, sweet potatoes, green leafy vegetables, whole milk or fortified milk, fish, liver, eggs, chicken, beef, etc. The recommended daily allowance (RDA) of vitamin A is 900 mcg (micrograms) for men above 51 years and 700 mcg for women above 51 years of age.

Who Is at Risk for Developing Vitamin A Deficiency?

When the body cannot get enough vitamin A to satisfy physiological needs, it is called vitamin A deficiency. The prevalence of vitamin A deficiency is mostly seen in underdeveloped countries, especially in children, and adults are rarely affected. Certain groups of people at risk of developing vitamin A deficiency include:

• Infants.

• Young children.

• Pregnant and nursing mothers.

• Elderly individuals due to the physiological decline in food intake or chronic diseases.

What Are Some of the Conditions Associated With Vitamin A Deficiency?

Certain diseases or underlying conditions may impair the ability of the intestine to absorb fat which may result in a deficiency of vitamin A. It includes the following conditions:

• Cystic fibrosis is a genetic disorder that affects the lungs, liver, intestine, and kidneys

• Celiac disease is an autoimmune disorder that triggers a reaction to the consumption of protein, gluten which may damage the small intestine.

• Pancreatic disorders such as chronic pancreatitis may interfere with the absorption of fat-soluble vitamins.

• Block in the bile duct.

• Chronic diarrhea, which lasts for more than two weeks, can result in reduced food intake and a decrease in the nutrients required for the body.

• Inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis affect the lining of the intestine leading to low absorption of essential nutrients.

• Certain surgeries, such as bariatric surgery and intestine or pancreatic surgeries, can affect the absorption of drugs, vitamins, and minerals resulting in a deficiency.

What Are the Complications of Vitamin A Deficiency?

A deficiency of vitamin A can lead to the following complications:

• Eye disorders.

• Skin problems.

• Infertility.

• Respiratory tract infections.

• Delayed growth and development.

What Are the Signs and Symptoms of Vitamin A Deficiency?

Signs and symptoms associated with vitamin A deficiency include:

• Night blindness.

• The inability to see in low light is called xerophthalmia, which may lead to blindness.

• Prolonged deficiency of vitamin A can pose the risk of infections such as pneumonia or other respiratory diseases.

• Accumulation of keratin in the eyes may cause hazy vision, called Bitot’s spots.

• Dryness of the skin, itching, and scaling.

How Can Vitamin A Deficiency Be Managed in Older People?

• Mild forms of vitamin A deficiency can be managed with a regular intake of vitamin A-rich foods such as eggs, milk, fish, liver, chicken, beef, green leafy vegetables, orange-colored fruits, and vegetables such as carrots, mangoes, papaya, apricots, pumpkin, sweet potatoes, squash, etc. Severe forms of vitamin deficiency can be managed by taking vitamin A oral supplements, multivitamin tablets, breakfast cereals, grains, bread, etc., that are fortified with vitamin A. It is advisable to consume at least five servings of vegetables and fruits rich in vitamin A so as to provide an equitable and comprehensive carotenoid distribution. Foods fortified with vitamin A are equivalent to 10 to 15 percent of the daily RDA.

• The therapy aims to reduce significant morbidity and prevent the complications associated with deficiency of vitamin A as it plays a key role in synthesizing deoxyribonucleic acid (DNA) as well as protein, fats, and carbohydrate metabolism. The role of vitamin A as a cofactor in cellular respiration, especially aerobic respiration, makes it highly essential.

Vitamin A is available in various formulations and dosages:

• Capsules containing 7500 U /8000 U /10,000 U OR 25000 U.

• Injectables as a solution of 50000 U/ml.

• Tablet formulation contains a dose of 10000 to 15000 U.

The RDA is expressed as a retinol activity equivalent (RAE) where 1 mcg of retinol is equivalent to 1 RAE. Males are recommended an intake of vitamin A equivalent to 3000 U/day (900 mcg) and females 3000 U/day (700 mcg). Oral therapy is recommended for almost two months (10 to 20 thousand units per day).

• Oral administration is not advisable for individuals suffering from malabsorption; therefore, intramuscular (IM) injections are preferred. IM injections are administered at a dose of 1,00,000 U/day for almost three days, followed by 50,000 U/day for almost two weeks.

• The administration of vitamin A may lead to various adverse effects such as dermatitis, conjunctivitis, acne with granuloma-like lesions, paronychia, cheilitis, and alopecia. If more than 25000 units per day are administered, it is advised to monitor the patient closely. It is also advised to determine the underlying other vitamin deficiencies or any other medical conditions, as the deficiency of vitamin A alone is rarely seen. It is essential to consider other dietary sources when large doses of vitamin A are administered.

Conclusion:

Vitamin A is a fat-soluble nutrient essential for the vision, immune system, vision, reproduction, gene expression, growth, and development. Deficiency of vitamin A is rarely seen but can be due to reduced intake of diet and underlying medical conditions in elderly people. It can be managed with a regular intake of foods rich in vitamin A or by oral or intramuscular injections.