Other commonly known names of vitamin A include Retinol, Retinal, Retinoic acid and Carotenoids.

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1 Medical Nutrition Therapy Nutrient: Vitamin A 1. What is the nutrient? Vitamin A is a fat-soluble group of retinoids including retinol, retinal, retinoic acid and retinyl esters. Vitamin A is involved in immune function, vision, reproduction and cellular communication. This vitamin is also known as retinol because it produces the pigments in the retina of the eye. Therefore, vitamin A promotes good vision health. Vitamin A is found in two forms known as performed vitamin A and provitamin A carotenoids. Both provitamin A and preformed vitamin A must be metabolized intracellularly to retinal and retinoic acid, the active forms of vitamin A, to support the vitamin's important biological functions Other commonly known names of vitamin A include Retinol, Retinal, Retinoic acid and Carotenoids. 2. What is the RDA/DRI for the nutrient? The Recommended Dietary Allowances (RDAs) for Vitamin A are listed in the table below: Age Male Female Pregnancy Lactation 0 6 months 400 mcg RAE 400 mcg RAE 7 12 months 500 mcg RAE 500 mcg RAE 1 3 years 300 mcg RAE 300 mcg RAE 4 8 years 400 mcg RAE 400 mcg RAE 9 13 years years 900 mcg RAE 700 mcg RAE 750 mcg RAE 1,200 mcg RAE years 900 mcg RAE 700 mcg RAE 770 mcg RAE 1,300 mcg RAE 51+ years 900 mcg RAE 700 mcg RAE 3. How is the nutrient metabolized? Absorption: Maximum absorption of vitamin A occurs within two to six hours after digestion. Approximately 70-90% of vitamin A from dietary intake is absorbed in the intestine. While in the intestine, vitamin A is incorporated into a micelle and absorbed into the enterocytes. Within the enterocytes precursors of vitamin A, known as carotenoids, are converted into their active forms. The newly formed products are then packaged into chylomicrons and are ready for transport throughout the body. Transport: Packaged vitamin A is first circulated through the lymphatic system and then through general circulation. When arrived at the extra hepatic cells, chylomicrons release triglycerides. When retinol is needed it is transported from the liver to the blood with the help of Retinol Binding Proteins (RBP). Storage: When vitamin A status is adequate, approximately 50-85% of the total body retinol is stored in the liver.

2 Excretion: The kidneys are the main path of retinol excretion. Source: Vitamin A (Retinol) University of Maryland Medical Center. 4. What are food sources of the nutrient? Foods containing vitamin A include animal products such as liver, beef, milk and other dairy products such as egg yolk and fish liver oil. Dark red, green and yellow vegetables or fruits are also known to contain vitamin A. the deeper the color of the vegetable, the more betacarotene it is known to contain. Source: Vitamins University of Maryland Medical Center. 5. What disease states alter the nutrients metabolism? Healthy adults usually have one year's worth of storage of vitamin A in the liver. A temporary lack of nutrients is unlikely to cause a serious vitamin A deficiency. Because this vitamin is absorbed in the intestine and stored in the liver, any disease state that may compromise these organs can negatively alter vitamin A metabolism. Those who suffer from renal disease often experience elevated serum levels of retinol and therefore must be aware of vitamin A toxicity. Individuals at higher risk for a Vitamin A deficiency include: a. Preschool children and children who do not get enough protein, calories, and zinc b. People with iron deficiency, which may affect the metabolism of vitamin A c. People with asthma d. People with serious disorders of the intestine, liver, or pancreas, such as cystic fibrosis, steatorrhea, biliary obstruction, inflammatory bowel disease, and cirrhosis e. People who have had Roux-en-Y gastric bypass surgery f. Vegans (vegetarians who do not eat eggs and dairy) g. People who abuse alcohol Source: Vitamin A University of Maryland Medical Center. 6. What are the tests or procedures to assess the nutrient level in the body? To assess the level of vitamin A within the body, serum levels of Vitamin A are the most commonly used biochemical measure to assess the nutrient status. 7. What is the drug nutrient interactions? Drug-nutrient interactions that involve Vitamin A are listed below: Drug: Effect on Vitamin A: Antacids Combination of antacids and vitamin A may be more effective

3 Cholesterol lowering medications Doxorubicin Neomycin Omeprazole Retinoids Olestra Tetracycline antibiotics Blood thinners Medications processed by the liver than antacids alone in treating and healing of ulcers May reduce the body s ability to absorb vitamin A With vitamin A it may increase the action of Doxorubicin to treat some cancers Decrease absorption of vitamin A May influence the absorption and effectiveness of beta-carotene supplements Can cause birth defects in pregnant women Prevent body from absorbing enough vitamin A Those who take this medication with a high dose of vitamin A may be at risk for a condition called intracranial hypertension (a rise in the pressure of brain fluid) In combination with a high doses of vitamin A it an increase the risk of bleeding. Taking high doses of vitamin A along with some mediations that are processed by the liver can cause liver damage or even liver failure Source: Vitamin A (Retinol) University of Maryland Medical Center. 8. How is the nutrient measured? Vitamin A is measured is RAE s or IU s. The Recommended Dietary allowances (RDA) of vitamin A are given as mcg of retinol activity equivalents (RAE) to account for the different bioactivities of retinol and provitamin A carotenoids. Currently, vitamin A can be found on food and supplement labels in international units (IU s). Conversion rates between IU and RAE are as follows: 1 IU retinol = 0.3 mcg RAE 1 IU beta-carotene from dietary supplements = 0.15 mcg RAE 1 IU beta-carotene from food = 0.05 mcg RAE 1 IU alpha-carotene or beta-cryptoxanthin= mcg RAE

4 9. What is the Upper Tolerable Limits? The tolerable upper limits (UL) are the maximum daily intake of vitamin A that is unlikely to cause adverse health effects. The UL s for vitamin A are listed in the table below: Age Male Female Pregnancy Lactation 0 12 months 1 3 years 4 8 years 900 mcg RAE (3,000 IU) 900 mcg RAE (3,000 IU) 9 13 years 1,700 mcg RAE (5,667 IU) 1,700 mcg RAE (5,667 IU) years 19+ years 10. What are the physical signs of deficiency Physical signs of deficiency for vitamin A include: Reduced vision in the night or dim light Dry eyes Eye inflammation Rough or dry skin 11. What are physical signs of toxicity? Vitamin A is very toxic when taken in high-doses for long periods of time. Large amounts of beta-carotene will not make people sick, but they can turn the skin yellow or orange. Excess vitamin A can affect almost every part of the body, including the eyes, bones, blood, skin, central nervous system, liver, and genital and urinary tracts. The symptoms of a vitamin A toxicity include: Dizziness Nausea and vomiting Headache Skin damage Mental problems Less frequent periods in women Toxicity in Adults: A severe toxicity can cause blindness and may even be life threatening. High doses of vitamin A may also increase the risk for gastric cancer, osteoporosis, and hip fractures. A

5 pregnant woman who intakes a high amount of vitamin A increases the risk for birth defects. Toxicity in Children: In children a long-term vitamin A toxicity can cause fluid on the brain, liver damage, as well as the same complications seen in adults. Source: Vitamins University of Maryland Medical Center.

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