Vitamin A and its metabolites are required for vision, cell function for growth, reproduction, haematopoiesis, and immunity. Vitamin A deficiency is known to be associated with increased morbidity and mortality from infectious diseases. It is also known to result in visual disturbance, classically night blindness, anaemia, growth retardation and reduced fertility. Vitamin A deficiency is primary associated with the developing world, being seen in populations where malnutrition is commonplace. In 2002 it was estimated to affect 127 million preschool children and 7.2 million pregnant women worldwide. Vitamin A deficiency is being increasing seen in developed countries, invariably due to malabsorption with causes including chronic pancreatitis, chronic liver disease, intestinal failure and following bariatric surgery. Following bariatric surgery incidence of Vitamin A deficiency has been shown to be up to 69%.Introduction
Our aim was to review the vitamin A deficient patients in our population, a large tertiary centre in a developed country. We wanted to review this cohort in order to obtain information about the aetiology of their deficiency, their symptoms, management and response to supplementation.Methods
We reviewed all Vitamin A assay requests which were reported as <1 umol/L across a 5 year period between 2012–2016. We looked at the indication for the test, whether the patient was symptomatic, and what their symptoms were. In addition, we collected data regarding past medical history.Results
We identified 80 patients with Vitamin A deficiency. Of our cohort, 16 patients were symptomatic, presenting with predominantly visual symptoms: blurred vision, night blindness, recurrent miscarriage, poor vision and xerophthalmia. Vitamin A assays were requested by a variety of departments but most commonly by Liver, Gastroenterology/Nutrition and Ophthalmology. Only one of our symptomatic patient’s Vitamin A deficiency was due primarily to poor intake and in one patient the aetiology of Vitamin A deficiency was unknown. Our other symptomatic patients had coexisting chronic illnesses which resulting in malabsorption.Conclusion
We demonstrated that Vitamin A deficiency is a cause of morbidity and potentially mortality in a developed country. We have also shown that the cause of deficiency in developed countries is not the same as in developing countries. We found the cause of Vitamin A deficiency to be overwhelmingly due to malabsorption, most commonly secondary to surgery or hepatobiliary disease.