Vitamin A deficiency: experience from a tertiary referral UK hospital; not just a low- and middle-income country issue

Abstract

Objective: Vitamin A (VA) deficiency, more common in low- and middle-income countries (LMIC) secondary to malnutrition, is associated with increased morbidity and mortality. The prevalence and impact of VA deficiency in high-income countries (HIC) where chronic conditions may predispose is less well understood. Setting: We examined the scale of low and deficient VA status in our tertiary University Teaching Hospital (HIC). Participants: Patients undergoing serum retinol concentrations 2012-2016 were identified from laboratory records, and records examined. Design: Interpretation of serum retinol may be affected by inflammation, so C-reactive protein (CRP) levels were sought. Binary logistic regression and generalised estimating equations were performed to review the relationship between CRP and VA. Results: 628 assays were requested, with 82 patients VA low (0.7-0.99umol/L) or deficient (<0.7umol/L). 16 patients were symptomatic (15 deficient), predominantly visual. Only one symptomatic patient’s VA deficiency was secondary to poor intake. Other symptomatic patients had chronic illnesses resulting in malabsorption. The incidence of a low VA level increases significantly with a raised CRP. Conclusion: The majority of patients tested either were replete or likely to have abnormal VA levels due to concomitant inflammation. A minority of patients had signs and symptoms of VA deficiency and was a cause of significant morbidity, but aetiology differs from LMIC, overwhelmingly malabsorption, most commonly secondary to surgery or hepatobiliary disease. A correlation between inflammation and low VA levels exists, which raises the possibility that requesting a VA level in an asymptomatic patient with active inflammation may be of questionable benefit.

Lessons from the self-terminating COVID-19 pandemic: Vaccination, vitamin A deficiency and a brief epidemiological view

“…In the meantime, a recent study has been published recently, showing that vitamin A deficiency is not unique to underdeveloped countries, but can also be seen in developed western societies (100). This study also emphasized the relationship between vitamin A deficiency and inflammation (100).…”

“…Vitamin A deficiency is the main reason behind chronic diseases, which is seen as the most important reason why COVID-19 hits big metropolises more than rural areas. The relationship between vitamin A deficiency and inflammation and chronic disease has been shown in many studies (100,101,102,103) The main reason behind obesity, diabetes, cardiovascular diseases, and many other chronic inflammatory diseases that cause comorbidity for COVID-19 is nutrition with low nutritional value, western style, high calorie packaged foods (104,105,106). Healthy-eating adults have a lower risk of obesity, heart disease, type 2 diabetes, and cancer, and they live longer (107).…”

The Impact of the COVID-19 Pandemic on the Food Security of UK Adults Aged 20–65 Years (COVID-19 Food Security and Dietary Assessment Study)

“…Vitamin A has roles in growth, and in the prevention of night blindness [ 64 ] and reduced vitamin A status increases the risk of infection [ 65 ]. Marley et al (2021) recently demonstrated that in patients replete or having abnormal levels of vitamin A have increased rates of inflammation and C-reactive protein [ 66 ]. This study pointing to an important role of vitamin A in mitigating rates of inflammation.…”

Lack of iron, zinc, and vitamins as a contributor to the etiology of atopic diseases

“…Subclinical vitamin A deficiency is linked to a worsened outcome and disease course and is closely linked to iron deficiency and to inflammation (156)(157)(158). Retinol is mobilized from the liver by an iron-dependent enzyme (159), with irondeficient conditions hindering the mobilization of this vitamin.…”