Prevalence of vitamin A deficiency and dietary inadequacy in Indian school-age children and adolescents

Abstract

There are no representative estimates of vitamin A deficiency (VAD) and risk of vitamin A (VA) dietary inadequacy in Indian children and adolescents. To evaluate, from national surveys, the prevalence of VAD measured by serum retinol concentrations (<\u20090.7 µmol/L or\u2009<\u200920 µg/dL), and the risk of VA dietary inadequacy and excess intake beyond the tolerable upper limit (TUL). National and state-level VAD prevalence adjusted for inflammation was estimated in school-age children (5–9 years: 10,298) and adolescents (10–19 years: 9824) from the Comprehensive National Nutrition Survey (CNNS 2016-18). The risk of dietary inadequacy against age-specific average VA requirements, and excess intake against the TUL, was assessed from the National Sample Survey Office (NSSO 2014) data. Serum retinol concentrations increased with age (5–19 years) in both genders and were significantly lower in school-age children (1.02 µmol/L, CI: 1.01–1.03) compared to adolescents (1.13 µmol/L, CI 1.12–1.15). The inflammation-adjusted prevalence of VAD in school-age children and adolescents was 19.3% (CI 18.8–19.9) and 14.4% (CI 13.9–14.9) respectively, and this was\u2009>\u200920% in seven and four states for children and adolescents, respectively. The prevalence of VAD was significantly higher among children with lower socio-economic status. The risk of dietary VA inadequacy, from the NSSO survey, was 69 and 78% in children and adolescents, respectively. This risk reduced to 6 and 17% with VA fortified oil and milk intake, while the proportion of intakes exceeding the TUL became 6 and 0.5% in children and adolescents, respectively. The national prevalence of VAD in school-age children and adolescents in India was just less than 20%. The risk of dietary VA deficiency is likely to decline substantially with VA fortified food intake, but a risk of excessive intake also begins to appear; therefore, a careful assessment of the risk of hypervitaminosis A is required at these ages.