1. VITAMIN
By Dr. INDRAJEET KUMAR
TUTOR
DEPARTMENT OF COMMUNITY MEDICINE
Facebook: psm dept

2. FACTS ABOUT VITAMINS
They are micronutrients.
They have no calorie value.
Types :
Fat soluble: Vitamin -A, D, E & K
Water soluble: Vitamin - C & B-complex

3. VITAMIN A

4. Forms:
PRE – FORMED
VITAMIN A
PRO – VITAMIN A
“BETA – CAROTENE”
(INACTIVE FORM)
INTEST
INE
“RETINOL”
(ACTIVE FORM)

5. SOURCES
 ANIMAL FOODS :-as “RETINOL
e.g: fish liver oils(Halibut/ Cod*), egg,
butter, whole milk, meat.
 PLANT FOODS:-as “BETA - CAROTENE”
1. Green leafy veg.* like spinach**& amaranth
2. Yellow fruits: e.g papaya, mango, pumpkin.
3. Roots: e.g carrot*.
 FORTIFIED FOOD:- vanaspati, baby food, milk

6. STORAGE & TRANSPORTATION
Vit A is stored in Liver in it’s active form ‘RETINOL PALMITATE”
but it is highly toxic.
Therefore transported in circulation in combination
with a protein “RETINOL BINDING PROTEIN”
produced by liver
Deficiency of protein (PEM) leads to deficiency of Vit-A

7. FUNCTION:

Normal vision & dim vision : important component of
rhodopsin(Rods)

Maintain the integrity and normal functioning of the
glandular & epithelial tissue. e.g : intestinal, respiratory,
urinary, skin & eyes.

Support growth: skeletal growth.

Anti – infective: role in immune response.

Anti-cancer vitamin: Protect against some epithelial cancer
e.g. Bronchial cancer.

8. EPIDEMIOLOGY OF VIT-A DEFICIENCY
(XEROPHTHALMIA)
 INADEQUATE INTAKE:
 AGE: common in children between 1-3yrs.
Related to ‘faulty weaning practices’ & ‘PEM.’
 INFECTION: Diarrhoea, Measles & Respiratory tract infections.
 EPIDEMIC OF XEROPHTHALMIA: associated with food
donation programme involving “skimmed milk”
 SOUTHERN & EASTERN STATES: rice eating state

9. DEFICIENCY FEATURES
1. OCULAR (xerophthalmia)
2. EXTRA - OCULAR
 Night blindness.
 Follicular
 Conjunctival Xerosis.
hyperkeratosis.
 Anorexia.
 Growth retardation.
 Increase in morbidity
& mortality.
 Bitot’s Spot.
 Corneal Xerosis.
 Corneal ulceration.
 Keratomalacia.

10. Xerophthalmia
Conjunctival Xerosis:
Corneal xerosis:
Normally wet, smooth & shiny
( muddy, dull, dry & wrinkled.)
Normally wet, smooth, shiny
(dry, dull, opaque)

11. BITOT’S SPOT
Triangular pearly white or yellowish foamy spots on bulbar
conjunctiva on either side of the cornea.

12. Corneal ulcer

13. Follicular hyperkeratosis
(Thorny skin / Phrynoderma)
Cone shaped elevated papules due to thickening of
Stratum corneum.

14. ROSE BENGAL DYE TEST
(Tetra-chloro tetra-iodo fluorescin)
1% of the dye applied on the conjunctiva
Development of PINK COLOUR stain on conjunctiva
xerosis present

15. TREATMENT
Normal requirement: 600mcg of Vit.A (retinol)
= 2000 IU of retinol Palmitate.
Vitamin A : > 12month of age: 2,00,000 (2lakh) I.U
of retinol palmitate orally on two
consecutive days.
< 12month of age: 1,00,000 (1lac) I.U of
retinol palmitate orally on two
consecutive days.

17. PREVENTION
SHORT TERM ACTION
MEDIUM TERM ACTION
LONG TERM ACTION

18. SHORT TERM ACTION (quick result but short lived)
By giving large doses of vit.a to the vulnerable groups
at periodic intervals.
INDIVIDUAL
ORAL DOSE OF RETINOL
PALMITATE
TIMING
New born
50,000 IU
At birth
Children < 12m
1,00,000 IU
Every 6month
Children > 12m
2,00,000 IU
Women of child bearing
age
3,00,000 IU
Within 1 month of
giving birth
Pregnant & lactating
5000 IU
20,000 IU
Every day
Weekly
,,

19. MEDIUM TERM ACTION
Fortification: addition of some nutrient to an edible
substance to increase its nutritive value.
By fortification of certain foods with Vitamin A.
e.g : Dalda (vanaspati).
Baby food.
Dried skimmed milk.
Under consideration:
sugar, salt, tea etc.

20. LONG TERM MEASURES
Action is slow but long lasting.
 Health education: advised to take vitamin A rich diet.
How to prepare a balanced diet.
How to prepare proper weaning diet.
 Promote Breast Feeding: Exclusive breast feding upto
6month. Colostrum is rich in vitamin A
and antibodies.
 Immunization: against infectious diseases particularly
measles.

21. VISION 2020
‘The RighT To SighT”
 a global initiative, launched by
WHO: 18th February 1999
India: 14th October 2004
 Objective: to reduce avoidable blindness
(preventable & treatable) by the year 2020.
e.g: vit-A def, cataract, glaucoma, refractive error etc
 Goal: reduce the prevalence of blindness in india to
0.5% by the year 2020 (current is 1%)

23. VITAMIN-A PROPHYLAXIS PROGRAMME
 2,00,000 IU of Vitamin-A (retinol palmitate) for children
between 1-6 yrs.
 family is kept under surveillance for 1yr and children for
5yrs.
NOTE: Vitamin-A solution has been incorporated into the
“National Immunization Schedule” given at
9m – 18m – 24m – 30m – 36m (total 5 doses)

24. VITAMIN- A PROPHYLAXIS
 Every child between 9m – 3yrs of age
given 5 doses of vitamin A.
 1st dose at 9month 1,00,000 IU or 1ml
along with measles
vaccine.
 2nd dose at 16month 2,00,000 IU or 2ml
along with booster of DPT.
 3rd dose after 6month 2L IU
 4th dose after 6month 2L IU
 5th dose after 6month 2L IU