Does India Need a Universal High-Dose Vitamin A Supplementation Program?

Greiner, Ted; Mason, John; Benn, Christine Stabell; Sachdev, H. P. S.

doi:10.1007/s12098-018-02851-x

Cited by 13 publications

(16 citation statements)

References 31 publications

(42 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The World Health Organization recommends high-dose vitamin A supplementation for infants and young children in places where vitamin A deficiency is a public health problem, as indicated by a prevalence rate of night blindness of 1% or higher in children 24–59 months of age, or in situations where vitamin A deficiency (serum retinol ≤ 0.7 µmol/L) is 20% or higher in infants and children 6–59 months of age. However, the policy and practice of administering high-dose vitamin A (defined as 25,000 to 50,000 IU vitamin A, equivalent to 7.5 mg and 15 mg retinol equivalents, respectively) to reduce child mortality has been strongly challenged and has led to reports of acute toxicity [180], ranging from increased intracranial pressure, bone demineralization and growth restriction, to mental retardation and death [181,182]. In a review of 21 studies evaluating the effect of vitamin A supplementation in community settings on all-cause mortality, 12 also reported cause-specific mortality for diarrhea and pneumonia and six reported measles-specific mortality.…”

Section: Could Other Risk Factors Be Involved?mentioning

confidence: 99%

Rubella Virus Infection, the Congenital Rubella Syndrome, and the Link to Autism

Mawson

Croft

2019

IJERPH

View full text Add to dashboard Cite

Rubella is a systemic virus infection that is usually mild. It can, however, cause severe birth defects known as the congenital rubella syndrome (CRS) when infection occurs early in pregnancy. As many as 8%–13% of children with CRS developed autism during the rubella epidemic of the 1960s compared to the background rate of about 1 new case per 5000 children. Rubella infection and CRS are now rare in the U.S. and in Europe due to widespread vaccination. However, autism rates have risen dramatically in recent decades to about 3% of children today, with many cases appearing after a period of normal development (‘regressive autism’). Evidence is reviewed here suggesting that the signs and symptoms of rubella may be due to alterations in the hepatic metabolism of vitamin A (retinoids), precipitated by the acute phase of the infection. The infection causes mild liver dysfunction and the spillage of stored vitamin A compounds into the circulation, resulting in an endogenous form of hypervitaminosis A. Given that vitamin A is a known teratogen, it is suggested that rubella infection occurring in the early weeks of pregnancy causes CRS through maternal liver dysfunction and exposure of the developing fetus to excessive vitamin A. On this view, the multiple manifestations of CRS and associated autism represent endogenous forms of hypervitaminosis A. It is further proposed that regressive autism results primarily from post-natal influences of a liver-damaging nature and exposure to excess vitamin A, inducing CRS-like features as a function of vitamin A toxicity, but without the associated dysmorphogenesis. A number of environmental factors are discussed that may plausibly be candidates for this role, and suggestions are offered for testing the model. The model also suggests a number of measures that may be effective both in reducing the risk of fetal CRS in women who acquire rubella in their first trimester and in reversing or minimizing regressive autism among children in whom the diagnosis is suspected or confirmed.

show abstract

Section: Could Other Risk Factors Be Involved?mentioning

confidence: 99%

Rubella Virus Infection, the Congenital Rubella Syndrome, and the Link to Autism

Mawson

Croft

2019

IJERPH

View full text Add to dashboard Cite

show abstract

“…In addition, concerns have been raised about the sustainability of VAS programs. These questions have led some to recommend shifting the current policy supporting VAS toward a range of other interventions, including food-based approaches (e.g., fortification) or regular low-dose supplementation or even total cessation of current high-dose VAS ( 32 , 33 ). Other bodies have argued strongly against the last, until affected countries show impact on under-5 mortality rates ( 8 , 34 ).…”

Section: Current Status Of Knowledgementioning

confidence: 99%

Perspective: Integration to Implementation (I-to-I) and the Micronutrient Forum—Addressing the Safety and Effectiveness of Vitamin A Supplementation

Raiten

Darnton‐Hill

Tanumihardjo

et al. 2020

Advances in Nutrition

View full text Add to dashboard Cite

An ongoing challenge to our ability to address the role of food and nutrition in health promotion and disease prevention is how to design and implement context-specific interventions and guidance that are safe, efficacious, and avoid unintended consequences. The integration to effective implementation (I-to-I) concept is intended to address the complexities of the global health context through engagement of the continuum of stakeholders involved in the generation, translation, and implementation of evidence to public health guidance/programs. The I-to-I approach was developed under the auspices of the Micronutrient Forum and has been previously applied to the question of safety and effectiveness of interventions to prevent and treat nutritional iron deficiency. The present article applies the I-to-I approach to questions regarding the safety and utility of large-dose vitamin A supplementation programs, and presents the authors’ perspective on key aspects of the topic, including coverage of the basic and applied biology of vitamin A nutrition and assessment, clinical implications, and an overview of the extant data with regard to both the justification for and utility of available intervention strategies. The article includes some practical considerations based on specific country experiences regarding the challenges of implementing vitamin A–related programs. This is followed by an overview of some challenges associated with engagement of the enabling communities that play a critical role in the implementation of these types of public health interventions. The article concludes with suggestions for potential approaches to move this important agenda forward.

show abstract

“…As discussed above, the two tenets on which the recommendation for routine VAS were based (child mortality and VAD reduction) appear no longer to be valid. This has resulted in vigorous debate in the past few years, [5,11,13,19,20] with the new scientific evidence largely being ignored by the proponents of HDVAC. In our view, this is partly because many from both science and pharma have invested considerably in promoting HDVAC as a magic bullet against mortality.…”

Section: What Of the Possibility Of Harm In Hdvac Programmes?mentioning

confidence: 99%

Is it time for South Africa to end the routine high-dose vitamin A supplementation programme?

et al. 2019

View full text Add to dashboard Cite

Does India Need a Universal High-Dose Vitamin A Supplementation Program?

Cited by 13 publications

References 31 publications

Rubella Virus Infection, the Congenital Rubella Syndrome, and the Link to Autism

Rubella Virus Infection, the Congenital Rubella Syndrome, and the Link to Autism

Perspective: Integration to Implementation (I-to-I) and the Micronutrient Forum—Addressing the Safety and Effectiveness of Vitamin A Supplementation

Is it time for South Africa to end the routine high-dose vitamin A supplementation programme?

Contact Info

Product

Resources

About