The acute and chronic toxic effects of vitamin A

Armed Forces Medical Services
Ministry of Defense
New Delhi
India
E-mail: drrajat_prakash{at}yahoo.co.in

Dear Sir:

The review by Penniston and Tanumihardjo (1) in a recent issue of the Journal highlights the important issue of adverse affects associated with supplementation with preformed vitamin A. The fact that excess supplementation of preformed vitamin A can lead to adverse effects in both the acute and chronic settings (2, 3) is well known, but the issue of subtoxicity without overt signs of toxicity requires more study. This lack of knowledge about subtoxicity has serious implications, particularly in developing countries, where vitamin A supplementation programs for young children and lactating mothers are in vogue and subtoxic effects may occur in many recipients of preformed vitamin A.

Although vitamin A deficiency (VAD) is decidedly the greater problem—especially in developing nations—and has received much attention in terms of public health initiatives, excessive vitamin A intake is a growing problem (4). Unfortunately, whether because of aggressive promotion policies of international agencies or debatable claims about benefits of supplementation (5, 6), the focus of initiatives to combat VAD has shifted from a logical and sustainable approach—namely, dietary diversification—to an expensive and unsustainable approach—universal supplementation with synthetic vitamin A. It is sincerely hoped that the article by Penniston and Tanumihardjo, besides generating research into the adverse effects of vitamin A supplementation, may help to turn the minds of health policy managers toward a safer and more sustainable approach to tackling VAD—that is, by diet diversification and biofortification.

ACKNOWLEDGMENTS

The author had no personal or financial conflict of interest.

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