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

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Abstract

Purpose

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 (< 0.7 µmol/L or < 20 µg/dL), and the risk of VA dietary inadequacy and excess intake beyond the tolerable upper limit (TUL).

Methods

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.

Results

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 > 20% 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.

Conclusions

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.

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Abbreviations

CNNS:

Comprehensive National Nutrition Survey

CRP:

C-reactive protein

EAR:

Estimated average requirement

NSSO:

National Sample Survey Office

RAE:

Retinol activity equivalents

RDA:

Recommended dietary allowance

SES:

Socioeconomic status

TUL:

Tolerable upper limits

VA:

Vitamin A

VAD:

Vitamin A deficiency

WASH:

Water, sanitation and hygiene

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Acknowledgements

The CNNS study was conducted by the Ministry of Health and Family Welfare, Government of India, and the UNICEF, with support from the Mittal Foundation. The data were provided to Indian researchers after a data user workshop conducted by UNICEF, India. The views expressed here by the authors are in their individual capacity but not of the Institutions the authors belong to.

Funding

The Comprehensive National Nutrition Survey (CNNS 2016-18) was conducted by the Ministry of Health and Family Welfare, Government of India, and the UNICEF, with support from the Mittal Foundation.

Author information

Authors and Affiliations

  1. National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India

    Geereddy Bhanuprakash Reddy, Tattari Shalini, Raghu Pullakhandam, Boiroju Naveen Kumar, Bharati Kulkarni, Avula Laxmaiah & Rajkumar Hemalatha

  2. Department of Physiology, St. John’s Medical College, Sarjapur Road, Bengaluru, 560034, India

    Santu Ghosh & Anura V. Kurpad

  3. Institute of Liver and Biliary Sciences, New Delhi, India

    Umesh Kapil

  4. Ministry of Health and Family Welfare, Delhi, India

    Sila Deb

  5. Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India

    Harshpal S. Sachdev

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  1. Geereddy Bhanuprakash Reddy
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Contributions

GBR, TS, SG, RP, NKB, BK, AL, UK, SD, RH, AVK and HSS performed initial statistical analyses on the CNNS data; further comments and iterations involved all authors. AVK and SG analysed the publicly available NSSO dietary intake data. GBR, TS, RP, and SG performed the initial iteration of the estimation of the distribution of requirements and analyses of dietary inadequacy. While GBR, TS, RP, AVK and HSS wrote and edited the manuscript, all authors were involved at every iteration of all analyses and approved the final manuscript.

Corresponding authors

Correspondence to Anura V. Kurpad or Harshpal S. Sachdev.

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Conflict of interest

HSS designed the draft protocol of the CNNS with consultancy support from the UNICEF, India. HSS, AL, UK and AVK were members of the Technical Advisory Committee of the CNNS, constituted by the Ministry of Health and Family Welfare of the Government of India, to oversee its conduct and analysis. HSS is a member of the World Health Organization Nutrition Guidance Expert Advisory Group (NUGAG) Subgroup on Diet and Health and member of Expert Groups of the Ministry of Health and Family Welfare on Nutrition and Child Health. AVK is a Nutrition Advisor to the Tata Trusts. SG has consultancy support for statistical analyses from UNICEF, India. There were no other conflicts to declare.

Ethical approval

The CNNS was conducted after obtaining due International Ethical approval from the Population Council’s International Review Board, New York, USA and National Ethical approval from Post Graduate Institute of Medical Education and Research, Chandigarh, India [14].

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Reddy, G.B., Shalini, T., Ghosh, S. et al. Prevalence of vitamin A deficiency and dietary inadequacy in Indian school-age children and adolescents. Eur J Nutr 61, 197–209 (2022). https://doi.org/10.1007/s00394-021-02636-7

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