Vit a print

VITAMIN

By Dr. INDRAJEET KUMARTUTOR

DEPARTMENT OF COMMUNITY MEDICINE

Facebook: psm dept

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

VITAMIN A

Forms:

PRO – VITAMIN A

“BETA – CAROTENE”

(INACTIVE FORM)

PRE – FORMED

VITAMIN A

“RETINOL”(ACTIVE FORM)

INTESTIN

E

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

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

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.

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

DEFICIENCY FEATURES1. OCULAR (xerophthalmia)

2. EXTRA - OCULAR

Night blindness. Conjunctival

Xerosis. Bitot’s Spot. Corneal Xerosis. Corneal ulceration. Keratomalacia.

Follicular hyperkeratosis. Anorexia. Growth retardation. Increase in morbidity & mortality.

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

Corneal xerosis: Normally wet, smooth, shiny (dry, dull, opaque)

BITOT’S SPOT Triangular pearly white or yellowish foamy spots on bulbar

conjunctiva on either side of the cornea.

Corneal ulcer

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

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

TREATMENTNormal 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.

PREVENTION

SHORT TERM ACTION

MEDIUM TERM ACTION

LONG TERM ACTION

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

PALMITATETIMING

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 dayWeekly

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.

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.

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%)

END

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)

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