Advice and guidance on the health needs of migrant patients for healthcare practitioners.
Vitamin A deficiency is extremely rare in people born in the UK, but is a serious public health concern in many low income countries, particularly in Africa and South East Asia.
Vitamin A deficiency particularly affects young children and pregnant women from low-income countries. It is :
- a major cause of preventable blindness in children, and increases the risk of disease and death from severe infections
- can lead to night blindness
- may increase the risk of maternal mortality and poor pregnancy outcomes
Consider vitamin A deficiency in at-risk migrant patients. Where you suspect it, seek advice on appropriate diagnosis and management from your local endocrinology or paediatric team.
Consider supplementation of vitamins A, C and D for all infants and children aged 6 months to 5 years old, in line with UK government recommendations.
Pregnant women and children under the age of four in low-income families in the UK may qualify for the Healthy Start scheme. Free Healthy Start children’s vitamin supplements which contain vitamin A are available as part of the scheme.
However, advise pregnant women or women who may become pregnant to avoid vitamin A supplementation and foods rich in vitamin A (such as liver and liver products) because high vitamin A intake can cause birth defects.
The main cause of vitamin A deficiency globally is a diet that is chronically low in vitamin A. This deficit is exacerbated by high rates of infection, especially diarrhoea which can also reduce vitamin A absorption. These factors may co-exist in people who are socio-economically disadvantaged or migrants from countries with a high incidence of infectious diseases.
Vitamin A is an essential nutrient needed in small amounts for:
- normal functioning of the visual system
- maintenance of cell function for growth and development
- epithelial integrity (skin and mucous membranes)
The daily amount of vitamin A needed by adults is:
- 0.7mg (700 micrograms) a day for men
- 0.6mg (600 micrograms) a day for women
Most people can get all the vitamin A they need from a healthy balanced diet. The requirement for vitamin A is higher in pregnant and lactating women. It’s also important that infants and young children have a varied diet to provide the vitamin A needed for growth and development.
Some research suggests that having more than an average of 1.5mg (1500 micrograms) per day of vitamin A over many years may affect bone health and make them more likely to fracture as people get older. Women who have been through the menopause and older men, who are more at risk of osteoporosis, should avoid having more than 1.5mg (1500 micrograms) of vitamin A a day from food and supplements.
Vitamin A deficiency may be subclinical. However, it can cause a number of issues, including:
- xerophthalmia (dry eyes), which can be an early sign of childhood blindness
- night blindness (impaired adaptation to low-intensity light)
- increased susceptibility to infections, such as respiratory and diarrhoeal infections
- increased severity and mortality from infections
Be alert to the possibility of vitamin A deficiency in at-risk migrant patients, including:
- pregnant and lactating women, infants and young children in low-income countries (including infants who are exclusively breastfed by mothers who are vitamin A deficient)
- recent migrants from low-income countries that have a high incidence of vitamin A deficiency and/or infectious disease
- children with inadequate health care or immunisations
The Department of Health and Social Care recommends daily supplementary vitamin drops containing vitamins A, C and D for all infants and children between the ages of 6 months and 5 years. If infants are drinking 500ml or more of infant formula a day, supplements are not needed.
Healthy Start children’s vitamin drops contain vitamins A, C and D, and are available free of charge to children under 4 years in families who qualify for the Healthy Start Scheme.
NHS organisations may have local arrangements where they provide the vitamins free, or at a small cost, to those not on the scheme.
- not to take supplements containing vitamin A (including fish liver oils) as they can cause birth defects
- not to eat liver or liver products, such as paté, as they may contain high levels of vitamin A
Vitamin A deficiency is rare in people born in the UK, and there are no standard UK guidelines for the diagnosis and treatment of vitamin A deficiency. However, low intakes are relatively common and primary care practitioners who suspect vitamin A deficiency in a migrant patient may wish to seek advice on appropriate diagnosis and treatment from their local endocrinology or paediatric team.
Vitamin A has toxic effects at high serum concentrations, particularly in pregnant women. Excessive supplementation in pregnant women can cause birth defects.
NHS.UK has more information about vitamin A.
The Healthy Start website has information on how to claim free vitamin supplements for young children and pregnant women.
UK government advice on vitamin A is based on recommendations from the Scientific Advisory Committee on Nutrition (SACN).