22 July 2010
By Killugudi Jayaraman
Vitamin A deficiency is no longer a public health problem in India and massive doses can actually be toxic
Top Indian nutritionists have urged the Indian government to scrap the ongoing programme of “massive–dose” Vitamin A administration to children.
“Vitamin A deficiency is no longer a public health problem in India and massive doses can actually be toxic,“ former Chief of the Indian Council of Medical Research and a leading nutritionist C Gopalan warns.
“It is distressing that in India, this approach has been permitted as a 'universalised' public health policy,” he adds.
Gopalan, Umesh Kapil of the All India Institute of Medical Sciences and HPS Sachdev of the Sitaram Bhartia Institute of Science and Research, both in New Delhi, have said in the international journal World Nutrition that the Vitamin A programme, which has found a foothold in India due to “powerful commercial interests”, should be scrapped.
The Vitamin A prophylaxis programme was launched nationally to combat keratomalacia, an eye disorder, often referred to as night blindness that was prevalent in the 1950s and 1960s.
“In any case, by the 1980s, keratomalacia had ceased to be a major public health problem in India,” Gopalan, who is founder President of the Nutrition Foundation of India, says.
Under this programme, children aged between 9 and 36 months receive massive doses of Vitamin A, twice yearly, totalling 900,000 international units (IU).
In the Eleventh Five Year Plan period, the programme was extended to cover all children up to five years of age, thereby increasing the dosage received per child to 1,700,000 IU.
The amount of Vitamin A from food recommended in normal circumstances for children between 6–12 months is 600 international units a day; that for children between 4 and 5 years old is 900 a day.
“I question the validity of the claim that child mortality can be reduced by 30 per cent or more with massive doses of Vitamin A,” Gopalan says.
He says studies carried out by the National Institute of Nutrition in Hyderabad and Harvard University in the United States, besides one of the largest studies conducted in Uttar Pradesh between 1999 and 2004, found no significant difference in death rates between children who received the massive dose of Vitamin A and those who did not.
Far from reducing child mortality, Gopalan says, the massive dose Vitamin A approach could actually lead to fatalities in children as evidenced by the episode in Assam in 2004 in which a number of children died as a result.
According to scientists, massive doses of Vitamin A could aggravate zinc and Vitamin D deficiency already present in these children.
“The possible role of the ongoing programme of massive dose Vitamin A prophylaxis in the persistence of stunting in our poor children requires serious consideration,” the scientists wrote in the journal.
They said there is also an increased risk of developing acute respiratory infection and possible long–term effects on mental development.
“Given the present situation of lower prevalence and milder form of Vitamin A deficiency in India, and taking note of the possible deleterious effects of administering massive doses of Vitamin A as a universal programme, this approach should be scrapped forthwith,” Gopalan wrote.
A balanced diet that includes adequate amounts of a variety of vegetables and other foods is the surest way of preventing micronutrient deficiencies, the scientists wrote.
“This will not only avoid the considerable unnecessary expenditure which the Indian and other governments are incurring on the programme but, more importantly, will save our children from undesirable side effects.”
The programme costs the Indian government Rs eight billion a year.
In his commentary in the journal, renowned nutritionist Michael Latham of Cornell University in the United States described the global use of Vitamin A supplements as a “great Vitamin A fiasco.”
The approach of giving Vitamin A supplements to all the children in the age group of 6 months to 60 months “is possibly doing more harm than good,” he wrote.