Plan to discontinue the vitamin A supplement programme is hasty

Synopsis:  Some researchers have suggested stopping of vitamin A nutrition supplement program. But this needs careful analysis.

Introduction

Recently, in a study published the American Journal of Clinical Nutrition, some researchers argued that the government’s National vitamin A Supplement (VAS) programme should be partially discontinued.

They argued that the VAS programme is leading to a condition of hypervitaminosis (abnormally high levels of vitamins that can cause toxicity). So, the researchers said that the VAS programme should be discontinued in all except 7 states — Bihar, Jharkhand, Mizoram, Telangana, Haryana, Madhya Pradesh and Uttar Pradesh.

Why vitamin A is important?

Discontinuing VAS programme would deprive the vitamin A supplement for children between 6 months and 5 years. This may adversely impact optimum immune responses against diseases. It may even lead to the re-emergence of eye damage and blindness caused by nutritional deficiencies. It will also adversely impact the ongoing anaemia control measures.

What is the VAS programme?

VAS programme was introduced in 1970 and modified in 1991. It was based on the reason that the daily diet of children in the country is deficient in this essential nutrient. Surveys by the National Nutrition Monitoring Bureau (NNMB) confirmed that over 70% of children consumed less than 70% of the recommended level of this vitamin.  Comprehensive National Nutrition Survey (CNNS), 2016-19, re-confirmed the low dietary intake of vitamin A-rich foods. Among children aged 2 to 4 years, only 5 percent consumed vitamin A-rich fruits and vegetables.

“Management of Vitamin A Deficiency” was thus introduced in 1991. It was guided by the findings of the National Institute of Nutrition, ICMR that reported the seroconversion of measles vaccine in field conditions was significantly higher in children who had taken a vitamin A supplement as compared to those who did not.

What are the problems associated with the debate to limit the VAS?

First, the survey is based on a limited sample. For e.g. In Madhya Pradesh and Maharashtra, the sample size was as low as 35 and 134 as against the recommended minimum 500.

Second, as per CNNS, vitamin A deficiency is a severe public health problem in not 7 but 12 states.

Moreover, there are wide intra-state variations that cannot be overlooked when dropping an entire state from the VAS programme.

What should be the way forward?

The fear of hypervitaminosis should not be used to stop the VAS programme until there are proper studies that prove hypervitaminosis. Vitamin A is an essential nutrient that should be provided as part of the Diet to meet any deficiency.

Source: This post is based on the following articles “Plan to discontinue the vitamin A supplement programme is hasty” published in The Indian Express on 28^th September 2021.