Nutrients, Vol. 18, Pages 1310: Rethinking Vitamin A Deficiency: Its Causes, Ophthalmologic Presentation, and Management Gaps at a New England Tertiary Hospital
Nutrients doi: 10.3390/nu18081310
Authors:
Katherine H. Fearon
Corbin M. Dameron
Shannon L. Kelleher
Amer Al-Nimr
Michael E. Zegans
Background/Objectives: To evaluate ocular disease and eye care utilization among adults with vitamin A deficiency (VAD) in a high-resource healthcare setting, with particular emphasis on nutritional etiologies, clinical nutrition oversight, and outcomes associated with severity of deficiency. Methods: A retrospective chart review was conducted at Dartmouth Hitchcock Medical Center (DHMC) from 1 January 2019 through 31 December 2022. Adults (>18 years) with measured serum retinol concentrations were identified, and data were extracted on retinol concentration, diagnosis, referring service, and vital status. Patients with VAD (serum retinol <32.5 µg/dL per our laboratory threshold) underwent detailed chart review, including social determinants of health and documented nutritional risk factors. For patients with VAD who received an ophthalmologic evaluation, slit lamp findings, ocular symptoms, duration of deficiency, and vitamin A treatment were assessed. Results: VAD was identified in 752 of 2725 patients (27.7%) tested for VAD, and 330 patients had concentrations below the World Health Organization (WHO) threshold for VAD (<20 µg/dL). Hepatic, nutritional, and malabsorptive conditions were prominent contributors, including cirrhosis related to alcohol use or hepatitis C virus (30%), malnutrition or malabsorption following bariatric surgery (24%), and pancreatic insufficiency (20.1%). Food insecurity data were incomplete but showed no significant association with vitamin A concentration. Despite biochemical evidence of deficiency, only 72 patients with VAD (9.6%) underwent ophthalmologic evaluation, and only three were referred specifically due to VAD. Clinical signs or symptoms consistent with xerophthalmia were observed in 21% of those evaluated, and 18% demonstrated corneal findings. Vitamin A supplementation was documented in just over half of symptomatic patients, with objective or symptomatic improvement noted in three cases. VAD was explicitly acknowledged in only 9.7% of ophthalmology notes. Increasing severity of VAD was strongly associated with mortality (p < 0.001), independent of food insecurity, which showed no association with serum retinol concentrations. Conclusions: In this high-resource clinical setting, VAD is common in an at-risk population and largely driven by nutrition-related disease states affecting absorption, metabolism, and hepatic storage. Despite clear biochemical deficiency and associated mortality risk, VAD is underrecognized, undertreated, and infrequently linked to ocular evaluation, highlighting a critical gap in nutrition-focused screening, interdisciplinary communication, and proactive vitamin A assessment in medically complex adults.
Background/Objectives: To evaluate ocular disease and eye care utilization among adults with vitamin A deficiency (VAD) in a high-resource healthcare setting, with particular emphasis on nutritional etiologies, clinical nutrition oversight, and outcomes associated with severity of deficiency. Methods: A retrospective chart review was conducted at Dartmouth Hitchcock Medical Center (DHMC) from 1 January 2019 through 31 December 2022. Adults (>18 years) with measured serum retinol concentrations were identified, and data were extracted on retinol concentration, diagnosis, referring service, and vital status. Patients with VAD (serum retinol <32.5 µg/dL per our laboratory threshold) underwent detailed chart review, including social determinants of health and documented nutritional risk factors. For patients with VAD who received an ophthalmologic evaluation, slit lamp findings, ocular symptoms, duration of deficiency, and vitamin A treatment were assessed. Results: VAD was identified in 752 of 2725 patients (27.7%) tested for VAD, and 330 patients had concentrations below the World Health Organization (WHO) threshold for VAD (<20 µg/dL). Hepatic, nutritional, and malabsorptive conditions were prominent contributors, including cirrhosis related to alcohol use or hepatitis C virus (30%), malnutrition or malabsorption following bariatric surgery (24%), and pancreatic insufficiency (20.1%). Food insecurity data were incomplete but showed no significant association with vitamin A concentration. Despite biochemical evidence of deficiency, only 72 patients with VAD (9.6%) underwent ophthalmologic evaluation, and only three were referred specifically due to VAD. Clinical signs or symptoms consistent with xerophthalmia were observed in 21% of those evaluated, and 18% demonstrated corneal findings. Vitamin A supplementation was documented in just over half of symptomatic patients, with objective or symptomatic improvement noted in three cases. VAD was explicitly acknowledged in only 9.7% of ophthalmology notes. Increasing severity of VAD was strongly associated with mortality (p < 0.001), independent of food insecurity, which showed no association with serum retinol concentrations. Conclusions: In this high-resource clinical setting, VAD is common in an at-risk population and largely driven by nutrition-related disease states affecting absorption, metabolism, and hepatic storage. Despite clear biochemical deficiency and associated mortality risk, VAD is underrecognized, undertreated, and infrequently linked to ocular evaluation, highlighting a critical gap in nutrition-focused screening, interdisciplinary communication, and proactive vitamin A assessment in medically complex adults. Read More