Findings In 3 Clinical Trials Challenge The Accuracy Of The Institute Of Medicine'S Estimated Average Requirements For Vitamin A In Children And Women

Background: Vitamin A (VA) estimated average requirements (EARs) for women and children are extrapolated from rats and adult males. The retinol isotope dilution (RID) test can sensitively characterize VA status and intake requirements.Objectives: These studies evaluated current EARs for children 4-8 y and women 19-30 y old.Methods: Zambian children (n = 133, ages 5-7 y), US women (n = 51, ages 19-27 y). and Indonesian women (n = 29, ages 19-30 y) were provided diets or supplements containing 3090-155% of VA EARs for 42-90 d. RID was performed before and after the intervention to quantify changes in total body VA stores (TBSs) and total liver VA reserves (TLRs). Linear regression was performed between VA intake and change in TBSs or TLRs.Results: Baseline mean +/- SD TLRs were hypervitaminotic in Zambian children (1.13 +/- 0.41 mu mol/g VA/g liver), optimal in US women (0.46 +/- 0.32 mu mol/g VA/g liver), and deficient to marginal in Indonesian women (0.10 +/- 0.08 mu mol VA/g liver). VA intakes, resulting in no change in TBSs or TLRs, were 185 (95% CI: 18, 288) or 257 (95% CI: 124, 411) and 285 or 330 (CIs undefined) mu g retinol activity equivalents (RAE)/d in the Zambian and US trials. respectively, but inconclusive in Indonesian women. The regression was not significant in either group of women.Conclusions: Point estimates of VA intakes to maintain stores were below the current EARs of 275 (children) and 500 (women) mu g RAE/d despite the TLRs being higher than the EARs were formulated to maintain (i.e.. 0.07 mu mol VA/g liver). Interventions based on these EARs may need to be scaled back. Lack of change in VA stores in women taking lower doses may result from physiological adaptation resulting in lower VA utilization. Longer, larger, and controlled studies are needed to accurately define EARs for VA.