Vitamin A (Retinol and Beta-Carotene): ICMR-NIN Values, Indian Sources and the Child Dose Schedule

Vitamin A is a fat-soluble vitamin that the eye, the skin and the linings of the gut and airways cannot do without. It reaches the plate in two forms: ready-made retinol in animal foods, and carotenoids such as beta-carotene in green, yellow and orange plant foods, which the body converts. ICMR-NIN's Nutrient Requirements for Indians 2020 sets the allowance at 1,000 mcg a day for an adult man and 840 mcg for an adult woman, and caps habitual intake at 3,000 mcg. This entry in the vitamins section of the handbook gives the values by age, the Indian foods, the survey figures and the schedule of doses children receive.

What does vitamin A do in the body?

It keeps you seeing in poor light and keeps surface tissues intact. ICMR-NIN's 2024 Dietary Guidelines describe vitamin A as necessary for clear vision, even in dim light, and for maintaining the integrity of epithelial tissues, the cells that line the eye, skin, gut and airways. The guidelines add that it has a role in maintaining the body's resistance to common infections. The National Family Health Survey report adds that deficiency increases the severity of infections such as measles and diarrhoeal disease in children and slows recovery from illness.

Because it dissolves in fat and not in water, vitamin A travels with the fat in a meal. The 2024 guidelines note that dietary fats serve as a vehicle for vitamins A, D, E and K and for carotenes, and promote their absorption. That is the reasoning behind a tadka on palak or a little oil on grated carrot.

Retinol and beta-carotene: the two forms on your plate

Retinol is the active form and comes only from animal foods: liver, egg, milk and its products, and some fish. Carotenoids are the plant pigments the body turns into retinol, and the guidelines list their sources as fruits and vegetables that are green or deep yellow or orange, such as green leafy vegetables, carrots, tomatoes, capsicum, orange-fleshed sweet potato, papaya and mango. The Indian Food Composition Tables 2017 report retinol and the individual carotenoids separately, and observe that many conversion factors exist and no universal one.

ICMR-NIN's expert group settled the factor for Indian use in 2020. It recommends counting 6 mcg of beta-carotene as 1 mcg of retinol, and 12 mcg for two lesser carotenoids, alpha-carotene and beta-cryptoxanthin. Every plant figure in this entry uses the 6 to 1 rule. The site's beta-carotene table of Indian foods ranks the raw carotene values, so divide a figure there by six to compare it with the allowance.

How much vitamin A do you need in India?

An adult man needs 1,000 mcg a day and an adult woman 840 mcg on ICMR-NIN's 2020 recommended allowance, the level meant to cover nearly every healthy person. The report also gives an estimated average requirement, 460 mcg and 390 mcg, which is the figure to use when judging a group's diet. Both rose in 2020: the expert group's own brief note shows the earlier allowance was 600 mcg for men and women alike. The table gives each group.

For infants under six months the report gives an adequate intake of 350 mcg. Men and women aged 60 and over keep the adult allowances of 1,000 and 840 mcg. One further line matters for vegetarian households: to ensure adequacy in vulnerable groups such as pregnant and lactating women, the expert group recommended that at least 50 per cent of their vitamin A be drawn from animal sources, which for a vegetarian means milk, curd, paneer and, if eaten, egg.

Which Indian foods supply the most vitamin A per portion?

Dark green leaves, carrot and liver lead by a wide margin, with egg, milk, mango and papaya filling in. The table converts the per 100 g values of the Indian Food Composition Tables 2017 into household portions; for plant foods the beta-carotene figure has been divided by six, as ICMR-NIN advises. Weights are for the raw edible portion.

Two things stand out. Colour is not a reliable guide: pumpkin is orange yet carries a fifteenth of the carotene of carrot in the food tables, and methi, an ordinary green leaf, beats both. And leaves differ among themselves, as the comparison of spinach and moringa leaves shows. Fortified staples add a little more. FSSAI's fortification standard requires fortified milk to carry 270 to 450 mcg of vitamin A per litre and fortified vegetable oil 6 to 9.9 mcg per gram, which works out at 54 to 90 mcg in a 200 ml glass and 120 to 198 mcg in 20 g of oil, about four teaspoons.

Too little: deficiency signs and the Indian survey figures

The eye shows deficiency first. In the 2024 guidelines' description, the white of the eye loses its lustre and becomes dry, and foamy white patches called Bitot's spots may appear; in severe deficiency the cornea ulcerates, leading to irreversible blindness in young children. Difficulty seeing at dusk, or night blindness, belongs to the same picture. The National Family Health Survey report calls severe vitamin A deficiency the leading cause of childhood blindness.

Blood tests show how common the milder form is. The Comprehensive National Nutrition Survey of 2019, as tabulated in the 2024 guidelines, found vitamin A deficiency in 17.5 per cent of children aged 1 to 4, 21.5 per cent at 5 to 9 and 15.6 per cent at 10 to 19 years. Diet is part of the reason: in the 2019-21 National Family Health Survey (NFHS-5), only 47 per cent of children aged 6 to 23 months had eaten a food rich in vitamin A in the previous day and night.

What does the national programme give children, and when?

Under the Ministry of Health and Family Welfare's national immunisation schedule, a child receives nine oral doses of vitamin A solution between nine months and five years. The table sets out the schedule as the Ministry publishes it. These are a programme's preventive doses, given by a health worker, and are reported here as such: they are not amounts for a parent to buy and give at home.

To see how large these are, use the conversion printed in FSSAI's standard, 1 IU of vitamin A to 0.3 mcg. One lakh IU is 30,000 mcg, about 77 days of a toddler's 390 mcg allowance in one spoonful. Coverage is the weak point. NFHS-5 found that 37 per cent of children aged 6 to 59 months had been given a vitamin A supplement in the previous six months, ranging from 20 per cent in Lakshadweep and Manipur to 47 per cent in Goa.

What does the evidence say about vitamin A doses and beta-carotene pills?

For young children where deficiency is common, the evidence is strong. The Cochrane review updated in 2022 pooled 47 trials with about 1,223,856 children, 16 of them set in India. Supplementation lowered deaths from any cause by 12 per cent on high-certainty evidence, and reduced Bitot's spots and night blindness on moderate-certainty evidence. Vomiting within 48 hours of a dose was about twice as common. This is the basis on which WHO recommends supplements for children aged 6 to 59 months.

The largest single trial, from north India, is more sober. DEVTA covered about one million pre-school children and gave 200,000 IU every six months. Bitot's spots fell from 3.5 to 1.4 per cent, but the ratio of deaths was 0.96, a difference that was not statistically significant. Its authors concluded that the result contradicts the 20 to 30 per cent fall once expected, yet a pooled analysis with eight earlier trials still showed an 11 per cent reduction. An expert group of India's academy of paediatricians argued in 2005 that evidence did not support routine large doses after three years of age.

For adults who are not deficient, pills have done harm in trials. In a Finnish trial of 29,133 male smokers, 20 mg of beta-carotene a day was followed by 18 per cent more lung cancer and 8 per cent higher total mortality. An American trial of 18,314 smokers, former smokers and asbestos workers, using 30 mg of beta-carotene with 25,000 IU of retinol, was stopped early with a relative risk of lung cancer of 1.28. Both trials tested high-dose supplements, not vegetables.

A worked example: one vegetarian day in Pune

This is an illustration, not a real person. Take a 30-year-old vegetarian schoolteacher in Pune whose allowance is 840 mcg. On a day of poha, dal, rice, chapati and a pumpkin sabzi, her vitamin A comes from one glass of milk (117 mcg), a tomato in the dal (151 mcg) and 100 g of pumpkin (61 mcg): 329 mcg, below even the average requirement of 390 mcg. The plate is simply short of dark leaves and deep orange vegetables.

In season, 150 g of ripe mango would add another 292 mcg. A dish such as palak paneer covers leaf, fat and a dairy source of retinol in one bowl. For a child's plate, the Indian diet chart for children uses the same foods in smaller portions.

Common mistakes and myths about vitamin A

The second mistake is to read a label in IU as if it were micrograms: by FSSAI's conversion, 5,000 IU of retinol is 1,500 mcg, more than a day's allowance. The third is to assume a child who has had the syrup no longer needs the vegetables, when the dose is a six-monthly top-up and the daily supply still comes from food. The fourth is to treat every eye complaint as vitamin A deficiency. The earlier site article on vitamin A deficiency and food sources explains the eye signs at more length.

Too much vitamin A, pregnancy and when to see a doctor

ICMR-NIN's tolerable upper limit is 3,000 mcg a day for adults, including pregnant and lactating women. For children it is 600 mcg up to 3 years, 900 mcg at 4 to 9, 1,700 mcg at 10 to 12 and 2,800 mcg at 13 to 18. The limit describes habitual intake from all sources. A 100 g serving of chicken liver holds 3,486 mcg of retinol, above the adult limit in one sitting, so liver is an occasional food and not a daily one, and it should not be stacked on a retinol supplement.

Pregnancy needs the most care. A study of 22,748 pregnant women in the New England Journal of Medicine found that babies of women taking more than 10,000 IU of preformed vitamin A a day from supplements had 4.8 times the prevalence of one group of birth defects compared with those taking 5,000 IU or less, with the excess concentrated before the seventh week. Ten thousand IU is 3,000 mcg, the same figure as the ICMR-NIN limit. The pregnancy diet guide covers the diet as a whole.

Studying this with NNWA

Vitamin A is taught at NNWA under micronutrients, life-stage nutrition and public health. The academy is a private skill institution in Kolkata that teaches online in English and Hindi; its courses prepare people to coach healthy clients and to refer medical cases, and none is a degree or a dietitian qualification. The Public Health Nutrition course looks at supplementation and fortification programmes, and the Diploma in Nutrition, Dietetics and Public Health covers requirements and diet planning. The handbook's entry on iron covers the other deficiency the same surveys track.