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• Cause of vitamin A deficiency in coeliac disease
  Published on: 23 February 2001

• Published on: 23 February 2001

  Cause of vitamin A deficiency in coeliac disease

  • , Ophthalmologist
  • Other Contributors:
    • Jörn Oliver Sass, Peter Heinz-Erian

  Editor,
  With great interest we read the case report by Dr. Alwitry on "Vitamin A deficiency in coeliac disease", which raises the question whether a deficiency of vitamin A with subsequent keratomalacia may be caused by this disorder. However, although coeliac disease cannot be excluded as a cause of reduced vitamin A absorption,[1] Alwitry's report does not convincingly show that the vitamin A deficie...

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  Editor,
  With great interest we read the case report by Dr. Alwitry on "Vitamin A deficiency in coeliac disease", which raises the question whether a deficiency of vitamin A with subsequent keratomalacia may be caused by this disorder. However, although coeliac disease cannot be excluded as a cause of reduced vitamin A absorption,[1] Alwitry's report does not convincingly show that the vitamin A deficiency in his patient was indeed due to this disease. If, as was stated in the letter, the patient really had been on a gluten-free diet, his diarrhoea - and probably related vitamin A malabsorption - may well have had other causes; e.g., fat maldigestion, mostly resulting from hepatic and/or pancreatic disorders. In addition, it is not known whether Alwitry's patient received enough dietary fat and (with it) vitamin A. Furthermore, Alwitry refers to the report by Sommer et al[2] for the statement "supplementation via the oral or intramuscular route, each of which have been demonstrated to be equally efficacious." Sommer's article, however, deals with Indonesian children with xerophthalmia, and not with patients with coeliac disease. This should be considered, if different administration regimens of vitamin A are compared. In agreement with Sommer's work, additional determination of serum retinol-binding protein (RBP) would result in a more comprehensive view of the patient's vitamin A status. In this context a further criticism of Alwitry's contribution is that only a single serum vitamin A value is presented and that the corresponding concentration unit as well as sufficient information on the time of sampling in relation to vitamin A administration are not given.

  References
  1. Johnson EJ, Krasinski SD, Howard LJ, et al. Evaluation of vitamin A absorption by using oil-soluble and water-miscible vitamin A preparations in normal adults and in patients with gastrointestinal disease. Am J Clin Nutr 1992;55:857-64.
  2. Sommer A, Muhilal, Tarwotjo I, et al. Oral versus intramuscular vitamin A in the treatment of xerophthalmia. Lancet 1980;1:557-9.

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  Conflict of Interest:
  None declared.

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