Bowman B, Russell R, eds. Unlike preformed vitamin A, beta-carotene is not known to be teratogenic or lead to reproductive toxicity [ 1 ]. The supply of potable water is not approved or does not meet the applicable requirements for sampling and public notification set forth in chapter A of NRS and any regulations adopted pursuant thereto, and an operator does not use items intended for a single-use and bottled drinking water from an approved source. Vitamin E supplements have the potential to interact with several types of medications. However, prospective cohort studies of 87, women in the Nurses' Health Study and 47, men in the Health Professionals Follow-up Study failed to replicate these results [ 35 ]. Design, construction and installation.
Measles is a major cause of morbidity and mortality in children in developing countries. About half of all measles deaths happen in Africa, but the disease is not limited to low-income countries.
Vitamin A deficiency is a known risk factor for severe measles. The World Health Organization recommends high oral doses , IU of vitamin A for two days for children over age 1 with measles who live in areas with a high prevalence of vitamin A deficiency [ 33 ]. A Cochrane review of eight randomized controlled trials of treatment with vitamin A for children with measles found that , IU of vitamin A on each of two consecutive days reduced mortality from measles in children younger than 2 and mortality due to pneumonia in children [ 33 ].
Vitamin A also reduced the incidence of croup but not pneumonia or diarrhea, although the mean duration of fever, pneumonia, and diarrhea was shorter in children who received vitamin A supplements. A meta-analysis of six high-quality randomized controlled trials of measles treatment also found that two doses of , IU in infants and , IU in older children significantly reduced measles mortality [ 34 ].
The vitamin A doses used in these studies are much higher than the UL. The effectiveness of vitamin A supplementation to treat measles in countries, such as the United States, where vitamin A intakes are usually adequate is uncertain. The body needs vitamin A to maintain the corneas and other epithelial surfaces, so the lower serum concentrations of vitamin A associated with measles, especially in people with protein-calorie malnutrition, can lead to blindness. None of the studies evaluated in a Cochrane review evaluated blindness as a primary outcome [ 35 ].
However, a careful clinical investigation of African children with measles revealed that half of all corneal ulcers in these children, and nearly all bilateral blindness, occurred in those with vitamin A deficiency [ 36 ]. Because vitamin A is fat soluble, the body stores excess amounts, primarily in the liver, and these levels can accumulate.
Although excess preformed vitamin A can have significant toxicity known as hypervitaminosis A , large amounts of beta-carotene and other provitamin A carotenoids are not associated with major adverse effects [ 37 ]. The manifestations of hypervitaminosis A depend on the size and rapidity of the excess intake.
The symptoms of hypervitaminosis A following sudden, massive intakes of vitamin A, as with Arctic explorers who ate polar bear liver, are acute [ 38 ]. Chronic intakes of excess vitamin A lead to increased intracranial pressure pseudotumor cerebri , dizziness, nausea, headaches, skin irritation, pain in joints and bones, coma, and even death [ 2 , 4 , 5 ].
Although hypervitaminosis A can be due to excessive dietary intakes, the condition is usually a result of consuming too much preformed vitamin A from supplements or therapeutic retinoids [ 3 , 5 ]. When people consume too much vitamin A, their tissue levels take a long time to fall after they discontinue their intake, and the resulting liver damage is not always reversible. Observational studies have suggested an association between high intakes of preformed vitamin A more than 1, mcg daily—only slightly higher than the RDA , reduced bone mineral density, and increased fracture risk [ 1 , 4 , 39 ].
However, the results of studies on this risk have been mixed, so the safe retinol intake level for this association is unknown. Total intakes of preformed vitamin A that exceed the UL and some synthetic retinoids used as topical therapies such as isotretinoin and etretinate can cause congenital birth defects [ ]. These birth defects can include malformations of the eye, skull, lungs, and heart [ 4 ].
Women who might be pregnant should not take high doses of vitamin A supplements [ 2 ]. Unlike preformed vitamin A, beta-carotene is not known to be teratogenic or lead to reproductive toxicity [ 1 ]. The most significant effect of long-term, excess beta-carotene is carotenodermia, a harmless condition in which the skin becomes yellow-orange [ 1 , 24 ]. This condition can be reversed by discontinuing beta-carotene ingestion.
Supplementation with beta-carotene, with or without retinyl palmitate, for 5—8 years has been associated with an increased risk of lung cancer and cardiovascular disease in current and former male and female smokers and in male current and former smokers occupationally exposed to asbestos [ 26 , 40 ].
In the ATBC study, beta-carotene supplements 20 mg daily were also associated with increased mortality, mainly due to lung cancer and ischemic heart disease [ 26 ]. The CARET study ended early, after the investigators found that daily beta-carotene 30 mg and retinyl palmitate 25, IU supplements increased the risk of lung cancer and cardiovascular disease mortality [ 40 ].
The FNB based these ULs on the amounts associated with an increased risk of liver abnormalities in men and women, teratogenic effects, and a range of toxic effects in infants and children. The FNB also considered levels of preformed vitamin A associated with decreased bone mineral density, but did not use these data as the basis for its ULs because the evidence was conflicting.
The FNB advises against beta-carotene supplements for the general population, except as a provitamin A source to prevent vitamin A deficiency.
However, many dietary supplements such as multivitamins do not provide all of their vitamin A as retinol or its ester forms. For example, the vitamin A in some supplements consists partly or entirely of beta-carotene or other provitamin A carotenoids. In such cases, the percentage of retinol or retinyl ester in the supplement should be used to determine whether an individual's vitamin A intake exceeds the UL.
That amount is above the UL for children from birth to 13 years but below the UL for adolescents and adults. Vitamin A can interact with certain medications, and some medications can have an adverse effect on vitamin A levels.
A few examples are provided below. Individuals taking these and other medications on a regular basis should discuss their vitamin A status with their healthcare providers. The manufacturers of Alli and Xenical recommend encouraging patients on orlistat to take a multivitamin supplement containing vitamin A and beta-carotene, as well as other fat-soluble vitamins [ 42 , 43 ]. Several synthetic retinoids derived from vitamin A are used orally as prescription medicines.
Retinoids can increase the risk of hypervitaminosis A when taken in combination with vitamin A supplements [ 41 ]. The federal government's Dietary Guidelines for Americans notes that "Nutritional needs should be met primarily from foods. Foods in nutrient-dense forms contain essential vitamins and minerals and also dietary fiber and other naturally occurring substances that may have positive health effects.
In some cases, fortified foods and dietary supplements may be useful in providing one or more nutrients that otherwise may be consumed in less-than-recommended amounts. For more information about building a healthy diet, refer to the Dietary Guidelines for Americans and the U.
Department of Agriculture's MyPlate. This fact sheet by the Office of Dietary Supplements ODS provides information that should not take the place of medical advice. We encourage you to talk to your healthcare providers doctor, registered dietitian, pharmacist, etc. Any mention in this publication of a specific product or service, or recommendation from an organization or professional society, does not represent an endorsement by ODS of that product, service, or expert advice.
March 2, History of changes to this fact sheet. Strengthening Knowledge and Understanding of Dietary Supplements. Encyclopedia of Dietary Supplements. London and New York: Vitamin A and Carotenoids. Modern Nutrition in Health and Disease. Bowman B, Russell R, eds.
Present Knowledge in Nutrition. International Life Sciences Institute; Food and Nutrition Board. National Academy Press; Am J Clin Nutr ; The Essential Guide to Nutrient Requirements. The National Academies Press; Recommended Dietary Allowances, 7th ed. National Academy of Sciences; Some of the studies analyzed took place in developing countries in which nutritional deficiencies are common. A review of the subset of studies in which vitamin E supplements were given to healthy individuals for the primary prevention of chronic disease found no convincing evidence that the supplements increased mortality [ 61 ].
Follow-up studies are assessing whether the cancer risk was associated with baseline blood levels of vitamin E and selenium prior to supplementation as well as whether changes in one or more genes might increase a man's risk of developing prostate cancer while taking vitamin E. Vitamin E supplements have the potential to interact with several types of medications.
A few examples are provided below. People taking these and other medications on a regular basis should discuss their vitamin E intakes with their healthcare providers. Vitamin E can inhibit platelet aggregation and antagonize vitamin K-dependent clotting factors. Some people take vitamin E supplements with other antioxidants, such as vitamin C, selenium, and beta-carotene. Oncologists generally advise against the use of antioxidant supplements during cancer chemotherapy or radiotherapy because they might reduce the effectiveness of these therapies by inhibiting cellular oxidative damage in cancerous cells [ 65 , 66 ].
Although a systematic review of randomized controlled trials has called this concern into question [ 67 ], further research is needed to evaluate the potential risks and benefits of concurrent antioxidant supplementation with conventional therapies for cancer.
The federal government's Dietary Guidelines for Americans notes that "Nutritional needs should be met primarily from foods. Foods in nutrient-dense forms contain essential vitamins and minerals and also dietary fiber and other naturally occurring substances that may have positive health effects. In some cases, fortified foods and dietary supplements may be useful in providing one or more nutrients that otherwise may be consumed in less-than-recommended amounts.
For more information about building a healthy diet, refer to the Dietary Guidelines for Americans and the U. Department of Agriculture's MyPlate. This fact sheet by the Office of Dietary Supplements ODS provides information that should not take the place of medical advice. We encourage you to talk to your healthcare providers doctor, registered dietitian, pharmacist, etc.
Any mention in this publication of a specific product or service, or recommendation from an organization or professional society, does not represent an endorsement by ODS of that product, service, or expert advice.
August 17, History of changes to this fact sheet. Strengthening Knowledge and Understanding of Dietary Supplements. Modern Nutrition in Health and Disease. Vitamin E regulatory mechanisms. Annu Rev Nutr ; Am J Coll Nutr ; The state of antioxidant affairs. Food and Nutrition Board. National Academy Press, Food and Drug Administration. Revision of the Nutrition and Supplement Facts Labels. Department of Agriculture, Agricultural Research Service. Nutrient Data Laboratory Home Page, http: A Food Labeling Guide Ann Intern Med ; Government Printing Office, Vitamin E supplementation for prevention of morbidity and mortality in preterm infants.
Cochrane Database Syst Rev;4: Vitamin E deficiency and impaired cellular immunity related to intestinal fat malabsorption. Neurologic findings in vitamin E deficiency. Am Fam Physician ; Ataxia with isolated vitamin E deficiency: Am J Hum Genet ; Effects of random allocation to vitamin E supplementation on the occurrence of venous thromboembolism: Vitamin E consumption and the risk of coronary disease in women.
N Engl J Med ; Antioxidant vitamin intake and coronary mortality in a longitudinal population study. Am J Epidemiol ; Heart disease and single-vitamin supplementation. Am J Clin Nutr ; Vitamin E supplementation and cardiovascular events in high-risk patients.
Effects of long-term vitamin E supplementation on cardiovascular events and cancer: Is there any hope for vitamin E? Effects of hormone replacement therapy and antioxidant vitamin supplements on coronary atherosclerosis in postmenopausal women: J Am Med Assoc ; Vitamin E in the primary prevention of cardiovascular disease and cancer: Vitamins E and C in the prevention of cardiovascular disease in men: Why clinical trials of vitamin E and cardiovascular diseases may be fatally flawed.
Commentary on "The relationship between dose of vitamin E and suppression of oxidative stress in humans. Effect of vitamin E and beta-carotene on DNA strand breakage induced by tobacco-specific nitrosamines and stimulated human phagocytes. J Exp Clin Cancer Res ; J Natl Cancer Inst ; Prostate cancer and supplementation with alpha-tocopherol and beta-carotene: J Natl Cancer Inst. Klein EA, Thompson Jr.
Vitamin E and the risk of prostate cancer: Reduced risk of colon cancer with high intakes of vitamin E: A prospective study on supplemental vitamin E intake and risk of colon cancer in women and men. Cancer Epidemiol Biomarkers Prev ; Diet in the epidemiology of postmenopausal breast cancer in the New York State Cohort. Vitamin C and vitamin E supplement use and bladder cancer mortality in a large cohort of US men and women.
Dietary antioxidants and primary prevention of age-related macular degeneration: Primary prevention of age related macular degeneration. Vitamin E supplementation and macular degeneration: For vitamin D, IUs still may be voluntarily declared in parentheses behind the microgram amount.
The table above includes changes related to reference values for labeling mandatory nutrients. Some reference values related to certain voluntary nutrients also were changed. For example, the DV for Vitamin K increased from 80 mcg to mcg for adults and children aged 4 and older.
Dietitians can find more information in the tables on pages to of the final rule https: Serving Sizes and Certain Package Sizes Since the FDA is required by law to base serving size amounts on how much people actually eat, not on what they should be eating, serving sizes for some commonly consumed products have changed. Related package sizes between one and two servings that people typically eat in one sitting, such as a oz can of soup, now will be labeled as one serving.
The purpose of these changes is to update nutrition information provided on food labels and assist consumers with maintaining healthful dietary practices.
The new food label reflects an opportunity for nutrition professionals to speak with their clients and patients about using and understanding food labels, especially when addressing issues such as obesity and diabetes.
For consumers seeking to understand the contribution of added sugars to their diets, the addition of added sugars on the label should assist them. These changes also highlight an opportunity for dietitians to counsel their clients about using the label to reduce intake of certain nutrients of public health concern, such as sodium and added sugars, and increase intake of beneficial minerals such as calcium and potassium.