Impairment of Intestinal Absorption of Vitamin A Palmitate in Severe Protein Malnutrition (Kwashiorkor)

The effect of an oral dose of 75,000 μg of vitamin A as palmitate on vitamin A serum levels has been tested in children suffering from kwashiorkor. It was found that on admission, this amount of the vitamin ester had no detectable effect on serum levels. After dietary treatment based exclusively on therapeutic amounts of acidified half skimmed milk, the test dose resulted in very marked serum vitamin A increases as early as the fifth day, and in some patients even by the third day of treatment. In another group of children an unsupervised ad libitumdiet failed to produce this change in three to five days. The possible relation of these observations to histopathologic and biochemical alterations in the pancreas, liver and intestine is discussed. It is suggested that the low levels of serum vitamin A found in kwashiorkor may be a consequence of a generalized failure to absorb fat-soluble factors.