Research Council (1989) attempted to set an optimal
intake level, and so recommended a higher RDA of
1000 RE per day for men and 800 RE per day for
women (the difference being due to a lower body
weight, on average). However, the most recent rec-
ommendations from the US Institute of Medicine are
calculated to maintain an adequate body pool size
and set an RDA of 900 mg of RAE for adult males,
700 mg of RAE for adult females.
Toxicity
003 3 Over600individualcasesofhumanvitaminAtoxicity
have been reported, owing to either acute (single or a
few large doses ingested over a brief period of time) or
chronic intake (moderately high doses taken fre-
quently for periods of months or years). Acute toxicity
in human adults is reported from doses of 300 000–
10 000 000 RE (1000–35 000 mmol); chronic doses of
15 000–300 000RE (50–1000 mmol) have produced
hypervitaminosis A. Symptoms include headache,
vomiting, diplopia, alopecia, dryness of mucous mem-
branes, desquamation, bone abnormalities, and liver
damage.However,singleoraldosesof60000 REinoil
have been successfully used in vitamin A intervention
programs for preschool children, with transient toxic
symptoms observed in no more than 3% of subjects.
Massive doses of b-carotene are not toxic, but may be
lessefficientlyabsorbedandusedthanvitaminAitself.
Rodent animal models have been extremely valuable
in elucidating vitamin A requirements and metabol-
ism, but the rat seems to be much less susceptible to
hypervitaminosis A than is the human.
0034 The toxic effects of high vitamin A intakes are
mediated by serum retinyl esters; retinol-RBP concen-
trations are maintained at normal levels in hypervita-
minosis A, but serum retinyl esters are markedly
elevated, bypassing the normal homeostatic controls
on vitamin A transport. Some carnivores, including
the dog, are unusual in having high fasting levels of
serum retinyl esters, presumably reflecting differences
in lipoprotein metabolism in these species; the impli-
cations of this for vitamin A metabolism and for
resistance to hypervitaminosis A are not clear.
0035 The most tragic consequences of excessive vitamin
A intake are teratogenicity (specifically, malforma-
tions of the cranium, face, heart, thymus, and central
nervous system) and embryotoxicity. Acidic retinoids
such as those that have been used in dermatology are
particularly potent, as they can attain high serum
levels and can readily pass the placental barrier. Al-
though large intakes of vitamin A itself (>7500 RE
per day, 26 mmol per day) early in human pregnancy
can cause birth defects (perhaps owing to metabolism
of retinol to retinoic acid?), serum concentrations of
retinol and retinyl esters are normally maintained at
moderate levels during pregnancy. It is assumed that
these teratogenic effects are related to the important
role of retinoids in differentiation of cells and that
these effects are mediated via the nuclear receptor
proteins. (Interestingly, the retinoid b-glucuronides
are much less teratogenic than retinoic acid.) In view
of these teratogenic effects occurring at less than
10 times the recommended daily intakes, a consensus
of several professional organizations is that women
should avoid vitamin A supplements during the first
trimester of pregnancy, and that subsequent supple-
ments, if taken at all, should be prudently limited to
8000 IU (2400 mg RE, 8.5 mmol) per day, although
10000 IU (3000 mg RE, 10 mmol) appears to be safe.
0036The previous two decades have been exciting in
retinoids research, with the disclosure of the roles of
retinoids in control of gene expression. Continuing
challenges in vitamin A research include: (1) the de-
velopment and confirmation of indirect indices of
vitamin A status; (2) elucidation of the mechanism
of control of serum retinol-RBP concentrations;
(3) more exact determination of vitamin A require-
ments for specific functions (not only growth and
prevention of blindness, but also immune function
and cell differentiation in individual tissues); and
(4) definition of the role of vitamin A in differenti-
ation in specific tissues, perhaps leading to chemical
design of distinctive retinoids to combat specific
cancers and dermatologic diseases.
Seealso: Carotenoids:Occurrence,Properties,and
Determination
Further Reading
Blomhoff R (1994) Vitamin A in Health and Disease. New
York: Marcel Dekker.
Chambon P (1996) A decade of molecular biology of reti-
noic acid receptors. FASEB Journal 10: 940–954.
Chambon P, Zelent A, Petkovich M et al. (1991) The family
of retinoic acid nuclear receptors. In: Saurat JH (ed.)
Retinoids: Ten Years On, pp. 10–27. Basel: Karger.
Clarke SD, Thuillier P, Baillie RA and Sha X (1999) Peroxi-
some proliferator-activated receptors: a family of lipid-
activated transcription factors. American Journal of
Clinical Nutrition 70: 566–571.
Collingwood TN, Urnov FD and Wolffe AP (1999) Nuclear
receptors: coactivators, corepressors, and chromatin
remodeling in the control of transcription. Journal of
Molecular Endocrinology 23: 255–275.
Dietary Reference Intakes for Vitamin A, Vitamin K, Ar-
senic, Boron, Chromium, Copper, Iodine, Iron, Manga-
nese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc
(2001), pp. 65–125. Washington, DC: National Acad-
emy Press. (available online at http://books.nap.edu/
books/0309072794/html/65.html).
4966 RETINOL/Physiology