VITAMIN A DEFICIENCY DURING GROWTH AND DEVELOPMENTAL PROCESS RINI ROSSELLINI UTAMI 030.08.

209 JAKARTA, 31 MEI 2011

INTRODUCTION Every single bodily function depends on an adequate supply of vitamins and minerals in the bloodstream, including the growth process. Nutrition has a major influence on the quality and speed of cell growth, starting in the uterus and continuing into adulthood. Poor prenatal nutrition will not only retard the growth process, but may also lead to birth defects and other physical abnormalities. Vitamin A is essential for growth, development and survival. For children in deprived settings an adequate vitamin A status may be more critical to survival protection than to growth and development. Because vitamin A is required for the normal functioning of the immune system, even children who are only mildly deficient in vitamin A have a higher incidence of respiratory disease and diarrhoea, as well as a higher rate of mortality from infectious diseases, than children who consume sufficient vitamin A. Some diseases may themselves induce vitamin A deficiency, most notably liver and gastrointestinal diseases, which interfere with the absorption and utilisation of vitamin A. In populations where vitamin A availability from food is low, infectious diseases can precipitate vitamin A deficiency by decreasing intake, decreasing absorption, and increasing excretion. Infectious diseases that induce the acute-phase response also impair the assessment of vitamin A status by transiently depressing serum retinol concentrations. According to literatures(2), deficiency of vitamin A intake during growth and developmental process will decrease immune response of the children.

ABSTRACT The underlying basic for the use of vitamin A supplementation to reduce infectious disease morbidity and mortality is its role in enhancing immunity. Vitamin A deficiency (VAD) can lead to blindness it is in fact the leading cause of greater risk of dying from ailments such as measles, diarrhoea or malaria. Infectious diseases that induce the acute-phase response also impair the assessment of vitamin A status by transiently depressing serum retinol concentrations. Vitamin A deficiency impairs innate immunity by impeding normal regeneration of mucosal barriers damaged by infection, and by diminishing the function of neutrophils, macrophages, and natural killer cells. Vitamin A is also required for adaptive immunity and plays a role in the development of T both-helper (Th) cells and B-cells. In particular, vitamin A deficiency diminishes antibody-mediated responses directed by Th2 cells, although some aspects of Th1-mediated immunity are also diminished. These changes in mucosal epithelial regeneration and immune function presumably account for the increased mortality seen in vitamin Adeficient infants, young children, and pregnant women in many areas of the world today.

I. Children Growth and Development and Nutrition Needed to Support Proper nutrition for a healthy child should provide adequate essential nutrients, sufficient enough to maintain proper growth, maximize cognitive development and promote health. Any nutrients that enter the body have its own function, here are the nutrients it needs little in the process of growth and development : Essential fatty acids (EFAS) is a nutrition that useful to build the cell, regulate the nervous system, strengthens the cardiovascular system, boost the immune system, is required for brain and eye function and help the body absorb energy. Magnesium is working to keep the bones stay strong, steady heart rhythm, muscle and nerve function and supports the immune system. Its source of avocado, banana, raisins, brown rice. Calcium is useful for building strong bones and teeth, nerve and muscle function promotes a healthy, help the process of blood clotting and helps convert food into energy. Its source of tofu, tofu, yogurt, milk, cheese. Potassium work together with sodium to control the fluid balance in the body, keeping blood pressure, muscle function and reduce the risk of kidney stones and osteoporosis. Its source of the potato, tomato juice, sunflower seeds, spinach, almonds, watermelons. Iron is important in making hemoglobin (the red pigment in blood oxygen carrier) and myoglobin (oxygen storage pigment in muscles). Its source of the spinach, beans, oatmeal.

Zinc needed by more than 70 enzymes that help digestion, metabolism and is essential for growth. Its source skinless chicken breasts, fruit yogurt, tofu, mozzarella and cheddar cheese.

Vitamin A plays an important role in vision and bone growth, protecting the body from infection, increasing the growth of cells and tissues. Its source of carrot juice, sweet potatoes, broccoli, raw spinach, papaya.

Vitamin C helps to improve and shape of red blood cells, bone and tissue, keeping the child's gums and strengthen blood vessels, and helps the body absorb iron. Its source of red guava, kiwi, mango, strawberries, potatoes with skin.

Vitamin D helps the body absorb minerals like calcium and build strong teeth and bones, play a role in cell regulation and insulin production. The source is egg yolk, salmon, mackerel.

Vitamin E, This vitamin is limiting production of free radicals that can damage cells, DNA repair and other metabolic processes. The source is corn oil, soybean oil, mango, and kiwi.

II. The Effect of Vitamin A Deficiency in Growth and Development For children, lack of vitamin A causes some of more serious manifestations of vitamin A deficiency such as:

Blindness due to inability to synthesize adequate quantities of rhodopsin. Moderate deficiency leads to deficits in vision under conditions of low light ("night blindness"), while severe deficiency can result in severe dryness and opacity of the cornea (xeropthalmia).

Increased risk of mortality from infectious disease Vitamin A deficiency increases susceptibility of some type of infection. Vitamin A deficiency contribute to lowering resistant to infection and vice versa disease influence on the occurrence of infection

Xerophthalmia(2).

Abnormal function of many epithelial cells, manifest by such diverse conditions as dry, scaly skin, inadequate secretion from mucosal surfaces.

Abnormal bone growth in vitamin A-deficient animals can result in malformations and, when the skull is affected, disorders of the central nervous system and optic nerve.

III. The Effect of Vitamin A Deficiency in Immune Response Vitamin A is required for the normal functioning of the immune system and therefore helps to protect against infections in a number of ways. It is essential in maintaining the integrity and function of the skin and mucosal cells, which function as a mechanical barrier and defend the body against infection(3). Vitamin A also plays a central role in the development and differentiation of white blood cells, such as lymphocytes, killer cells and phagocytes, which play a critical role in the defence of the body against pathogens(2). In the other hand, if our body can not get Vitamin A adequately, here are some effects to bodys defense(1) : Mucosal Immunity Vitamin A deficiency impairs the function of the mucosal as one aspect of immune function through several mechanisms, namely through the loss of cilia respiratory tract, loss microvillus on genitourinary gastrointestinal tract, and loss of mucin and goblets with respiratory, abnormal

genitourinary,

metaplasia

keratinization in the respiratory tract and genitourinary, secretory alterations specific antigen concentration immunoglobulin A (IgA), mucosal damage which associated with immune cell function and decreased bowel function.

Natural Killer Cell (NK Cell) Deficiency of vitamin A reduces the number of

circulating NK cell activity and destruction of cell cytolitic NK. These cells play a role in anti-viral immunity and

anti-tumor and involved in the regulation of immune responses. Netrophile Deficiency of Vitamin A affects the impairment function of neutrophile. Neutrophile act as non specific immune response.

Netrophile not only phagocyte bacteria and parasite but also phagocyte tumor cell and viral infected cell. Retinoic acid itself plays a role in netutrophile normal maturation. Haematopoetic Deficiency vitamin A in human body is characterized with the decreasing of total lymphocytes and CD4 + lymphocytes in peripheral blood. Retinoids implicated in the maturation of pluripotent cells into cell lineages that generate cells hematoputik, such as lymphocytes, granulocytes and megakariosit. Retinoids also play a role in the maturation of differentiation pluripotent cells become multipotent colony-form cells combined unit-granulocyte-eritroid (CFUGEMM) and differentiation and makropag into

CFU-GEMM

eritroid-form unit and later became the colony eritroid form of units. T-Lymphocyte and B-Lymphocyte Vitamin A maintains the balance of T-helper type-1 and T helper type-2. Vitamin A Deficiency damage the growth, activation and b-lymphocyte function. B-Lymphosyte for the use of metabolites

of retinol, 14-hydroxy-4, 14-retro-retinol, including acid retinoic as a mediator of growth. T cell-dependent antigen used for differentiation of sensitization B-Lymphosyte into immunoglobulin-secretion and cell all trans retinoic acid increased the synthesis of IgM and IgG. The high T- lymphosyte incubation with acid retinoic increase the synthesis of IgM by limphosit B, shows that retinoic acid affects T cells through production of cytokines. Monocyte and Macrophage Retinoic plays a role in differentiation and cell activation of monocytes macrophage. Antibody Responses Signs of vitamin A deficiency can be identified by the destruction of the capacity to generate antibody responses against Tcell antigen dependent and T cell-independent antigens type 2, such as pneumococcal polysaccharide. Antibody response associated with protective immunity against many types of infections and is the main basic for protection.

CONCLUSION Vitamin A is required for the normal functioning of the immune system and therefore helps to protect against infections in a number of ways. Due to the important role of vitamin A in supporting the functions of the immune system, individuals with insufficient intake of this vitamin often experience increased susceptibility to viral infections, most notably measles, diarrhea, malaria and respiratory syncytial virus (RSV).

REFFERENCES 1. Alamtsier, Sunita. 2002. Prinsip Dasar Ilmu Gizi. Jakarta. PT.Gramedia 2. Semba, Richard D. 2002. Vitamin A, Infection and Immune Function. USA. CABI Publishing 3. How Vitamin Influences Immune Function. Article reviews. Available at : http://findarticles.com/p/articles/mi_m0ISW/is_2002_April/ai_84211197/ 4. Vitamin A Deficiency. Medscape reference. Available at :

http://emedicine.medscape.com/article/126004-overview#a0101 5. The Role of Vitamin A and Related Retinoids in Immune Function. Available at : http://onlinelibrary.wiley.com/doi/10.1111/j.1753-

4887.1998.tb01643.x/abstract 6. Vitamin A, Infection and Immune Function. Available at :

http://www.annualreviews.org/doi/full/10.1146/annurev.nutr.21.1.167