How Many Americans Are Vitamin A Deficient? Prevalence and Risk Factors

January 8, 2026 •

4 min read

While clinical vitamin A deficiency (VAD) is rare in the U.S., affecting less than 1% of the population, inadequate intake is a more widespread concern. Recent National Health and Nutrition Examination Survey (NHANES) data from 2005–2016 reveals a significant portion of the adult population does not meet the estimated average requirement for this crucial nutrient.

Quick Summary

Severe, clinical vitamin A deficiency is uncommon in the U.S., but a large percentage of adults show inadequate dietary intake. Vulnerable subgroups, including those with chronic illnesses or certain ethnic backgrounds, face an elevated risk.

Key Points

Low Clinical Deficiency: Less than 1% of the U.S. population has a clinical vitamin A deficiency, which is very rare in developed countries.
High Inadequate Intake: Dietary surveys reveal that nearly half of American adults have inadequate vitamin A intake from food alone, indicating a significant nutritional gap.
High-Risk Subgroups: Populations with fat malabsorption disorders, liver disease, chronic alcohol use, or specific dietary restrictions (e.g., vegans) face a higher risk of deficiency.
Ethnic Disparities: Research shows disproportionately high rates of vitamin A inadequacy in pregnant women of Hispanic/Latino and non-Hispanic Black ancestries.
Early Symptoms: Initial signs of low vitamin A include night blindness, dry skin and eyes, and a weakened immune system, which can increase infection susceptibility.
Dietary Solutions: Increasing consumption of vitamin A-rich foods like leafy greens, orange vegetables, eggs, and fortified dairy can help address nutritional shortfalls.
Toxicity Concerns: Excessive intake of preformed vitamin A, often from over-supplementation, can be toxic due to its storage in the body's fat tissues.

The Nuance of Vitamin A Deficiency in the U.S.

The question of how many Americans are vitamin A deficient is not as straightforward as it seems. There is a critical distinction between a clinical deficiency—a severe, symptomatic condition—and subclinical or inadequate intake, which can still have significant health consequences over time. The Centers for Disease Control and Prevention (CDC) reported in 2012 that less than 1% of the U.S. population showed a clinical vitamin A deficiency based on serum retinol levels. However, this figure does not capture the full picture of nutritional status. A more comprehensive analysis of NHANES data from 2005–2016 revealed that 45% of U.S. adults had inadequate vitamin A intake from food alone, a number that decreased to 35% when including supplements. This disparity highlights that many Americans are not getting enough vitamin A from their diets, even if they don't show severe deficiency symptoms.

At-Risk American Populations for Vitamin A Inadequacy

While the average American has adequate vitamin A, specific subgroups face a higher risk due to underlying health issues, lifestyle choices, or socioeconomic factors. For these individuals, achieving sufficient intake through diet alone can be challenging. High-risk groups include:

Individuals with fat malabsorption disorders: Conditions like cystic fibrosis, Crohn’s disease, ulcerative colitis, and celiac disease can impede the absorption of fat-soluble vitamins, including vitamin A.
People with liver disease: Since the liver is the primary storage site for vitamin A, any chronic liver disease can interfere with normal vitamin A storage and usage.
Alcohol use disorder: Excessive alcohol consumption can affect the liver's ability to store and metabolize vitamin A.
Premature infants: Born with low liver stores of vitamin A, preterm infants are more susceptible to inadequacy.
Vegans: Those on strict vegan diets may have a higher risk if they do not consume sufficient provitamin A carotenoids, as animal products are a source of preformed vitamin A.
Low-income children and recent immigrants: These groups may have reduced access to a diverse range of nutrient-rich foods.
Ethnic disparities: Some studies have indicated disproportionately higher rates of vitamin A inadequacy in pregnant women of Hispanic/Latino and non-Hispanic Black ancestries, highlighting potential genetic or dietary differences.

Clinical vs. Subclinical Vitamin A Status: A Comparison

The difference between a diagnosable clinical deficiency and a milder, yet widespread, inadequacy is important for understanding public health. Here is a comparison:


Aspect	Clinical Deficiency	Subclinical Inadequacy
Definition	A severe, symptomatic condition resulting from depleted liver stores.	Insufficient dietary intake, leading to low liver stores over time, often without overt symptoms.
Prevalence (U.S.)	Rare, affecting less than 1% of the general population.	More widespread, with up to 45% of adults reporting inadequate intake from food alone.
Diagnostic Marker	Low serum retinol levels (under 20 mcg/dL), specific eye signs like xerophthalmia.	Primarily identified through large-scale dietary intake assessments, like NHANES.
Symptoms	Night blindness, dry eyes, weakened immune system, skin issues, corneal damage.	May have no obvious symptoms initially, but could be associated with increased infection risk or slower growth over time.
Affected Groups	Typically associated with chronic illnesses or severe malnutrition.	Can affect broader segments of the population, including healthy individuals with unbalanced diets.

Signs of Inadequate Vitamin A Intake

Recognizing the more subtle signs of low vitamin A status is key, especially for at-risk groups. While not as severe as clinical deficiency, these symptoms indicate a need for dietary adjustment. They include:

Night blindness: Difficulty adjusting to low light, which is one of the earliest indicators.
Dry skin and eyes: A lack of vitamin A can cause skin to become dry, scaly, or bumpy, and lead to reduced tear production.
Increased infection susceptibility: A weakened immune system can make an individual more prone to respiratory and gastrointestinal infections.
Poor wound healing: Vitamin A plays a role in skin cell repair, so low levels can affect the body's ability to heal.
Infertility: For both men and women, vitamin A is important for reproductive health.

Addressing Nutritional Gaps with Diet and Supplements

For many Americans with inadequate vitamin A intake, improving their diet can effectively bridge the nutritional gap. A balanced intake of both preformed vitamin A (retinol) from animal sources and provitamin A carotenoids from plants is recommended. Key food sources include:

Animal-based (preformed vitamin A): Liver, eggs, and dairy products like milk and cheese.
Plant-based (provitamin A carotenoids): Orange and yellow vegetables (carrots, sweet potatoes, pumpkin), dark green leafy vegetables (spinach, kale, broccoli), and certain fruits (cantaloupe, mango).

In cases of malabsorption or other medical conditions, or for individuals on restrictive diets, supplements may be necessary to ensure adequate vitamin A status. However, it's crucial to consult a healthcare provider, as excessive preformed vitamin A intake, particularly from supplements, can be toxic due to its storage in the body. The NIH provides a comprehensive guide on dietary supplements for those seeking more information on recommended intake levels.(https://ods.od.nih.gov/factsheets/VitaminA-Consumer/)

Conclusion: Beyond the Rare Clinical Case

In conclusion, while the headline figure of clinical vitamin A deficiency remains low in the U.S., it masks a more prevalent issue of nutritional inadequacy. The national average of inadequate dietary intake, coupled with specific high-risk populations facing absorption issues, chronic diseases, and socioeconomic disparities, indicates that vitamin A status is a concern for a significant portion of the American populace. Addressing these gaps requires a targeted approach that combines public health awareness, dietary adjustments, and, for certain individuals, medical oversight regarding supplementation. Understanding this distinction is the first step towards ensuring better nutritional health for all Americans.

Frequently Asked Questions

Inadequacy refers to not consuming enough vitamin A to meet estimated dietary requirements over time. Clinical deficiency is a severe state where liver reserves are depleted, leading to physical symptoms like vision problems.

High-risk groups include people with fat malabsorption disorders (like cystic fibrosis), liver disease, alcohol use disorder, very restrictive diets (such as veganism), and premature infants.

Symptoms can include difficulty seeing in low light (night blindness), dry skin and eyes, poor wound healing, and an increased susceptibility to infections.

Yes, some studies have shown higher proportions of vitamin A inadequacy in specific ethnic groups, particularly among pregnant women of Hispanic/Latino and non-Hispanic Black ancestries.

Preventing inadequacy involves eating a balanced diet rich in both preformed vitamin A from animal sources (e.g., liver, eggs, milk) and provitamin A carotenoids from plants (e.g., carrots, sweet potatoes, spinach).

For those with malabsorption issues or specific dietary needs, supplements may be necessary. However, since vitamin A is fat-soluble and can accumulate to toxic levels, supplements should be used cautiously and ideally with a doctor's guidance.

Clinical vitamin A deficiency is rare in the U.S. and not considered a major public health problem for the general population. The bigger issue is widespread suboptimal intake, which can lead to negative health outcomes over time.