Who are the most vulnerable people regarding vitamin A deficiency in the United States?

November 13, 2025 •

4 min read

While vitamin A deficiency is uncommon in the general United States population, data suggests less than 1% of individuals have low serum retinol levels. Despite this, specific subgroups, particularly those with malabsorption issues, certain medical conditions, and increased nutritional needs, represent the most vulnerable people regarding vitamin A deficiency in the United States.

Quick Summary

This guide details the specific populations within the United States who are most susceptible to vitamin A deficiency, including those with malabsorption disorders, premature infants, individuals with chronic alcoholism, and pregnant or breastfeeding women.

Key Points

Rare but Present: While uncommon in the general US population, vitamin A deficiency disproportionately affects specific at-risk subgroups.
Malabsorption is a Major Cause: Medical conditions affecting fat absorption, including cystic fibrosis, celiac disease, and Crohn's disease, are leading risk factors for VAD.
Increased Needs in Vulnerable Life Stages: Premature infants and pregnant or breastfeeding women have heightened vitamin A requirements, placing them at greater risk.
Socioeconomic Factors Contribute: Poverty, restrictive diets (such as some vegan approaches), and chronic alcoholism can increase a person's vulnerability to deficiency.
Genetics Play a Role: Emerging research indicates that specific genetic variations can affect serum retinol levels and contribute to differences in VAD prevalence across ethnic groups.
Early Intervention is Key: For at-risk individuals, proactive monitoring, dietary adjustments, and supplementation are crucial for preventing serious health complications.

Who Faces the Highest Risk for Vitamin A Deficiency?

Although a significant public health issue in developing nations, severe vitamin A deficiency (VAD) is rare in the United States. However, its rarity in the general population can obscure the fact that certain groups are disproportionately affected due to underlying health conditions, lifestyle factors, and specific life stages. Recognizing these at-risk populations is crucial for prevention and early intervention. The most susceptible individuals often fall into several distinct categories based on physiological and external factors.

Medical Conditions Impairing Absorption and Storage

Since vitamin A is a fat-soluble vitamin, any condition that interferes with the body's ability to digest and absorb fats increases the risk of VAD.

Gastrointestinal Disorders

Chronic issues affecting the digestive system are a primary cause of malabsorption and subsequent VAD. The following conditions put individuals at high risk:

Cystic Fibrosis: Up to 90% of people with cystic fibrosis experience pancreatic insufficiency, which impairs the digestion and absorption of fats, and therefore, fat-soluble vitamins like A. Specialized, lifelong supplementation is standard care for these patients.
Crohn's Disease and Ulcerative Colitis: These inflammatory bowel diseases (IBD) can damage the intestinal lining, hindering nutrient absorption. Studies show a notable percentage of individuals with these disorders develop VAD.
Celiac Disease: An autoimmune disorder where consuming gluten damages the small intestine. This damage can lead to widespread malabsorption, including of vitamin A.
Other Pancreatic and Bile Duct Disorders: Proper fat absorption requires pancreatic enzymes and bile. Conditions affecting the pancreas or blocking bile ducts can severely disrupt this process.

Liver Disorders

The liver is the primary storage site for vitamin A. A compromised liver, due to conditions such as cirrhosis, cannot store the vitamin effectively, depleting the body's reserves over time.

Post-Surgery Patients

Individuals who have undergone bariatric surgery, such as gastric bypass, are at increased risk. The surgical alterations to the digestive tract reduce the surface area available for nutrient absorption, necessitating careful monitoring and supplementation.

Life Stages with Increased Requirements

Certain life stages place a higher demand on the body for vitamin A, creating a window of vulnerability even with normal dietary intake.

Premature Infants

Premature infants are born with very low liver stores of vitamin A. Their rapid growth and developing systems place high demand on these limited reserves, increasing their risk of deficiency and related health complications.

Pregnant and Lactating Women

Pregnancy and breastfeeding significantly increase a woman's vitamin A requirements. Deficiencies during these periods can impact both the mother and the infant, who receives vitamin A through breast milk. Studies have also revealed a higher prevalence of VAD in specific ethnic subgroups of pregnant women, even in resource-rich areas of the U.S..

Lifestyle and Socioeconomic Factors

Dietary choices and socioeconomic status can also predispose individuals to VAD.

Restrictive Diets

Strict vegan diets, if not carefully planned, can lead to VAD. Plant-based sources provide provitamin A carotenoids, which must be converted to active vitamin A. Animal-based foods contain preformed vitamin A, which is more readily absorbed. While fortified foods help, relying solely on plant sources without adequate dietary fat can be problematic for some.

Chronic Alcoholism

Excessive alcohol consumption interferes with vitamin A metabolism and impairs liver function, disrupting its storage capabilities.

Socioeconomic Status and Immigrants

Toddlers and preschool children living in poverty are at higher risk due to potentially inconsistent access to nutritious, vitamin A-rich foods. Recent immigrants and refugees, particularly from regions where VAD is endemic, may also be at risk due to poor nutritional status upon arrival or limited access to adequate food.

Comparison of At-Risk Groups and Risk Factors


Vulnerable Group	Primary Risk Factor(s)	Underlying Cause	Prevention Strategy
Cystic Fibrosis Patients	Fat Malabsorption	Pancreatic insufficiency prevents fat and vitamin A absorption	Lifelong pancreatic enzymes and fat-soluble vitamin supplementation
Premature Infants	Low stores at birth	Immature liver and rapid growth increase demand on limited reserves	Supplementation, careful monitoring
Pregnant/Lactating Women	Increased physiological needs	Higher demand for fetal development and milk production	Ensure adequate intake from diet or supplements
Bariatric Surgery Patients	Reduced absorption	Surgical changes to the GI tract limit nutrient uptake	Consistent monitoring and supplementation
Vegans	Dietary source	Reliance on less bioavailable provitamin A from plant sources	Balanced diet rich in beta-carotene; consider fortification
Chronic Alcoholics	Impaired metabolism and storage	Alcohol use disrupts liver function and vitamin conversion	Address alcoholism; monitor liver function and nutritional status

Proactive Strategies for Prevention

For many at-risk groups, prevention involves working with healthcare providers to develop tailored dietary and supplementation plans. A varied diet that includes both preformed vitamin A (found in animal products like liver, eggs, and fortified milk) and provitamin A carotenoids (from fruits and vegetables like carrots, sweet potatoes, and spinach) is the foundation of preventing VAD. For individuals with absorption issues or specific genetic predispositions, high-quality supplements may be necessary to ensure adequate levels. For more information on vitamin A, consult the NIH's Office of Dietary Supplements fact sheet on Vitamin A and Carotenoids.

Conclusion

Although uncommon in the broader US population, vitamin A deficiency is a real concern for several vulnerable groups. Individuals with malabsorption disorders like cystic fibrosis and Crohn's disease, those in certain high-demand life stages such as premature infants and breastfeeding women, and those with lifestyle factors like chronic alcoholism or restrictive vegan diets face elevated risk. Ethnic and socioeconomic factors can also play a role in susceptibility. By recognizing these populations, healthcare providers and individuals can implement effective monitoring and intervention strategies to prevent the potentially severe health consequences of VAD.

Frequently Asked Questions

No, clinical vitamin A deficiency is considered rare in the general US population due to widespread access to nutritious food. However, it is a concern for specific at-risk groups with medical conditions, unique dietary needs, or socioeconomic challenges.

Conditions that disrupt fat absorption are primary causes. These include gastrointestinal disorders like cystic fibrosis, celiac disease, Crohn's disease, and ulcerative colitis, as well as liver disorders and complications from bariatric surgery.

Yes, pregnant and lactating women have increased vitamin A requirements to support fetal development and milk production. While supplementation is often recommended, excessive intake should be avoided.

A poorly planned vegan diet can increase risk because it lacks preformed vitamin A found in animal products. Vegans must ensure they consume sufficient provitamin A carotenoids from sources like carrots, sweet potatoes, and leafy greens and pair them with healthy fats to aid absorption.

Chronic alcoholism can impair the liver's ability to store vitamin A and disrupt its metabolism. The liver is the body's main storage site for vitamin A, so damage to this organ significantly increases deficiency risk.

Premature infants are born with low vitamin A stores because they have not completed the full term of gestation. Their rapid growth rates also create higher demands, increasing their susceptibility to deficiency.

Lower socioeconomic status can impact access to varied, nutrient-dense foods, increasing the risk of deficiency in vulnerable groups like toddlers and preschool children. Recent immigrants and refugees may also be at risk due to nutritional status from their home countries.