Food and Behaviour Research

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Vitamin A Deficiency Due to Selective Eating as a Cause of Blindness in a High-Income Setting.

Martini S, Rizzello A, Corsini I, Romanin B, Fiorentino M, Grandi S, Bergamaschi R. (2018) Pediatrics Apr 2018 141(Suppl 5) S439-S444 doi: 10.1542/peds.2016-2628.

Web URL: Read this and related abstracts on PubMed here


Vitamin A is a fat-soluble micronutrient involved in the regulation of several physiologic functions, such as visual acuity, epithelial tissue integrity, immune response, and gene expression, thus playing a crucial role in childhood growth and development.

Although vitamin A deficiency (VAD) in resource-limited settings is still an actual issue and represents the leading cause of preventable childhood blindness, its occurrence in high-income countries is rare, although possibly underdiagnosed because of its nonspecific early manifestations.

A good awareness of VAD symptoms and risk factors could aid its early diagnosis, which is fundamental to undertake a prompt treatment and to prevent ocular complications. Nevertheless, the role of restrictive dietary habits, increasingly common in developed countries, is often overlooked in infants and children.

We present a case of VAD with permanent ocular sequelae in a 5-year-old girl from a high-income country. In the case described, VAD ensued from a highly restricted diet, mainly limited to oat milk, which had been followed for more than 2 years.

This child presented with ocular symptoms, opportunistic infection, anemia, poor growth, and a diffuse squamous metaplasia of the bladder; after commencing retinol supplementation, a gradual healing of clinical VAD manifestations occurred, with the exception of the ocular sequelae, which resulted in irreversible visual loss.


As this case report makes clear, while severe deficiencies in essential nutrients such as Vitamin A may be thankfully rare in developed, high-income countries, their possibility should never be overlooked by clinicians.

In this case, a young girl suffered irreversible loss of vision after following a highly resrticted diet for over 2 years.  Severe Vitamin A deficiency was identified in the end - but by then it was too late to save her sight.

Recent years have seen a increase in the number of children with selective - and seriously restricted - eating patterns. These are often (but by no means always) associated with Autism Spectrum Disorder or other developmental conditions.

Given the fundamental importance of nutrition, asking some questions about diet always makes sense.  However, many health professionals need more nutritional education and training themselves, as there is still minimal attention paid to nutrition in most medical training courses.

Doctors also need to be able to make referrals to specialist dietitians - or other suitably qualified professionals - when needed, to help these children and their families to avoid serious malnutiriton.

For more information on selective eating, see: