Usefulness of vitamin A isotope methods for status assessment: from deficiency through excess

A variety of methods exist to assess vitamin A status of groups and populations. Vitamin A status is usually defined by the liver retinol concentration. Most indicators of status do not measure or estimate liver stores of retinol. Clinical signs only have utility when liver reserves are almost exhausted, and serum retinol concentrations have utility in the zone of overt deficiency. Dose response tests offer more coverage, but cannot distinguish among liver vitamin A stores in the adequate through toxic range. Different countries continue, or are beginning, to add preformed vitamin A to a variety of staple foods through fortification, and vitamin A supplements are still being distributed in many countries, especially to preschool children. Further, provitamin A biofortified crops are currently being released in several countries. Assessing population vitamin A status in response to these interventions needs to move beyond serum retinol concentrations. Indicators that work in the excessive to toxic range of liver reserves are needed. To date, the only indirect indicator that has been validated in this range of liver reserves in animals and humans is the retinol isotope dilution test using deuterium or 13C, which spans the entire liver reserve continuum from deficiency through excess.