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Vitamin A

Related Terms

3,7-Dimethyl-9-(2,6,6,trimethyl-1-cyclohexen-1-yl)-2,4,6,8-natetraen-1-ol, 3-dehydroretinol, Accutane?, acitretin, adapalene, alitretinoin, all-trans retinoic acid, Altinac?, Amnesteem?, antixerophthalmic vitamin, Aquasol A?, Avita?, axerophtholum, beta-carotene, beta-carotene oleovitamin A, bexarotene, carotenoids, Differin?, etretinate, isotretinoin, Palmitate-A?, Renova?, Retin-A?, Retin-A Micro?, retinaldehyde (RAL), retinyl acetate, retinyl N-formyl aspartamate, retinyl palmitate, retinoic acid, retinol, Solatene?, Soriatane?, SourceCF?, Targretin?, tazarotene, Tazorac?, Tegison?, topical retinoids, tretinoin, Vesabiod?, Vesanoid?, Vitamax?, vitamin A USP, vitamin A1, vitamina A, vitaminum A.

Background

Vitamin A is a fat-soluble vitamin that comes from two sources: preformed retinoids and provitamin carotenoids. Retinoids, such as retinal and retinoic acid, are found in animal sources such as liver, kidney, eggs, and dairy products. Carotenoids, such as beta-carotene (which has the highest vitamin A activity), are found in plants such as dark or yellow vegetables and carrots.

Natural retinoids are present in all living organisms, either as preformed vitamin A or as carotenoids, and are required for biological processes such as vision and cellular growth. A major biologic function of vitamin A (as the metabolite retinal) is in the visual cycle. Research also suggests that vitamin A may reduce death from measles, prevent some types of cancer, aid in growth and development, and improve immune function.

Recommended dietary allowance (RDA) levels for vitamin A oral intake have been established by the U.S. Institute for Medicine of the National Academy of Sciences to prevent deficiencies in vitamin A. At recommended doses, vitamin A is considered nontoxic. Excess dosing may lead to short or long-term toxicity.

Vitamin A deficiency is rare in developed nations but remains a concern in developing countries, particularly in areas where poor nutrition is common. Prolonged deficiency can lead to xerophthalmia (dry eye) and ultimately to night blindness or total blindness, as well as to skin disorders, infections (such as measles), diarrhea, and lung disorders.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *

Retinoids that are applied to the skin are considered among the best treatments for acne. Tretinoin (all-trans retinoic acid) and other forms of vitamin A, retinoids, and oral prescription medications, such as isotretinoin (Accutane?), are available for treatment. Isotretinoin may cause severe side effects, such as burning, erythema, and pruritus, and should be used only for severe resistant acne. Adapalene (Differin?) is also effective and reported to have fewer side effects. Another retinoid, tazarotene (Tazorac?), has been shown to be superior to either tretinoin or adapalene. In general, retinoid use (including tretinoin) must be avoided in women that are pregnant, plan to become pregnant, or have a chance of being pregnant, due to a risk of severe birth defects. These medications should be prescribed by a qualified licensed healthcare professional. Multiple retinoid use should be avoided, due to a risk of increased toxicity.

A

The prescription drug all-trans retinoic acid (ATRA, Vesanoid?) is a form of vitamin A that is a recognized treatment for acute promyelocytic leukemia that improves survival in this disease. Treatment should be under strict medical supervision. Other vitamin A forms should not be used at the same time with ATRA, due to a risk of increased toxicity.

A

Vitamin A deficiency has been shown to impair iron use, as well as impair red blood cell formation, and increase the risk of infection. Vitamin A supplementation has been shown to raise hemoglobin levels and serum iron concentrations, particularly in children and pregnant women. It has also been shown to enhance the efficacy of iron supplementation in patients with vitamin A deficiency and iron deficiency anemia.

A

Prolonged vitamin A deficiency can lead to xerophthalmia (dry eye). It is widely seen in rural, underdeveloped areas, such as India and Southeast Asia. Oral vitamin A is the treatment of choice for xerophthalmia caused by prolonged vitamin A deficiency, and it should be given immediately once the disorder is established. Bitot's spot, or the buildup of keratin debris in the conjunctiva, is a sign of xerophthalmia and may also be treated with vitamin A supplementation.

A

Retinitis pigmentosa is a genetic disorder that affects night vision. Early symptoms include night blindness and loss of vision over time. Based on recent findings, vitamin A in the palmitate form has been recommended in patients with retinitis pigmentosa.

A

Limited research suggests that vitamin A may reduce fever, morbidity, and parasite blood levels in patients with malaria (Plasmodium falciparum infection). However, there is a lack of evidence suggesting that vitamin A is equal to or superior to well-established drug therapies used for the prevention or treatment of malaria. Patients with malaria or those who are living or traveling in diseased areas should speak with a physician about appropriate measures.

A

Vitamin A should be given to children diagnosed with measles in areas where vitamin A deficiency may be present. Measles is a viral disease that can lead to diarrhea, pneumonia (lung infection), and encephalitis (inflammation of the brain). In children with measles, vitamin A has been shown to be beneficial by decreasing the length and impact of the disease. Side effects such as diarrhea, pneumonia, and death have been reduced with the use of vitamin A. Management of measles should be under strict medical supervision.

A

Vitamin A is needed for healthy growth and development, and recommended dietary allowances (RDAs) should be assured, particularly in children. Major causes of vitamin A deficiency in children are maternal vitamin A deficiency (thus low levels of vitamin A in breast milk), inadequate vitamin A intake upon weaning, and prevalent illness. Experts have maintained that in developing countries, diet alone is insufficient to maintain adequate vitamin A levels in children. Vitamin A is associated with a reduced risk of mortality (death) in children.

A

Some studies suggest that topical tretinoin (all-trans retinoic acid, the acid form of vitamin A) may improve sun damaged skin. Common adverse effects are skin pain and redness.

A

Vitamin A deficiency is generally rare in industrialized nations. In developing countries, diet alone may be insufficient to maintain adequate vitamin A levels, especially in children. Vitamin A supplementation can help prevent or treat vitamin A deficiency.

A

Photorefractive keratectomy is a type of laser eye surgery used to correct nearsightedness. High-dose vitamin A use in addition to vitamin E has been suggested to help improve eye healing after surgery and to improve visual acuity, although additional evidence is necessary before a definitive conclusion can be reached.

B

The role of vitamin A in the prevention, transmission, or treatment of HIV is controversial and not well established. A clear conclusion cannot be formed based on the available scientific research.

B

Vitamin A may improve clinical resolution of oral leukoplakia (white patches or plaque in the mouth), although relapse is common. Further research is required.

B

Although this has not been well studied in humans, the use of vitamin A and carotenoids may be useful in the prevention of age-related macular degeneration. Further research is required.

C

Vitamin A intake is inversely associated with asthma risk and severity. A clear conclusion cannot be formed based on the available scientific research.

C

Vitamin A and D ointment may be useful for sore and cracked nipples that occur during breastfeeding. However, available studies have not shown vitamin A or any other topical therapy to relieve the pain of breastfeeding.

C

Vitamin A is thought to be important in immune function. A clear conclusion cannot be formed on the effects of vitamin A on bronchiolitis (inflammation of the bronchioles) based on the available scientific research.

C

Research results are lacking as to whether vitamin A is beneficial for bronchopulmonary dysplasia in premature infants. Further research is needed.

C

Research has shown mixed results for cancer risk reduction with vitamin A use, and some studies suggest an increased risk of cancer with vitamin A supplementation. According to a review of epidemiological studies, beta-carotene may be most beneficial in prevention of renal cancer, while vitamin A appears to be harmful in heavy smokers at risk for lung cancer. Further research is needed to clarify risk status in various populations.

C

Antioxidants have been suggested in delaying cataract progression. However, research suggests that beta-carotene lacks the ability to reduce risk. Further trials are required to form conclusions.

C

Human research suggests that vitamin A may have protective effects in cervical cancer. Compared to low intakes and low serum levels, high intake and high serum levels were associated with a decreased risk of cervical cancer. Further, high quality research is needed.

C

The effect of vitamin A supplementation on chemotherapy-related side effects, including nausea, vomiting, diarrhea, or mouth sores, is unclear. Also, it is unclear if vitamin A interacts with chemotherapy agents. Further research is needed.

C

Alpha-carotene and vitamin A may protect against recurrence of colorectal cancer in nonsmokers and nondrinkers. Further research is needed before a conclusion can be drawn.

C

In people with cystic fibrosis, intake and absorption of fat-soluble antioxidants such as carotenoids are reportably lower. However, high-quality human research is lacking, and further research is needed in this field.

C

Some forms of vitamin A may be beneficial in liver cancer prevention. Acyclic retinoid is a synthetic retinoid that has been shown to inhibit cell growth in liver cancer cells. Further research is needed.

C

There is insufficient evidence on the use of antioxidant supplements (including vitamin A) in patients with liver disease. More research is needed in this area.

C

Vitamin A has been studied as a possible treatment for lung cancer, without evidence of benefits. The available evidence suggests that high-dose vitamin A and beta-carotene may actually increase the risk of adverse effects, especially among alcohol users and smokers.

C

Poor nutrition is associated with an increased risk of miscarriage. However, excess intake of vitamin A has been reported to increase the risks of some birth defects. Vitamin A supplementation above the recommended daily amount is not advised in pregnancy.

C

Adequate vitamin A (either through diet or supplementation) appears to have a major role in the prevention of morbidity and mortality. Further research is needed.

C

Maternal supplementation of vitamin A shortly after childbirth provides limited number of benefits to maternal health status. A clear conclusion is lacking based on the available scientific research.

C

Vitamin A supplementation during pregnancy and lactation does not appear to reduce infant morbidity and mortality; however, it does appear to reduce maternal morbidity. A clear conclusion cannot be formed based on the available scientific research.

C

Early research suggests a positive effect of retinoid treatment for oral lichen planus; however, more research is required to form conclusions.

C

In developing countries, and in diets of developed countries where limited amounts of vitamin A are consumed, vitamin A intake is of concern. Upon analysis of small fish consumed in developing countries, high levels of vitamin A, iron, and zinc were collected, suggesting an alternative source to increase micronutrient intake. In young children under the age of two, fortified milk and cereals increased levels of vitamin A, and according to some research, micronutrient powders decreased iron deficiency and anemia. Further research is required to make conclusions of vitamin A intake in these populations.

C

Research of vitamin A intake suggests a lack of relationship between self-recalled antioxidant consumption from foods and ovarian cancer risk; however, adolescent intake appeared to reduce risk by 46%. Further research is needed to make conclusions based on these findings.

C

After deworming, children supplemented with vitamin A may be less prone to the Ascaris parasite reinfection. These benefits may be less in children with stunted growth. More research is needed in this area.

C

It is unclear whether dietary vitamin A affects prostate cancer risk. Interventional studies are lacking. More research is needed in this area.

C

The use of vitamin A in psoriasis treatment has been reviewed and discussed. Research has shown that treatment with vitamin A reduces psoriasis symptoms.

C

In some research, vitamin A supplementation appeared to reduce symptoms of chronic radiation proctopathy (damage from pelvic radiation); however, significance was lacking. Further research is needed to form conclusions.

C

Isotretinoin is a well-known treatment for rosacea; however, high quality studies and optimal dosages are lacking. Future research is needed.

C

It is unclear if vitamin A or beta-carotene, taken by mouth or used on the skin with sunscreen, is beneficial in the prevention or treatment of skin cancers or wrinkles.

C

Higher intakes of beta-carotene and vitamin A were associated with reduced risk of esophageal adenocarcinoma. There is insufficient evidence to form a clear conclusion at this time.

C

There is insufficient evidence to assess the use of vitamin A for tuberculosis. Further research is needed before a conclusion can be drawn

C

Vitamin A supplementation has been suggested to help prevent NoV infection in children and to reduce the symptoms associated with NoV infections. More research is needed in this area.

C

Daily vitamin A with calcium has been suggested for weight loss. In one study, an average loss of two pounds was reported after two years of supplementation in young women. More research is needed in this area.

C

In preliminary research, vitamin A (retinol palmitate) significantly reduced rectal symptoms of radiation proctopathy (damage from pelvic radiation), perhaps because of wound-healing effects. Further research is needed to confirm these results.

C

The available evidence lacks support for the treatment of any form of arthritis with vitamin A (or combination products containing vitamin A). Further research is needed to confirm these results.

D

Research has suggested that beta-carotene in combination with other antioxidants may reduce mortality in individuals with breast cancer, but the effects of beta-carotene alone are lacking. A reduction in breast cancer risk was reported with high vitamin A or retinol intake; however, significant concerns still exist. Additional research is needed before a conclusion may be made.

D

Vitamin A is necessary for healthy growth and development, and recommended dietary amounts should be assured, particularly in children. Overall, the available evidence has shown a lack of any significant changes in growth in children with respect to height and weight due to vitamin A.

D

Overall evidence lacks the support of vitamin A use in HIV-infected pregnant women to reduce mother-to-child transmission of HIV.

D

Overall, studies suggest a lack of effect of vitamin A supplementation shortly after childbirth on infant mortality.

D

Overall, studies suggest a lack of effect of prenatal vitamin A supplementation on perinatal or neonatal infant mortality.

D

There is a lack of effect of vitamin A on mortality as reported in some research; however, in developing countries, vitamin A supplementation appeared to be helpful in reducing mortality up to six months of age. Further research is needed in this area.

D

Some research has shown that isotretinoin lacks a significant effect on the incidence of inflammatory bowel disease (IBD), Crohn's disease (CD), or ulcerative colitis (UC). Additional high quality research is needed before a conclusion may be made.

D

There is insufficient evidence to support the use of vitamin A for the reduction of pneumonia or mortality in children without measles. More research is needed in this area.

D

Evidence suggests that vitamin A fails to reduce the rates of gastric cancer or precancerous gastric lesions and also links vitamin A supplementation with increased mortality.

F

* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)

Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

Dosing

Adults (18 years and older)

Vitamin A is found in dairy products, fish, and darkly colored fruits and vegetables. Five servings of fruits and vegetables daily supplies 5-6 milligrams of provitamin A carotenoids, which provides about 50-65% of the adult recommended dietary allowance (RDA) for vitamin A.

Vitamin A is included in most multivitamins, and the U.S. recommended dietary allowance (RDA) for adults is as follows: 900 micrograms daily (3,000 IU) for men and 700 micrograms daily (2,300 IU) for women; for pregnant women 19 years old and older, 770 micrograms daily (2,600 IU); and for lactating women 19 years old and older, 1,300 micrograms daily (4,300 IU).

For vitamin A deficiency, unrelated to xerophthalmia (dry eye), vitamin A has been given at a daily dose of 100,000 IU by mouth or intramuscularly for three days, followed by 50,000 IU daily for two weeks. After two weeks, daily doses of 10,000-20,000 IU have been given for two months. In mothers six weeks after childbirth, either 400,000 IU of vitamin A (in two doses separated by 24 hours) or 200,000 IU as one dose (plus placebo 24 hours later) has been taken.

For community based intervention, a single dose of 200,000 IU has been given by mouth as monthly doses for six months, four months, or one month.

For acne, isotretinoin was given by mouth daily as 0.5-0.7 milligrams per kilogram (normal and intermittent dose) or 0.25-0.4 milligrams per kilogram daily (low-dose) for one out of every four weeks. Vitamin A and retinoids are available as gels, creams, and liquids and are typically applied to the skin once daily but can be used every other day if poorly tolerated. Tretinoin 0.025% and adapalene 0.1% have been applied to the skin once to twice daily for up to 16 weeks.

For acute promyelocytic leukemia (treatment), all-trans retinoic acid (Vesanoid? (tretinoin)) has been administered as follows: 45 milligrams per square meter of body surface area daily by mouth, as two evenly divided doses until complete remission; therapy should be discontinued 30 days after the achievement of complete remission or after 90 days of treatment, whichever occurs first. In addition, 25-45 milligrams per square meter daily or 30-40 milligrams of all trans-retinoic acid (ATRA) has been taken daily for two to three years.

For arthritis, 0.5 milligrams per kilogram of etretinate (vitamin A form) was taken daily for four weeks then reduced to 0.25 milligrams per kilogram daily if there was a lack of improvement or if side effects were observed. Vitamin A was also given as 50,000 IU daily for three weeks; however, further research concluded that there was a lack of convincing evidence that vitamin A is effective for treating any type of arthritis.

For breast cancer, 1,000-6,000 milligrams of retinol and 3,000 IU-10,000 IU of vitamin A has been taken daily.

For cancer of the stomach and intestine, 5,000 IU and 50,000 IU have been administered in weekly doses; however, research suggests that these doses of vitamin A may have been associated with an increased risk of mortality.

For cancer (general), 20-50 milligrams of beta-carotene was given by mouth daily or every other day for 5-12 years.

For cancer-related side effects, weekly injections of 100,000 IU of vitamin A have been used.

For cervical cancer, vitamin A supplementation (dosing information was lacking) was taken for 1-3 years.

For colorectal cancer, 25,000 IU of vitamin A in combination with 30 milligrams of beta-carotene has been taken once daily for up to seven years with a lack of effect.

For HIV support, a large dose of vitamin A (400,000 IU in adults and 50,000 IU in infants) was given to women and infants shortly after birth for two years. In other research, high doses (180 milligrams daily or 600,000 IU) of beta-carotene were given for one month. Lower doses of vitamin A (10,000 IU daily) have also been given to adults in areas of high prevalence of vitamin A. Additionally, 200,000-300,000 IU have been given for 4-8 weeks, but reported a lack of benefit on CD4 counts and viral load.

For infant mortality (given to the mother during pregnancy), pregnant women with HIV received iron and folate, either alone or combined with vitamin A (three milligrams of retinol equivalents) daily by mouth from 18-28 weeks of gestation. In other research, pregnant women took 7,000 micrograms of retinol equivalents of vitamin A (as four milligrams of all-trans beta-carotene retinyl palmitate) or 42 milligrams of beta-carotene once weekly by mouth during pregnancy; moreover, vitamin A (5,000 IU-23,300 IU) has been taken with our without 30 milligrams of beta-carotene during pregnancy. Also during 12-24 weeks of gestation, vitamin A (5,000 IU or 10,000 IU) was taken by mouth daily. Doses of 200,000 IU weekly and 200,000 IU at the time of delivery have also been used.

For infant mortality (given to mother shortly after childbirth), vitamin A (?200,000 IU or >200,000 IU) has been given as a single dose or as multiple doses to mothers within six weeks of delivery. Doses consisting of 200,000-400,000 IU of vitamin A or 7.8 milligrams of beta-carotene, alone or in combination with another supplement, have also been taken daily by mouth.

For inflammation of the oral mucosa (oral lichen planus), 0.1% tretinoin or 0.05-0.18% isotretinoin two to three times daily for 8-16 weeks, 0.05% retinoic acid four times daily for four weeks, and 0.1% vitamin A twice daily for up to seven days have been applied to the mouth.

For liver disease, daily amounts of 5,000 IU of vitamin A have been taken for six months or 10,000 IU for four months.

For lung cancer, 20-50 milligrams of beta-carotene was taken by mouth daily or every other day for 5-12 years.

For treating lung cancer, 0.5-1 milligram per kilogram of 13-cis-retinoic acid has been given daily for 11 weeks to one year; for the prevention of primary lung cancer, 25,000 IU retinyl palmitate daily in combination with 30 milligrams of beta-carotene or 22.5 milligrams of zinc daily for 13 months to 5.5 years has been used; and for the prevention of secondary lung cancer, 150,000-300,000 IU retinyl palmitate daily or 10-30 milligrams of isotretinoin every other day for one to two years has been used. Additionally, all-trans retinoic acid (ATRA) 20 milligrams per square meter of body surface area has been used injected daily in combination with cisplatin and paclitaxel.

For mortality reduction, 1,333-200,000 IU of vitamin A trials has been taken daily or every other day for 28 days to nine years, with a lack of effect on all-cause mortality.

For mortality reduction (for the mother shortly after childbirth), vitamin A has been taken during pregnancy at doses ranging from 5,000-10,000 IU daily, about 200,000 IU weekly, and 200,000 IU at the time of delivery.

For oral leukoplakia, vitamin A (as retinyl acetate) was given by mouth at doses of 300,000 IU weekly for 12 months, 200,000 IU of vitamin A (form unclear) weekly (0.14 milligrams per kilogram of body weight) daily for six months, or 13-cis-retinoic acid 1-2 milligrams per kilogram of body weight daily for three months. In addition, 0.05-0.18% isotretinoin gel three times daily for four months, 0.05% tretinoin gel four times daily for a mean follow-up of 23 months, or 20 milligrams of acitretin daily have been applied to the mouth.

For psoriasis, one milligram per kilogram of retinoids was taken daily (frequency information lacking). Additionally, 10-75 milligrams of acitretin was taken by mouth daily either alone or in combination with psorlen plus ultraviolet A/B (PUVA/PUVB) light, and one milligram per kilogram or 75 milligrams of etretinate was taken by mouth daily for six weeks to 12 months.

For radiation therapy side effects, 10,000 IU retinol palmitate was taken daily for 90 days.

For retinitis pigmentosa (vision disorder), the National Eye Institute (NEI) recommends that patients with typical forms of retinitis pigmentosa receive 15,000 IU of vitamin A palmitate daily under medical supervision.

For skin cancer, 100,000 IU of vitamin A was taken daily by mouth for 18 months; however, there was an overall lack of benefit with vitamin A therapy.

For skin damage caused by the sun, 0.02% or higher doses of tretinoin have been applied to sun-damaged skin once daily for a treatment duration of 4-11 months; other retinoids, tazarotene 0.01-0.1% and isotretinoin 0.1%, were also applied to the skin once daily.

For tuberculosis, 5,000-200,000 IU has been taken three times before starting tuberculosis therapy with one study having a treatment duration of six months.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Interactions

Interactions with Drugs

Vitamin A may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants (blood thinners) such as warfarin (Coumadin?) or heparin, antiplatelet drugs such as clopidogrel (Plavix?), and nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin?, Advil?) or naproxen (Naprosyn?, Aleve?).

Vitamin A may interfere with the way the body processes certain drugs using the liver's cytochrome P450 enzyme system. As a result, the levels of these drugs may be increased or decreased in the blood and may cause increased or decreased effects or potentially serious adverse reactions. Patients using any medications should check the package insert and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.

Vitamin A may cause low blood pressure. Caution is advised in people taking drugs that lower blood pressure.

Vitamin A may also interact with agents for depression, agents for diarrhea, agents for lowering cholesterol, agents for the stomach and for intestine disorders, agents for weight loss, agents for worm infections, agents that affect the nervous system, agents that affect the liver, alcohol, antibiotics, anticancer agents, antifungals, antimalarials, antivirals, birth control agents taken by mouth, folate agents, iron salts, mineral oil, nicotine, orlistat, osteoporosis agents (for decreased bone density), phytonadione (vitamin K), retinoids, skin disorder agents, thyroid agents, vaccines, and valproic acid.

Attribution

This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

Armstrong AW, Cheeney S, Wu J, et al. Harnessing the power of crowds: crowdsourcing as a novel research method for evaluation of acne treatments. Am J Clin.Dermatol. 12-1-2012;13(6):405-416.

Bjelakovic G, Nikolova D, Gluud LL, et al. Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. Cochrane.Database.Syst.Rev. 2012;3:CD007176.

Bremner JD, Shearer KD, and McCaffery PJ. Retinoic acid and affective disorders: the evidence for an association. J Clin.Psychiatry 2012;73(1):37-50.

Cortes-Jofre M, Rueda JR, Corsini-Munoz G, et al. Drugs for preventing lung cancer in healthy people. Cochrane.Database.Syst.Rev. 2012;10:CD002141.

Etminan M, Bird ST, Delaney JA, et al. Isotretinoin and risk for inflammatory bowel disease: a nested case-control study and meta-analysis of published and unpublished data. JAMA Dermatol. 2013;149(2):216-220.

Gamble R, Dunn J, Dawson A, et al. Topical antimicrobial treatment of acne vulgaris: an evidence-based review. Am J Clin.Dermatol. 6-1-2012;13(3):141-152.

Girard AW, Self JL, McAuliffe C, et al. The effects of household food production strategies on the health and nutrition outcomes of women and young children: a systematic review. Paediatr.Perinat.Epidemiol 2012;26 Suppl 1:205-222.

Hanson B, MacDonald R, and Shaukat A. Endoscopic and medical therapy for chronic radiation proctopathy: a systematic review. Dis.Colon Rectum 2012;55(10):1081-1095.

Masetti R, Biagi C, Zama D, et al. Retinoids in pediatric onco-hematology: the model of acute promyelocytic leukemia and neuroblastoma. Adv.Ther. 2012;29(9):747-762.

Masset E, Haddad L, Cornelius A, et al. Effectiveness of agricultural interventions that aim to improve nutritional status of children: systematic review. BMJ 2012;344:d8222.

Thorne-Lyman AL and Fawzi WW. Vitamin A and carotenoids during pregnancy and maternal, neonatal and infant health outcomes: a systematic review and meta-analysis. Paediatr.Perinat.Epidemiol 2012;26 Suppl 1:36-54.

Wallace A, Ryman T, Mihigo R, et al. Strengthening evidence-based planning of integrated health service delivery through local measures of health intervention delivery times. J Infect.Dis. 2012;205 Suppl 1:S40-S48.

Wallace AS, Ryman TK, and Dietz V. Experiences integrating delivery of maternal and child health services with childhood immunization programs: systematic review update. J Infect.Dis. 2012;205 Suppl 1:S6-19.

Zeichner JA. Optimizing topical combination therapy for the treatment of acne vulgaris. J Drugs Dermatol. 2012;11(3):313-317.

Zhang X, Dai B, Zhang B, et al. Vitamin A and risk of cervical cancer: a meta-analysis. Gynecol.Oncol. 2012;124(2):366-373.

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