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In order to address this problem, the World Health Organization recommends periodic high\u2010dose supplementation to children 6\u201359\u00a0months of age in areas of highest risk. Originally, supplementation was meant as a short\u2010term solution until more sustainable interventions could be adopted. Currently, many countries are fortifying commercialized common staple and snack foods with retinyl palmitate. However, in some countries, overlapping programs may lead to excessive intakes. Our review uses case studies in the United States, Guatemala, Zambia, and South Africa to illustrate the potential for excessive intakes in some groups. For example, direct liver analysis from 27\u00a0U.S. adult cadavers revealed 33% prevalence of hypervitaminosis A (defined as \u22651\u00a0\u03bcmol\/g liver). In 133 Zambian children, 59% were diagnosed with hypervitaminosis A using a retinol isotope dilution, and 16% had \u22655% total serum VA as retinyl esters, a measure of intoxication. In 40 South African children who frequently consumed liver, 72.5% had \u22655% total serum VA as retinyl esters. All four countries have mandatory fortified foods and a high percentage of supplement users or targeted supplementation to preschool children.<\/jats:p>","DOI":"10.1111\/nyas.13965","type":"journal-article","created":{"date-parts":[[2018,9,28]],"date-time":"2018-09-28T22:43:23Z","timestamp":1538174603000},"page":"102-116","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":47,"title":["Overlapping vitamin A interventions in the United States, Guatemala, Zambia, and South Africa: case studies"],"prefix":"10.1111","volume":"1446","author":[{"given":"Sherry A.","family":"Tanumihardjo","sequence":"first","affiliation":[{"name":"Department of Nutritional Sciences University of Wisconsin\u2010Madison  Madison Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chisela","family":"Kaliwile","sequence":"additional","affiliation":[{"name":"National Food and Nutrition Commission  Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erick","family":"Boy","sequence":"additional","affiliation":[{"name":"HarvestPlus  Washington DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad A.","family":"Dhansay","sequence":"additional","affiliation":[{"name":"Burden of Disease Research Unit South African Medical Research Council  Cape Town South Africa"},{"name":"Division of Human Nutrition, Faculty of Medicine and Health Sciences University of Stellenbosch  Cape Town South Africa"},{"name":"Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences University of Stellenbosch  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha E.","family":"van Stuijvenberg","sequence":"additional","affiliation":[{"name":"Non\u2010Communicable Diseases Research Unit South African Medical Research Council  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,9,28]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"World Health Organization.2011.Guideline: vitamin A supplementation in infants and children 6\u201359 months of age. 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