Iron deficiency can affect vitamin A uptake; other causes include fibrosis, pancreatic insufficiency, inflammatory bowel disease, and small-bowel bypass surgery. Protein energy malnutrition is often seen in VAD; suppressed synthesis of retinol binding protein (RBP) due to protein deficiency leads to reduced retinol uptake. Excess alcohol consumption can deplete vitamin A, and a stressed liver may be more susceptible to vitamin A toxicity. People who consume large amounts of alcohol should seek medical advice before taking vitamin A supplements. In general, people should also seek medical advice before taking vitamin A supplements if they have any condition associated with fat malabsorption such as pancreatitis, cystic fibrosis, tropical sprue, and biliary obstruction. Other causes of vitamin A deficiency are inadequate intake, fat malabsorption, or liver disorders. Deficiency impairs immunity and hematopoiesis and causes rashes and typical ocular effects (e.g., xerophthalmia, night blindness). Diagnosis
Initial assessment may be made based on clinical signs of VAD. Conjunctival impression cytology can be used to assess the presence of xerophthalmia which is strongly correlated with VAD status (and can be used to monitor recovery progress). Several methods of assessing bodily vitamin A levels are available, with HPLC the most reliable. Measurement of plasma retinol levels is a common laboratory assay used to diagnose VAD. Other biochemical assessments include measuring plasma retinyl ester levels, plasma and urinary retonioic acid levels, and vitamin A in breast milk. Prevention and treatment
Treatment of VAD can be undertaken with both oral vitamin A and injectable forms, generally as vitamin A palmitate.
Makena may refer to:

Makena Onjerika, Kenyan writer and 2018 Caine Prize winner
A brand name of hydroxyprogesterone caproate
Makena, Hawaii, a census-designated place in Maui County, Hawaii
Makena State Park
Makena Beach & Golf Resort, a resort in Maui

See also
McKenna (disambiguation)
MacKenna (disambiguation)