Yasser Al Nasser; Mohammed Albugeaey1. Affiliations Last Update: December 6, Beta-Carotene is the main carotenoid found in plants and is most responsible for this condition. Although benign, this condition is often confused with jaundice, leading to unnecessary investigations.
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A history of excessive carotene intake consistent with the diagnosis of hypercarotenemia is usually present. Metabolic carotenemia without a history of excessive carotene intake may be due to a genetic defect in the metabolism of carotenoids. As previously mentioned, amenorrhea may be associated with carotenemia. This occurs in patients who consume a pure or predominantly vegetarian diet without red meat.
Dietary modifications can reduce carotene levels, which, in turn, normalize the menstrual cycle. Patients may present with symptoms—such as pruritus, fatigue, abdominal pain, and weight loss—specific to one of the rare causes of carotenemia. It can also be due to taking nutritional supplements. This is called primary carotenemia and appears several weeks after increased ingestion of the responsible foods. Carotenemia with normal intake of carotenoids can however be a sign of underlying illness.
This is secondary carotenemia. Examples include: increased blood fats hyperlipidaemia , which bind the carotenoids preventing their excretion liver disease, hypothyroidism and diabetes mellitus, which impair the conversion of carotenoids to retinol.
Dietary sources Diet-induced carotenemia is observed most frequently in infants and young children 6. Mothers may induce the condition by giving their infants large amounts of carrots in commercial infant food preparations 7. In addition, vegetarians are more likely to develop carotenemia than nonvegetarians.
The condition may also be associated with the ingestion of carotene-rich nutritional supplements 8. The consumption of fresh fruits and vegetables, such as carrots, may be beneficial to patients with psoriasis and porphyria because of their high content of carotenoids Carotenes occur in all pigmented fruits and vegetables, being synthesized as they ripen.
In green vegetables, the color of carotene is often masked by the green color of chlorophyll. As a rule of thumb, the deeper the green or yellow of a fruit or vegetable, the more carotene it contains. Although often overlooked by parents, most strained baby foods on the market contain carrots. Ingestion of nutrient supplements is another source of carotenemia.
Human and cow milk also contain carotene. The occasional yellow color of milk is due to carotene content, and human milk provides a rich source of carotene, especially if maternal serum carotene levels are high.
The yellow color of colostrum is caused by carotene content. Diseases-related sources Diseases, including hypothyroidism 12 , diabetes mellitus 13 , hepatic disorders, anorexia nervosa, and renal diseases, may also give rise to carotenemia Carotenemia may be related to restricted dietary habits, hyperlipidemia, or a deficiency in the conversion of carotene into vitamin A by the liver. Hypothyroidism The commonly accepted cause of carotenemia in hypothyroidism is a decrease in the conversion of carotene into vitamin A, as well as associated hyperlipidemia and hypercholesterolemia.
Thyroid hormone is antagonistic to vitamin A and controls its rate of consumption. In hypothyroidism, the consumption of vitamin A is decelerated, and the rate of conversion from carotene to vitamin A is reduced.
Anorexia nervosa The association between carotenemia and anorexia nervosa is well documented. Carotenemia in patients with this disease is not thought to be associated with a high-carotene diet.
It may instead be related to hypercholesterolemia, which is an occasional, albeit reversible, defect in the conversion of carotene to vitamin A, or it may result from a normal intake of dietary carotene in the presence of a decreased requirement. Other Disorders associated with the development of carotenemia also include the following: Liver disease — Primary hepatic injury may prevent the conversion of carotene to vitamin A Kidney disease — Serum carotene levels may be markedly elevated in patients with chronic glomerulonephritis and nephrotic syndrome Inborn errors of metabolism — Carotenemia may result from a failure to convert carotene into vitamin A due to an inborn error of metabolism Familial conditions Carotenemia symptoms Carotenemia is characterized by yellow discoloration of the skin carotenoderma, xanthoderma , particularly in areas where the horny layer is thickened such as the soles and palms.
The yellow colour is also most evident on areas where subcutaneous fat is abundant. The sclera white outer coating of the eyeball and mucous membranes eyes, mouth, nostrils etc are unaffected by carotenemia — the presence of yellow sclera usually means there is increased circulating bilirubin and is known as jaundice.
Serum beta-carotene levels are usually elevated by times the normal level in a patient with visible carotenemia. Vitamin A levels should remain normal but are sometimes slightly high.
Liver function tests should remain normal in primary carotenemia. Carotenemia treatment The skin color can return to normal with dietary modification. Patients should be advised what foods contain carotene and advised not to overeat these foods. Even though serum levels of carotene may return back to normal soon after restricting carotene intake, the yellow color of the skin may persist for a few months due to accumulated carotene in tissues. Beta-carotene is an antioxidant and is sometimes used to treat photosensitivity disorders such as polymorphous light eruption and erythropoietic protoporphyria.
However its use has not been supported by controlled clinical trials, nor has it been found to reduce the risk of sunburn or to prevent skin cancer.
Carotenemia foods to avoid Concentrations of preformed vitamin A are highest in liver and fish oils Other sources of preformed vitamin A are milk and eggs, which also include some provitamin A Most dietary provitamin A comes from leafy green vegetables, orange and yellow vegetables, tomato products, fruits, and some vegetable oils The top food sources of vitamin A in the U.
The U. Table 2 suggests many dietary sources of vitamin A. The foods from animal sources in Table 2 contain primarily preformed vitamin A, the plant-based foods have provitamin A, and the foods with a mixture of ingredients from animals and plants contain both preformed vitamin A and provitamin A.
Pancreas disease Increased need for vitamin A should be determined by your health care professional. Claims that beta-carotene is effective as a sunscreen have not been proven. Although beta-carotene supplements are being studied for their ability to reduce the risk of certain types of cancer and possibly heart disease, there is not enough information to show that this is effective. Beta-carotene may be used to treat other conditions as determined by your doctor. Beta-carotene is available without a prescription. Importance of Diet For good health, it is important that you eat a balanced and varied diet. Follow carefully any diet program your health care professional may recommend.
Posted by Dr. Chris What is carotenemia? Carotenemia is a condition that arises with high levels of carotene in the body. Carotene can cause a discoloration of the skin when present in large amounts within the body. This discoloration is typically yellow and sometimes even slightly orange in color.