Vitamin deficiency
Vitamin deficiency | |
---|---|
Other names | Avitaminosis, hypovitaminosis |
Specialty | Endocrinology |
Vitamin deficiency is the condition of a long-term lack of a vitamin. When caused by not enough vitamin intake it is classified as a primary deficiency, whereas when due to an underlying disorder such as malabsorption it is called a secondary deficiency. An underlying disorder can have 2 main causes:
- Lifestyle choices: Lifestyle choices and habits that increase vitamin needs, such as smoking or drinking alcohol.[2] Government guidelines on vitamin deficiencies advise certain intakes for healthy people, with specific values for women, men, babies, children, the elderly, and during pregnancy or breastfeeding.[3][4][5][6] Many countries have mandated vitamin food fortification programs to prevent commonly occurring vitamin deficiencies.[7][8][9][10]
Conversely, hypervitaminosis refers to symptoms caused by vitamin intakes in excess of needs, especially for fat-soluble vitamins that can accumulate in body tissues.[3][5][11]
The history of the discovery of vitamin deficiencies progressed over centuries from observations that certain conditions – for example, scurvy – could be prevented or treated with certain foods having high content of a necessary vitamin, to the identification and description of specific molecules essential for life and health. During the 20th century, several scientists were awarded the Nobel Prize in Physiology or Medicine or the Nobel Prize in Chemistry for their roles in the discovery of vitamins.[12][13][14]
Defining deficiency
A number of regions have published guidelines defining vitamin deficiencies and advising specific intakes for healthy people, with different recommendations for women, men, infants, the elderly, and during pregnancy and breast feeding including Japan, the
Individual vitamin deficiencies
Water-soluble vitamins
Vitamin | Symptoms & Diagnosis | Information |
---|---|---|
Thiamine (Vitamin B1) deficiency | Weight loss, emotional disturbances, impaired sensory perception, weakness and pain in the limbs, and periods of irregular heart beat. Deficiency is assessed by red blood cell status and urinary output.[18][19] | Especially common in countries that do not require fortification of wheat and maize flour and rice to replace the naturally occurring thiamine content lost to beriberi, which became prevalent in Asia as more people adopted a diet primarily of white rice. Wernicke encephalopathy and Korsakoff syndrome are forms of beriberi. Alcoholism can also cause vitamin deficiencies. Long-term deficiencies can be life-threatening.[20]
|
Riboflavin (Vitamin B2) deficiency |
Deficiency causes painful red tongue with sore throat, chapped and cracked lips, and inflammation at the corners of the mouth (angular cheilitis). Eyes can be itchy, watery, bloodshot and sensitive to light. Riboflavin deficiency also causes anemia with red blood cells that are normal in size and hemoglobin content, but reduced in number. This is distinct from anemia caused by deficiency of folic acid or vitamin B12.[21][22] | Especially common in countries that do not require fortification of wheat and maize flour and rice to replace the naturally occurring riboflavin lost during processing.[10] |
Niacin (Vitamin B3) deficiency |
Deficiency causes pellagra, a reversible nutritional wasting disease characterized by four classic symptoms often referred to as the four Ds: diarrhea, dermatitis, dementia, and death. The dermatitis occurs on areas of skin exposed to sunlight, such as backs of hands and neck. Niacin deficiency is a consequence of a diet low in both niacin and the amino acid tryptophan, a precursor for the vitamin. Low plasma tryptophan is a non-specific indicator, meaning it can have other causes. The signs and symptoms of niacin deficiency start to revert within days of oral supplementation with large amounts of the vitamin.[23][24] | Chronic alcoholism is a contributing risk factor. |
Pantothenic acid (Vitamin B5) deficiency | Irritability, fatigue, and apathy.[25][26] | Extremely rare. |
Vitamin B6 deficiency | Uncommon, although it may be observed in certain conditions, such as Crohn disease or ulcerative colitis .
| |
Biotin (Vitamin B7) deficiency | Rashes including red, patchy ones near the mouth and fine, brittle hair. 3-hydroxyisovaleric acid are better indicators of biotin deficiency than concentration in the blood.[29] |
Rare, although biotin status can be compromised in alcoholics and during pregnancy and breastfeeding.Deficiency affects hair growth and skin health.[30][31] |
Folate (Vitamin B9) deficiency | Symptoms may include palpitations, shortness of breath, feeling faint, open sores on the tongue, loss of appetite, changes in the color of the skin or hair, irritability, and behavioral changes.[32] In adults, anemia (macrocytic, megaloblastic anemia ) can be a sign of advanced folate deficiency. |
Common, and associated with numerous health problems, but primarily with MTHFR gene that lead to compromised folate metabolism.[33][34] Cerebral folate deficiency is a rare condition in which concentrations of folate are low in the brain despite being normal in the blood.[35]
|
Vitamin B12 deficiency | Anemia, neurological and digestive disorders.[36][37] This may result in feeling tired, shortness of breath, lightheadedness, headaches, mouth ulcers, pale skin, rapid heartbeat, loss of appetite, hair loss, low blood pressure, decreased ability to think, joint pain, numbness and tingling to the fingers and toes, and tinnitus.[38] Damage to nerves may result in depression, confusion, memory loss, difficulty walking, sense loss, mania, and psychosis . |
Lead to megaloblastic anemia, subacute combined degeneration of spinal cord, and methylmalonic acidemia, among other conditions. Supplementation with folate can mask vitamin B12 deficiency.[39][40] Consuming a vegan diet increases the risk, since Vitamin B12 is mostly found in food and drinks made from animal products, including eggs and dairy products. |
Vitamin C deficiency | Deficiency leads to weakness, weight loss and general aches and pains. Longer-term depletion affects connective tissues, severe gum disease, and bleeding from the skin.[41][42] | Rare, consequently, no countries fortify foods as a means of preventing this deficiency.[10] The historic importance of vitamin C deficiency relates to occurrence on long sea-going voyages, when the ship food supplies had no good source of the vitamin. Deficiency results in scurvy when plasma concentrations fall below 0.2 mg/dL, whereas the normal plasma concentration range is 0.4 to 1.5 mg/dL. |
Fat-soluble vitamins
Vitamin | Symptoms & Diagnosis | Information |
---|---|---|
Vitamin A deficiency | Can cause nyctalopia (night blindness) and keratomalacia, the latter leading to permanent blindness if not treated. The normal range is 30 to 65 μg/dL, but plasma concentrations within the range are not a good indicator of a pending deficiency because the normal range is sustained until liver storage is depleted. After that happens, plasma retinol concentration falls to lower than 20 μg/dL, signifying a state of vitamin A inadequacy.[43][44][45] | It is the leading cause of preventable childhood blindness, afflicting 250,000 to 500,000 malnourished children in the developing world each year, about half of whom die within a year of becoming blind, as vitamin A deficiency also weakens the immune system. |
Vitamin D deficiency | Usually asymptomatic, causes reduce bone density (osteomalacia), rickets, myopathy, and is associated with the development of schizophrenia. It is typically diagnosed by measuring the concentration of the 25-hydroxyvitamin D (25(OH)D) in plasma, which is the most accurate measure of stores of vitamin D in the body. Deficiency is defined as less than 10 ng/mL, and insufficiency in the range of 10–30 ng/mL. Serum 25(OH)D concentrations above 30 ng/mL are "not consistently associated with increased benefit." Serum concentrations above 50 ng/mL may be cause for concern. | Common, most foods do not contain vitamin D, indicating that a deficiency will occur unless people get sunlight exposure or eat manufactured foods purposely fortified with vitamin D. Vitamin D deficiency is a known cause of rickets, and has been linked to numerous other health problems.[46][47] |
Vitamin E deficiency | Causes poor conduction of electrical impulses along nerves due to changes in nerve membrane structure and function.[48][49] The US Institute of Medicine defines deficiency as a blood concentration of less than 12 μmol/L. | Rare, occurring as a consequence of abnormalities in dietary fat absorption or metabolism, such as a defect in the alpha-tocopherol transport protein , rather than from a diet low in vitamin E.
|
Vitamin K deficiency | Signs and symptoms can include sensitivity to bruising, bleeding gums, nosebleeds, and heavy menstrual bleeding in women.[50][51] | Rare as consequence of low dietary intake. A deficient state can be a result of fat malabsorption diseases. Newborn infants are a special case. Plasma vitamin K is low at birth, even if the mother is supplemented during pregnancy, because the vitamin is not transported across the placenta. Vitamin K deficiency bleeding (VKDB) due to physiologically low vitamin K plasma concentrations is a serious risk for premature and term newborn and young infants. Untreated, consequences can cause brain damage or death. The prevalence of VKDB is reported at 0.25 to 1.7%, with higher risk in Asian populations. The recommended prevention treatment is an intramuscular injection of 1 mg of vitamin K at birth (called the Vitamin K shot.).[52] There are protocols for oral administration, but intramuscular injection is preferred.[53] |
Prevention
Food fortification
Food fortification is the process of adding
As defined by the
Genetic engineering
Starting in 2000, rice was experimentally genetically engineered to produce higher than normal
When eaten, beta-carotene is a
Hypervitaminosis
Some vitamins cause acute or chronic
The United States, European Union and Japan, among other countries, have established "tolerable upper intake levels" for those vitamins which have documented toxicity.[3][5][11]
History
Year of discovery | Vitamin |
---|---|
1913 | Vitamin A (Retinol) |
1910 | Vitamin B1 (Thiamine) |
1920 | Vitamin C (Ascorbic acid) |
1920 | Vitamin D (Calciferol) |
1920 | Vitamin B2 (Riboflavin) |
1922 | Vitamin E (Tocopherol) |
1929 | Vitamin K1 ( Phylloquinone )
|
1931 | Vitamin B5 (Pantothenic acid) |
1931 | Vitamin B7 (Biotin) |
1934 | Vitamin B6 (Pyridoxine) |
1936 | Vitamin B3 ( Niacin )
|
1941 | Vitamin B9 (Folate) |
1948 | Vitamin B12 (Cobalamins) |
In 1747, the Scottish surgeon
During the late 18th and early 19th centuries, the use of deprivation studies allowed scientists to isolate and identify a number of vitamins. Lipid from fish oil was used to cure rickets in rats, and the fat-soluble nutrient was called "antirachitic A". Thus, the first "vitamin" bioactivity ever isolated, which cured rickets, was initially called "vitamin A"; however, the bioactivity of this compound is now called vitamin D.[63] In 1881, Russian medical doctor Nikolai I. Lunin studied the effects of scurvy at the University of Tartu. He fed mice an artificial mixture of all the separate constituents of milk known at that time, namely the proteins, fats, carbohydrates, and salts. The mice that received only the individual constituents died, while the mice fed by milk itself developed normally. He made a conclusion that substances essential for life must be present in milk other than the known principal ingredients. However, his conclusions were rejected by his advisor, Gustav von Bunge.[64]
In East Asia, where polished
In 1910, the first vitamin complex was isolated by Japanese scientist
In 1930,
See also
- Mineral deficiency
- Essential nutrient
- Malnutrition
- Vitamin
- Hypervitaminosis
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