Fat-soluble vitamin deficiency or FSV deficiency refers to an abnormally low concentration of vitamins A, D, E or K in the serum. They are more commonly diagnosed in infants and children and can be caused either by conditions interfering with the absorption of fat, chronic conditions, cholestasis or, in adults, malnutrition.
Presentation
Symptoms related to fat-soluble vitamin deficiency do depend on the severity of the deficiency itself; in cases where a mild insufficiency is present, symptoms may be absent or too mild to observe. Profound FSV deficiency typically leads to a plethora of clinical symptoms and can even threaten an individual's life.
Vitamin A
Patients with vitamin A deficiency typically report night blindness and xerophthalmia [1] [2]. Bitot's spots may be visible due to a collection of keratin in the conjunctiva, and the observation of keratomalacia in pediatric patients requires immediate therapeutic intervention as a medical emergency [3]. Children presenting with vitamin A deficiency also display growth delays and may present with an active infection pertaining to the respiratory, gastrointestinal tract or other systems. Patients may also present with infertility and spontaneous abortions without apparent underlying gynecological pathology, dry skin with hyperkeratotic lesions and dry hair [4]. Vitamin A deficiency also results in anemia, in which case the individual may present with weakness, fatigue and, possibly, pallor.
Vitamin D
Vitamin D deficiency is known to cause rickets in children. Pediatric patients affected by rickets present with osphyalgia, pelvic pain or pain the legs, muscle weakness and skeletal deformities, such as:
- Bow knees or knock-knees
- Kyphoscoliosis
- Sternal deformities
- Rachitic rosary appearance of the ribs
- Thickened skull bone
- Craniotabes
Amongst the adult population, vitamin D deficiency is primarily responsible for causing osteomalacia and osteoporosis [1]; patients tend to present with fractures caused by mild forces or even spontaneous fractures as well as muscle hypotonia and persisting pain [5]
Vitamin E
Patients with decreased vitamin E serum levels present with neurological symptoms, such as ataxia, similar to Friedrich's ataxia [6] [7] [8] [9] [10]. Additional symptoms may include muscle hypotonia, a limited visual field or complete loss of vision, cardiac dysrhythmia and dementia.
Vitamin K
The predominant symptom of vitamin K deficiency is hemorrhage which can be observed in any region of the body; petechiae, easy and frequent bruising, hematomas, hematuria or constant bleeding that does not respond to the standard pressure [11]. Infants may also display an incomplete facial, nasal or skeletal development or present with epileptic activity, anemia, vomiting and mucosal bleeding, due to atraumatic intracranial hemorrhaging.
Entire Body System
- Weakness
Vitamin A deficiency also results in anemia, in which case the individual may present with weakness, fatigue and, possibly, pallor. Vitamin D Vitamin D deficiency is known to cause rickets in children. [symptoma.com]
The nervous and muscular system may also be affected, causing symptoms such as loss of appetite, irritability, fatigue, insomnia, restlessness, headache and muscle weakness. [food-info.net]
Calcium toxicity can cause abdominal pain, weak bones, constipation, irregular heartbeat, and depression among other symptoms. [prevention.com]
Vitamin Deficiency Water Soluble Fat Soluble Deficiency Weakness Poor growth Irritability Impaired immune function Paralysis Rickets Dementia nerve damage Nausea Night blindness Depression Weak and soft bones Fatigue Broken red blood cells Vitamins are [healtheappointments.com]
Adults may experience muscle loss and weakness and osteoporosis, which is a loss of bone mass. A deficiency is also associated with certain cancers, autoimmune disease, high blood pressure and infectious disease. [living.thebump.com]
- Fatigue
Deficiency more often due to poor absorption than low consumption Meat, seafood, eggs, and dairy C (ascorbic acid): Antioxidant 7.1% 31% Scurvy, fatigue, anemia, joint pain, petechia. [mdedge.com]
The nervous and muscular system may also be affected, causing symptoms such as loss of appetite, irritability, fatigue, insomnia, restlessness, headache and muscle weakness. [food-info.net]
Vitamin A deficiency also results in anemia, in which case the individual may present with weakness, fatigue and, possibly, pallor. Vitamin D Vitamin D deficiency is known to cause rickets in children. [symptoma.com]
Signs of a thyroid issue, like weight gain, an inability to lose weight, and fatigue, may be a sign to have your levels of iodine and vitamin A checked. [wwws.fitnessrepublic.com]
Symptoms of deficiency: digestive upsets, insomnia, headaches, fatigue, sore and swollen tongue (disease is much worse) Symptoms may include itching, skin flushing, and gastrointestinal distress Time-released capsules have caused impaired liver function [iceberglabs.net]
- Anemia
Infants may also display an incomplete facial, nasal or skeletal development or present with epileptic activity, anemia, vomiting and mucosal bleeding, due to atraumatic intracranial hemorrhaging. [symptoma.com]
[…] process Detoxifies free radicals, prevents damage to cell membranes Prevents LDL cholesterol from turning into damaging oxidized LDL, which initiates buildup of arterial plaque which can lead to heart disease No disease; may produce vague symptoms and anemia [iceberglabs.net]
Deficiency more often due to poor absorption than low consumption Meat, seafood, eggs, and dairy C (ascorbic acid): Antioxidant 7.1% 31% Scurvy, fatigue, anemia, joint pain, petechia. [mdedge.com]
Too little vitamin B12 causes a type of anemia called megaloblastic anemia. The red blood cells grow very large and have a short life span. [innerbody.com]
Signs of Deficiency: Iron deficiency anemia is one of the biggest signs of iron deficiency. Natural source: Spinach is a great natural source of iron. [nutrino.co]
- Inflammation
Also Read: 7 Amazing Health Benefits of Vitamin A Signs and Symptoms of Vitamin A Deficiency Xerophthalmia- dryness, and inflammation of the cornea and conjunctiva Night blindness Bitot’s spots- build-up of keratin in the conjunctiva Poor immunity Dry [ayurtimes.com]
Inflammation reduces the surface area of your intestines, causing them to be unable to absorb nutrients effectively. This can be due to infections that cause diarrhea as well as inflammatory bowel disease, such as Crohn's and ulcerative colitis. [livestrong.com]
Both gamma and alpha tocopherol are reported to better assess oxidative stress and inflammation. Vitamin K is important in the deposition of ionic calcium needed for proper blood coagulation and bone formation. [gdx.net]
Studies have proven that vitamin E is beneficial in helping to reduce the rate of inflammation in our skins for a youthful and healthy skin appearance. [oxfordvitality.co.uk]
Signs of Deficiency: Skin inflammation, hair loss, sore throat and diarrhea can be signs of zinc deficiency. Natural Source: Oysters are a great natural source of zinc. [nutrino.co]
- Malnutrition
They are more commonly diagnosed in infants and children and can be caused either by conditions interfering with the absorption of fat, chronic conditions, cholestasis or, in adults, malnutrition. [symptoma.com]
In addition, about 1 in 5 patients suffers from malnutrition, with most of those showing involuntary weight loss and a low BMI. [glutenfreetherapeutics.com]
These vitamins also play an important role in Protein Energy Malnutrition [PEM]. The level of vitamin A and E decreases in these children and thus supplementation becomes a priority for all the PEM cases. [completewellbeing.com]
In the 1960s, the World Health Organization (WHO) undertook the first global survey of VAD with associated xerophthalmia and complicated measles. [6] In 1973, an international vitamin A board was set up to alleviate global malnutrition. [emedicine.medscape.com]
Vitamin E deficiency and associated neurological deficits in children with protein-energy malnutrition. J Trop Pediatr 1998;44:291-5. [ Links ] 8. Kowdley KV. Lipids and lipid-activated vitamins in chronic cholestatic diseases. [scielo.isciii.es]
Gastrointestinal
- Vomiting
Infants may also display an incomplete facial, nasal or skeletal development or present with epileptic activity, anemia, vomiting and mucosal bleeding, due to atraumatic intracranial hemorrhaging. [symptoma.com]
[…] cortex function Part of chemistry of coenzyme A, which is vital to metabolism of carbohydrates, fats, and proteins and involved in making fatty acids, cholesterol, acetylcholine, steroid hormones, and nerve regulators Can result in abdominal distress, vomiting [iceberglabs.net]
But, The Mayo Clinic warns, large doses of vitamin C can cause problems like diarrhea, nausea, vomiting, heartburn, cramps, headache, insomnia, and kidney stones. [prevention.com]
The symptoms are nausea, vomiting, abdominal pain, diarrhoea and weight loss. [food-info.net]
[…] requirement of vitamin D) Excess Toxicity causes elevated plasma concentration of calcium which can have some side effects: Blood vessel contract, high blood pressure and Calcium deposits in soft tissues such as the heart and lungs, Kidney stones, Nausea, vomiting [wikilectures.eu]
- Nausea
Acute toxicity causes dry, itchy skin, headache, nausea, loss of appetite and blurred vision. [wikilectures.eu]
But, The Mayo Clinic warns, large doses of vitamin C can cause problems like diarrhea, nausea, vomiting, heartburn, cramps, headache, insomnia, and kidney stones. [prevention.com]
Some symptoms that are brought on by deficiency in these vitamins are: weakness, apathy, irritability, verve tingling, paralysis, cracks at corners of the mouth, diarrhea, dementia, nausea, depression, hallucinations, fatigue, and rashes. [healtheappointments.com]
Toxicity Hypervitaminosis A Caused by excess dosages ( 100 times RDA ) Can be fatal ( 13,000 times RDA ) Chronic : liver damage, hair loss, bone/muscle pain, loss of appetite, dry skin and mucous membranes, hemorrhages, coma Acute : gastrointestinal upsets/nausea [www2.highlands.edu]
symptoms include soft bones and teeth Most people do not take in supplemental form since the body produces its own via exposure to the sun Toxic in doses larger than 1,000-1,1500 I.U.s daily for a month or longer; produces nausea, weakness, and irritability [iceberglabs.net]
Jaw & Teeth
- Bleeding Gums
It’s also an antioxidant that helps with collagen formation and iron absorption Signs of Deficiency: If you have scurvy (bleeding gums, swollen joints, and slow healing wounds) you may have a vitamin C deficiency. [nutrino.co]
gums, petechiae, arthralgias, hyperkeratosis) Vitamin D = osteomalacia or rickets (in children), bone loss, muscle weakness or spasm Vitamin E = abnormal gait and balance, muscle weakness, neurologic abnormalities Vitamin K = poor blood clotting, skin [empoweryourhealth.org]
- Dental Caries
Fluoride Fluoride helps prevent dental caries. Nearly 99% of the body’s fluoride resides in the bones and teeth. The main source of fluoride is municipal water supplies that add fluoride to the water. Excess fluoride discolors and damages teeth. [innerbody.com]
Musculoskeletal
- Fracture
[…] caused by mild forces or even spontaneous fractures as well as muscle hypotonia and persisting pain Vitamin E Patients with decreased vitamin E serum levels present with neurological symptoms, such as ataxia, similar to Friedrich's ataxia. [symptoma.com]
Low vitamin K status is associated with low bone mineral density, high risk of osteoporosis and easy bone fractures. [ayurtimes.com]
In elderly persons, vitamin-D supplementation reduces the risk of osteoporotic fractures. Infants are born with stores of vitamin D that last about six months. [diet.com]
However, osteomalacia is not the same as osteoporosis, which we often hear about in relation to bone fractures. [study.com]
Skin
- Dermatitis
[…] anemia, neural tube birth defects, confusion Niacin (nicotinic acid, nicotinamide) Liver, red meat, fish, poultry, legumes, whole-grain or enriched cereals and breads Oxidation-reduction reactions Carbohydrate and cell metabolism Deficiency: Pellagra (dermatitis [merckmanuals.com]
[…] lips, sore throat, bloodshot eyes Older adults, low intake of animal and dairy products, heavy alcohol use Dairy, meat and fish, eggs, mushrooms, almonds, leafy greens, and legumes B6 (pyridoxal): Methylation cycle 11% to 24% ( 14% total, 26% of adults Dermatitis [mdedge.com]
The symptoms include swollen mouth and throat, dermatitis and anemia. Niacin - Nicotinamide, Nicotinic Acid Niacin assists in carbohydrate and fat metabolism; helps with cell differentiation; and participates in DNA replication and repair. [innerbody.com]
Toxicity Excessive intake of vitamin A during pregnancy could lead to foetal abnormalities; in normal adults the problems could vary from mild dermatitis to haemorrhage or liver damage. [completewellbeing.com]
[…] cause the following signs or symptoms: Vitamin A = difficulty seeing at night, xerophthalmia (corneal erosions and scarring), dry skin Vitamin B1 = double vision (nystagmus, ophthalmoplegia), impaired gait, confusion, memory loss Vitamin B2 = anemia, dermatitis [empoweryourhealth.org]
Eyes
- Night Blindness
Well, the answer is you will suffer from night blindness, which is abnormally poor vision in dim light. [study.com]
Vitamin A Patients with vitamin A deficiency typically report night blindness and xerophthalmia. [symptoma.com]
Vitamin A is important for the function of your retinas and a lack of this vitamin can cause night blindness and other vision problems. [livestrong.com]
Vitamin A deficiency in infants causes night blindness, Bitot spots (keratinization of the cornea), xerophthalmia (dry eyes), keratomalacia, corneal opacities, growth failure, hyperkeratosis, reduced resistance to infection, and death. [pedsinreview.aappublications.org]
Vitamin Deficiency Water Soluble Fat Soluble Deficiency Weakness Poor growth Irritability Impaired immune function Paralysis Rickets Dementia nerve damage Nausea Night blindness Depression Weak and soft bones Fatigue Broken red blood cells Vitamins are [healtheappointments.com]
- Dry Eyes
Vitamin A deficiency in infants causes night blindness, Bitot spots (keratinization of the cornea), xerophthalmia (dry eyes), keratomalacia, corneal opacities, growth failure, hyperkeratosis, reduced resistance to infection, and death. [pedsinreview.aappublications.org]
Once both forms get active, they play various essential roles in the body, such as- Vitamin A contains chemical structures that promote healthy vision, protect the cornea and reduce the risk of cataracts, dry eyes and age-related macular degeneration [ayurtimes.com]
Signs of Deficiency : If you have skin problems, poor night vision, or dry eyes, you may have a vitamin A deficiency. Natural Source: Carrots, dark coloured fruits, and dark coloured veggies are great sources of vitamin A. [nutrino.co]
- Visual Impairment
Types of outcome measures We planned to obtain data on at least one of the following outcome measures: Primary outcomes Vitamin A deficiency disorders visual impairment any other ocular dysfunction skin manifestations (e.g. phrynoderma) Growth and nutritional [cochranelibrary.com]
- Visual Impairment
Types of outcome measures We planned to obtain data on at least one of the following outcome measures: Primary outcomes Vitamin A deficiency disorders visual impairment any other ocular dysfunction skin manifestations (e.g. phrynoderma) Growth and nutritional [cochranelibrary.com]
Neurologic
- Irritability
Some symptoms that are brought on by deficiency in these vitamins are: weakness, apathy, irritability, verve tingling, paralysis, cracks at corners of the mouth, diarrhea, dementia, nausea, depression, hallucinations, fatigue, and rashes. [healtheappointments.com]
The nervous and muscular system may also be affected, causing symptoms such as loss of appetite, irritability, fatigue, insomnia, restlessness, headache and muscle weakness. [food-info.net]
symptoms include soft bones and teeth Most people do not take in supplemental form since the body produces its own via exposure to the sun Toxic in doses larger than 1,000-1,1500 I.U.s daily for a month or longer; produces nausea, weakness, and irritability [iceberglabs.net]
Deficiency during pregnancy is linked to neural tube defects Leafy green vegetables, fruits, dried beans, and peas B12 (cobalamin): Methylation cycle (cofactor methionine synthase) 10% to 15% of older adults Depression, irritability, anemia, fatigue, [mdedge.com]
The symptoms that arise are nausea, weight loss and irritability for mild cases, and mental and physical growth retardation, kidney damage and movement of calcium from bones into soft tissues for the severe cases. [wikilectures.eu]
- Confusion
Confusion and disorientation stem from the brain’s inability to oxidize glucose for energy because B1 is a critical cofactor in glycolysis and the tricarboxylic acid cycle. [mdedge.com]
Later signs are muscle cramps, irritability, confusion and cardiac abnormalities. [innerbody.com]
Patients should be apprised of the risk of hypoglycemia and be alert to potential signs and symptoms such as headache, dizziness, drowsiness, nervousness, confusion, tremor, hunger, weakness, perspiration, and palpitation. [drugs.com]
[…] green leafy vegetables, fruits, organ meats (eg, liver), enriched cereals and breads Maturation of RBCs Synthesis of purines, pyrimidines, and methionine Development of fetal nervous system Deficiency: Megaloblastic anemia, neural tube birth defects, confusion [merckmanuals.com]
Vitamin and mineral deficiencies may cause the following signs or symptoms: Vitamin A = difficulty seeing at night, xerophthalmia (corneal erosions and scarring), dry skin Vitamin B1 = double vision (nystagmus, ophthalmoplegia), impaired gait, confusion [empoweryourhealth.org]
Workup
Vitamin A levels in a symptomatic patient can be directly measured via a high-performance liquid chromatography serum retinol study. A concentration lower than 0.7 mg/L in patients under the age of 12 years is deemed pathologically low [12]. A serum RBP study can also be used to approximately evaluate the adequacy of vitamin A in the serum, but its accuracy is lower [13] [14]. The complete laboratory assessment for a potential vitamin A deficiency also includes an iron panel, biochemical profile, zinc and albumin levels and a complete blood count.
With reference to vitamin K, its suspected deficiency can be diagnosed by measuring des-gamma-carboxy prothrombin (DCP) in the serum, as it is a protein molecule which is known to be elevated in the absence of vitamin K and can be safely used as a marker of vitamin K deficiency and hemorrhage [15]. Serum phylloquinone can also be measured, although the results are not completely accurate; a concentration lower than 0.15 mcg/L implies a deficiency [16]. Patients with vitamin K deficiency also exhibit an increased serum prothrombin time (PT) and a normal activated partial thromboplastin time (aPTT) [17].
Furthermore, in order to measure the concentration of Vitamin E, serum alpha-tocopherol levels must be obtained. Individuals with hyperlipidemia are evaluated by calculating the alpha tocopherol to lipid ratio. Lastly, a potential vitamin D deficiency is diagnosed by measuring serum 25(OH)D concentration.
Serum
- Vitamin E Decreased
Megadose supplements of vitamin A and E can pose a risk to vitamin-K status. Vitamin A interferes with absorption of vitamin K, and large doses of vitamin E decrease vitamin K–dependent clotting factors, thus promoting bleeding. [diet.com]
Treatment
Search: name, specialism, conditions, treatments, tests or services Search: name, specialism, conditions, treatments, tests or services Search: name, specialism, conditions, treatments, tests or services Royal Brompton & Harefield NHS Foundation Trust [rbht.nhs.uk]
Treatment with specific vitamin supplements resulted in correction of these vitamin deficiencies. These data suggest that deficiency of a single or multiple fat-soluble vitamins is frequent even in treated patients with pancreatic insufficiency. [annals.org]
Blinding (or masking) The authors will grade each study for blinding as follows: blinding of clinician (person delivering treatment) to treatment allocation; blinding of participant to treatment allocation; blinding of outcome assessor to treatment allocation [cochranelibrary.com]
Vitamin E treatment of nonalcoholic steatohepatitis in children: A pilot study. J Pediatr 2000;136:734–738. PubMed CrossRef Google Scholar 14. Marceau P, Hould FS, Simard S, et al. Biliopancreatic diversion with duodenal switch. [link.springer.com]
Which of the following vitamins should supplement her treatment? Review Topic QID: 100131 M1 Select Answer to see Preferred Response PREFERRED RESPONSE 1 ARTICLES (6) Topic COMMENTS (24) Please login to add comment. [medbullets.com]
Epidemiology
"We should step back and ask ourselves whether there might be a lesson to take from this sad experience of actually causing cancer with high vitamin intake," says Tim Byers, MD, professor of epidemiology at the Colorado School of Public Health. [prevention.com]
Hygiene and epidemiology : selected chapters. 2. edition. Prague. 2008. ISBN 80-246-0793-X. [wikilectures.eu]
Pathophysiology
The role of SBA as a surrogate marker of FSV deficiency in other cholestatic liver diseases, such as progressive familial intrahepatic cholestasis, α-1-antitrypsin deficiency, and Alagille syndrome in which the pathophysiology is dominated by intrahepatic [ncbi.nlm.nih.gov]
Prevention
DS products may not include statements that they diagnose, treat, cure, or prevent disease. [iceberglabs.net]
This patient has fat absorption adequate to prevent EFAD but inadequate absorption of fat-soluble vitamins. In patients with short bowel, the requirements for parenteral lipids and fat-soluble vitamins should be determined independently. [ncbi.nlm.nih.gov]
It protects the cells against free radical damage and prevents the onset of diseases induced by oxidative stress. [ayurtimes.com]
If dry, add chicken broth to prevent sticking and burning. Season with S/P. Because of the added Sweet Potato, I calculated the GI and GL for the entire meal! [sacredvesselacupuncture.com]
However, the medical manifestations of fat-soluble vitamin deficiency are preventable if recognized early and treated appropriately. Vitamin A is present in food. [pedsinreview.aappublications.org]
References
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- Stephensen CB. Vitamin A, infection, and immune function. Annu Rev Nutr. 2001;21:167–92.
- Blecker U, Mehta DI, duPont AI, Davis R, Sothern MS, Suskind RM. Fat-soluble Vitamin Deficiencies. Pediatrics in Review. Nov. 1999; Vol. 20/ Issue 11.
- Harrison's Principles of Internal Medicine. 15th ed. New York, NY: McGraw-Hill; 2001. vol 1: 465-6.
- Holick MF. Vitamin D deficiency: what a pain it is. Mayo Clin Proc. 2003 Dec;78(12):1457-9.
- Benomar A, Yahyaoui M, Marzouki N, et al. Vitamin E deficiency ataxia associated with adenoma. J Neurol Sci. 1999 Jan 1; 162(1):97-101.
- Sokol RJ. Vitamin E and neurologic deficits. Adv Pediatr. 1990; 37:119-48.
- Sokol RJ, Guggenheim MA, Heubi JE, et al. Frequency and clinical progression of the vitamin E deficiency neurologic disorder in children with prolonged neonatal cholestasis. Am J Dis Child. 1985 Dec; 139(12):1211-5.
- Tanyel MC, Mancano LD. Neurologic findings in vitamin E deficiency. Am Fam Physician. 1997 Jan; 55(1):197-201.
- Rino Y, Suzuki Y, Kuroiwa Y, et al. Vitamin E malabsorption and neurological consequences after gastrectomy for gastric cancer. Hepatogastroenterology. 2007 Sep; 54(78):1858-61.
- Lee GR, Bithell TC, Forester J. Acquired coagulation disorders. Wintrobe's Clinical Hematology. Baltimore, Md: Williams & Wilkins; 1993; 1473-80.
- West KP Jr, Mehra S. Vitamin A intake and status in populations facing economic stress. J Nutr. 2010 Jan; 140(1):201S-7S.
- de Pee S, Dary O. Biochemical indicators of vitamin A deficiency: serum retinol and serum retinol binding protein. J Nutr. 2002 Sep; 132(9 Suppl):2895S-901S.
- Weinman AR, Jorge SM, Martins AR, et al. Assessment of vitamin A nutritional status in newborn preterm infants. Nutrition. 2007 Jun; 23(6):454-60.
- Liebman HA, Furie BC, Tong MJ. Des-gamma-carboxy (abnormal) prothrombin as a serum marker of primary hepatocellular carcinoma. N Engl J Med. 1984 May 31;310(22):1427-31.
- Martin J. Shearer, Xueyan Fu, Sarah L. Booth. Vitamin K Nutrition, Metabolism, and Requirement: Current Concept and Future Research. Advances in Nutrition. 2012; 3:182-195.
- Krasinski SD, Russell RM, Furie BC. The prevalence of vitamin K deficiency in chronic gastrointestinal disorders. Am J Clin Nutr. 1985 Mar; 41(3):639-43.