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Vitamin Deficiency

Deficiencies Vitamin

Micronutrient deficiencies, including vitamins and mineral deficiencies, are one of the major contributors to the global disease burden. Vitamin deficiencies increase the risk of infections and also cause premature death, poor health, blindness, stunted growth, mental retardation, learning disability and low work capacity.


Presentation

Mild form of vitamin deficiency may remain asymptomatic or have non-specific symptoms like malaise, lethargy, loss of appetite, poor weight gain and tachypnea. Many of them may present with increased history of infections like diarrhea. Specific symptoms of deficiency depend on the type of vitamin.

Anemia
  • BACKGROUND: Anemia is associated with increased morbidity and mortality in many chronic diseases. Little is known about anemia in cystic fibrosis (CF).[ncbi.nlm.nih.gov]
  • BACKGROUND: Patients with severe sickle cell anemia (SCA) have a higher potential for oxidative damage due to chronic redox imbalance in red blood cells that often leads to hemolysis, endothelial injury and recurrent vaso-occlusive episodes.[ncbi.nlm.nih.gov]
  • When folic acid was isolated and synthesized in the 1940s, it was shown to correct the macrocytic anemia associated with pernicious anemia, while the neurological manifestations progressed.[ncbi.nlm.nih.gov]
  • Symptoms of anemia due to vitamin B12 deficiency or folate deficiency develop slowly and are similar to symptoms caused by other types of anemia, such as fatigue, weakness, and paleness.[msdmanuals.com]
  • Causes of vitamin deficiency anemias, also known as megaloblastic anemias, include: Folate deficiency anemia. Folate, also known as vitamin B-9, is a nutrient found mainly in fruits and leafy green vegetables.[mayoclinic.org]
Fatigue
  • Fatigue isn’t something that you should ignore.[steptohealth.com]
  • For more information on how to reduce fatigue, consider reading about the 11 best vitamins and supplements to boost energy. Summary Excessive fatigue and tiredness may be a sign of vitamin D deficiency.[healthline.com]
  • Thyroid disease resulting from low levels of iodine — which can lead to hypothyroidism — can cause fatigue, weight gain and brittle nails as well as puffy eyes.[news.com.au]
  • Fatigue - Early on, someone with a vitamin C deficiency will tend to get tired easily and experience reduced energy. Because chronic fatigue is a symptom of so many illnesses, it can be hard to catch a specific condition based on this symptom.[fitday.com]
  • Chaitow, Leon The Beat Fatigue Workbook - how to identify the causes ( 1988 ) Trends of 'vitamin deficiency' Used Rarely. vitamin deficiency is in the lower 50% of commonly used words in the Collins dictionary[collinsdictionary.com]
Malnutrition
  • CONCLUSIONS: This is the first prospective cohort to investigate malnutrition after RYGB in nonseverely obese patients.[ncbi.nlm.nih.gov]
  • The oral manifestations of vitamin deficiencies are often the first indications of malnutrition. This is especially true among the elderly, whose more frequent physical and/or psychological disorders may prevent them from eating a balanced diet.[ncbi.nlm.nih.gov]
  • Deficiency of vitamin a due to malnutrition, malabsorption, or dietary lack. It is manifested with reduced night vision, night blindness, and xerophthalmia.[icd9data.com]
  • BACKGROUND: Extensive bowel resection may lead to a state of inadequate nutrient absorption and malnutrition known as short bowel syndrome.[ncbi.nlm.nih.gov]
  • The causes of vitamin deficiency are reviewed with special attention to the inhibition of oral thiamine hydrochloride absorption in man caused by malnutrition present in alcoholic patients or by the direct effects of ethanol on intestinal transport.[ncbi.nlm.nih.gov]
Nail Abnormality
  • Chronic toxicity causes changes in skin, hair, and nails; abnormal liver test results; and, in a fetus, birth defects. Diagnosis is usually clinical. Unless birth defects are present, adjusting the dose almost always leads to complete recovery.[merckmanuals.com]
  • Nail abnormalities: clues to systemic disease. Am Fam Physician. 2004;69(6):1417-1424. Seshadri D, De D. Nails in nutritional deficiencies. Indian J Dermatol Venereol Leprol. 2012;78(3):237-41.[podiatrytoday.com]
Tachypnea
  • Mild form of vitamin deficiency may remain asymptomatic or have non-specific symptoms like malaise, lethargy, loss of appetite, poor weight gain and tachypnea. Many of them may present with increased history of infections like diarrhea.[symptoma.com]
Failure to Thrive
  • Complications can include: Excessively high calcium level Failure to thrive (in infants) Kidney damage due to high calcium Liver damage Taking too much vitamin A during pregnancy may cause abnormal development in the growing baby.[medlineplus.gov]
  • In children, toxicity can cause pruritus, anorexia, and failure to thrive. Hepatomegaly and splenomegaly may occur. In carotenosis, the skin (but not the sclera) becomes deep yellow, especially on the palms and soles.[merckmanuals.com]
  • During infancy, signs of a vitamin B12 deficiency include failure to thrive, movement disorders, developmental delays, and megaloblastic anemia [ 33 ].[ods.od.nih.gov]
Regurgitation
  • If the infant vomits or regurgitates the formulation within 1 hour of administration, repeating the oral dose may be appropriate.[doi.org]
Chest Pain
Cracked Lips
  • lips, sore tongue and mouth, burning eyes; skin rashes; anemia Niacin Pellagra (diarrhea; inflamed skin and mucous membranes; mental confusion and/or dementia) Vitamin B6 Anemia; convulsions similar to epileptic seizures; skin rashes; upset stomach;[dummies.com]
  • Many of us suffer from bad breath, cracked lips and agonising headaches. But they could all be a sign of something much more sinister.[dailymail.co.uk]
  • The symptoms are cracked lips, swelling of the throat, bloodshot eyes, bright pink tongue and low red blood cell count.[stylecraze.com]
  • B6, folate, and glutathione synthesis 10% to 27% of older adults Fatigue, cracked 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,[mdedge.com]
  • Early symptoms of chronic toxicity are sparsely distributed, coarse hair; alopecia of the eyebrows; dry, rough skin; dry eyes; and cracked lips. Later, severe headache, pseudotumor cerebri, and generalized weakness develop.[merckmanuals.com]
Agitated Delirium
  • In the late 1880s, Korsakoff described a spectrum of cognitive disorders, including a confabulatory amnestic state following an agitated delirium, occurring in conjunction with peripheral polyneuropathy.[ncbi.nlm.nih.gov]
Guillain-Barré Syndrome
  • While length-dependent sensorimotor axonal peripheral neuropathy is the most common presentation, several examples present in a subacute severe fashion, mimicking Guillain-Barré syndrome.[ncbi.nlm.nih.gov]
Areflexia
  • Vitamin E – hyporeflexia, limb ataxia, muscle weakness, dissociated nystagmus, areflexia, dysphagia, and dysarthria. Vitamin K – ecchymosis, petechiae, hematomas, and bleeding at the site of puncture or surgery.[symptoma.com]
Dysarthria
  • Vitamin E – hyporeflexia, limb ataxia, muscle weakness, dissociated nystagmus, areflexia, dysphagia, and dysarthria. Vitamin K – ecchymosis, petechiae, hematomas, and bleeding at the site of puncture or surgery.[symptoma.com]

Workup

The initial test for the diagnosis of suspected vitamin deficiency is serum levels of specific vitamin. Imaging studies are used for evaluating the growth of the bones or for checking excessive deposition of periosteal bone. Urinary excretion of some vitamins, for example thiamine, may be useful. Deficiency may be assessed using radioassay and non-radioisotopic assay as well. Other procedures like dark adaptation test may be adopted for a particular vitamin.

Macrocytosis
  • […] and protein-energy malnutrition. 5 In elderly patients with ineffective erythropoiesis (formation of erythrocytes), it is important for pharmacists to note that microcytosis (low mean corpuscle volume: [MCV]) should suggest sideroblastic anemia, while macrocytosis[uspharmacist.com]
  • The expected findings of very low serum cobalamin levels, anemia, and macrocytosis are often lacking. Arch Intern Med 148:1712–1714. Carmel R. 1992.[nap.edu]
  • Circulating unbetabolied folic acid and 5-methyltetrahydrofolate in relation to anemia, macrocytosis, and cognitive test performance in American seniors.[ods.od.nih.gov]
Neurofibrillary Tangle
  • Abstract Neurofibrillary tangles (NFTs), composed of intracellular filamentous aggregates of hyperphosphorylated protein tau, are one of the pathological hallmarks of Alzheimer's disease (AD).[ncbi.nlm.nih.gov]

Treatment

Treatment modality depends on the severity of vitamin deficiency. Replenishment of the deficient vitamin is the first step in treatment. In most of the cases restoration of body stores helps to resolve the symptoms. The daily maintenance dose varies with the type of vitamin, age and severity of the condition. Parenteral administration of the vitamin is recommended in severe cases of deficiency. Duration of therapy depends on the symptoms and is usually continued till the symptoms improve. Comorbid conditions, if any, should be identified and treated appropriately. During recovery care should be taken to provide a balanced and liberal diet. Long term supplementation may be needed in some cases. If the deficiency affects gait, balance or functions of any of the organs, physical and occupational therapy may be helpful. Follow-up is very important to confirm that the levels are well within the acceptable range. Most of the cases can be treated on an outpatient basis, unless there is a serious associated condition. Support for cardiac function may be necessary in some cases, particularly wet beriberi. Some patients may need neuropsychological intervention to improve cognition and social functioning.

Prognosis

Timely diagnosis and treatment can help in early recovery. Most of the deficiencies are easily treatable, provided that it is subclinical and has not progressed much. Most of the manifestations resolve considerably when treated appropriately. In vitamin A deficiency, morbidity may increase with infection or when blindness has progressed. Corneal perforation, keratomalacia and punctate keratopathy are irreversible even with standard treatment modalities. Korsakoff syndrome is a poor prognostic factor in thiamine deficiency. Neurologic deficit in vitamin B12 deficiency improves considerably with vitamin B12 therapy. Outcome is generally better in younger patients.

Etiology

Poverty and food faddism are some of the common causes of vitamin deficiency in developed countries. In developing countries, dietary deficiency and malabsorption are the main causes of vitamin deficiency. Malabsorption is the main cause for the deficiency of fat soluble vitamins [3]. Diseases and conditions may also result in specific vitamin deficiency.
Some of the major etiological factors of vitamin deficiency include:

Epidemiology

About 250 million children worldwide are at risk of developing vitamin deficiency. The majority of them are malnourished and develop complications like measles and diarrhea that often lead to death. Vitamin A deficiency is the most common and every year about 500,000 children become blind due to the same. Accurate statistics on the prevalence and incidence of other vitamin deficiencies are not available. Difficulty in estimation may arise due to differences in etiologies and assays. Approximately 3 million people are affected by vitamin B12 deficiency in United States. Prevalence of vitamin C was found to be more among men, particularly those older than 60 years. Prevalence of vitamin C was reported as 8.2% in men and 6% in women [7]. Vitamin D deficiency is more prevalent among elderly and hospitalized patients. About 60% of the patients in nursing homes are reported to have deficiency of vitamin D [8]. Healthy adults also may have vitamin D deficiency. About 10.3% of the general population have this and the prevalence is greater among dark-skinned people. As the production of vitamin D declines with age, elderly population is at a higher risk of this deficiency. Although it may occur at any age, vitamin K deficiency is more common among infants. The prevalence varies according to geographic region in US [9].

Sex distribution
Age distribution

Pathophysiology

Deficiency of vitamins are caused by decreased intake, malabsorption, and increased requirements or due to altered metabolism. In most of the cases, the body stores vitamins to last for some time even when the diet has inadequate amounts when compared to daily requirements. This lasts for few weeks but once this reserve is over the serum levels of the vitamin drops. The concentration of the vitamin in the serum may also be affected by other factors like infection, nutritional status, and presence of other nutrients. When thiamine stores are depleted, it results in weakness, tachycardia and deep tendon reflexes. Vitamin C deficiency affects collagen synthesis leading to poor wound healing. Impaired collagen synthesis results in gum hemorrhage, defective dentine formation, and also loss of teeth. When the circulating level of vitamin D is lower, parathyroid hormone levels increase, resulting in decreased mineralization of bones. Vitamin E plays an important role as antioxidant, and also has an immunomodulator and antiplatelet effect [10]. Deficiency of this vitamin results in ataxia, hyporeflexia, and muscle weakness.

Prevention

Having a well-balanced diet is the most important preventive measure for vitamin deficiency. Having a variety of foods, like cereals, breads, crackers, vegetables, fruits and fortified foods help to provide the recommended doses of these nutrients. Those who have associated conditions like gastrectomy, pancreatectomy, or atrophic gastritis should undergo periodic testing to check for deficiencies. Vegetarians should supplement the amount of vitamin B12 in their diet as they are at an increased risk of developing deficiency.

Summary

Micronutrient deficiencies, including vitamins and mineral deficiencies, are one of the major contributors to the global disease burden [1]. About 2 million people all over the world are considered to be deficient in vitamins and other minerals. The most important nutrients among them are vitamin A, iodine, iron and zinc. Vitamin deficiencies increase the risk of infections and also cause premature death, poor health, blindness, stunted growth, mental retardation, learning disability and low work capacity. It also increases the mortality rate due to associated conditions like measles, malaria, pneumonia and diarrhea. These conditions are some of the leading causes of death in the world [2]. Vitamin deficiencies may also result in overt clinical syndromes like osteomalacia, peripheral neuropathy, night blindness and beriberi.

Patient Information

Vitamin and mineral deficiencies, called as micronutrient deficiencies, are one of the most important cause of diseases and death. Vitamin A, iron, zinc and iodine are the major deficiencies noted worldwide. These deficiencies cause diseases and also increase the risk of blindness, poor health, stunted growth and learning disability. Poverty, malnourishment, and fad diets are the most common causes of vitamin deficiency. It may also be caused by difficulty in absorbing the nutrients due to diseases or conditions. Inadequate exposure to sunlight is the major cause of deficiency of vitamin D. About 250 million children worldwide are at risk of developing different kinds of vitamin deficiency. Many of them develop measles and diarrhea which may lead to death.
In all these cases, the body uses up the vitamin stores when there is inadequate amounts of vitamins in the diet. When the body reserves are over, serum levels drop and start affecting metabolism. It results in signs and symptoms specific of different vitamins. Mild forms may remain asymptomatic for long time. Most common symptoms of vitamin deficiency are non-specific like tiredness, poor appetite, and lethargy. Each vitamin is associated with a specific set of symptoms like

Testing the levels of vitamin in the blood is the first way to assess deficiency of vitamin. Imaging techniques may be used to assess damage caused to the internal organs. Treatment suggested depends on the severity of the symptoms. Replenishing the deficient vitamins is the first step in the treatment. The dose and route of administration varies with the type of vitamin and severity of deficiency. Treatment is usually continued till the symptoms resolve. Having a well-balanced diet with lots of vegetables, fruits, whole grains and fortified foods go a long way in preventing and controlling the symptoms of vitamin deficiency. Those who have diseases that increase the risk of vitamin deficiency should monitor the levels to prevent complications. Timely diagnosis and treatment is the most important step in recovery. Most of the deficiencies are easily treatable.

References

Article

  1. Ezzati M., Lopez A. D., Rodgers A., Hoorn S. Vander, Murray C. J. Comparative Risk Assessment Collaborating Group. Selected Major Risk Factors and Global and Regional Burden of Disease. Lancet. 2002;360(9343):1342–1343.
  2. World Health Organization. The World Health Report 2001: Reducing risks, promoting healthy life. Geneva, World Health Organization, 2001.
  3. Kuwabara, A., Tanaka, K., Tsugawa, N., Nakase, H., Tsuji, H., Shide, K. et al. (2009) High prevalence of vitamin K and D deficiency and decreased BMD in inflammatory bowel disease. Osteoporos Int 20: 935–942.
  4. Sriram K, Manzanares W, Joseph K. Thiamine in nutrition therapy. Nutr Clin Pract. 2012;27(1):41-50.
  5. Al-Attas OS, Al-Daghri NM, Alfadda A, Abd Al-Rahman SH, Sabico S. Blood Thiamine and Derivatives as measured by High-Performance Liquid Chromatography: Levels and Associations in DM Patients with Varying Degrees of Microalbuminuria. J Endocrinol Invest. 2011; 35(11):951-956.
  6. Ansell JE, Kumar R, Deykin D. The spectrum of vitamin K deficiency. JAMA. Jul 4 1977;238(1):40-42.
  7. Hampl JS, Taylor CA, Johnston CS. Vitamin C deficiency and depletion in the United States: the Third National Health and Nutrition Examination Survey, 1988 to 1994. Am J Public Health. May 2004;94(5):870-875.
  8. Thomas MK, Lloyd-Jones DM, Thadhani RI, et al. Hypovitaminosis D in medical inpatients. N Engl J Med. Mar 19 1998;338(12):777-783.
  9. Shearer MJ. Vitamin K deficiency bleeding (VKDB) in early infancy. Blood Rev. 18 2008; 23(2):49-59.
  10. Traber MG, Stevens JF. Vitamins C and E: beneficial effects from a mechanistic perspective. Free Radic Biol Med. 2011;51(5):1000-1013.

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Last updated: 2019-07-11 21:29