- Vitamins are essential micronutrients required for normal metabolism, growth, and development.
- Vitamin supplementation in food products, adequate food security, and availability of supplements make vitamin deficiencies less common in developed countries. Certain populations are at increased risk.
- Toxicity is rare for water-soluble vitamins, whereas possible with fat-soluble vitamins (A, D, E, K).
- Higher incidence seen in geriatric patients, pregnant women, exclusively breastfed infants, individuals with highly restricted diets or certain chronic disease states
- Increased risk among individuals from Africa and Southeast Asia
- True incidence is unknown because most vitamin deficiencies are asymptomatic.
- Varies by age groups, comorbid conditions, geography, and setting (i.e., urban, rural)
- The prevalence of vitamin B12 deficiency is ~6% in patients <60 years old and increases to ~20% after age 60 (1).
- Vitamin D deficiency prevalence is increased in individuals with darker skin pigmentation, obesity, low dietary intake of vitamin D, or low sunlight exposure. This deficiency is seen in ~5% of the general population, with non-Hispanic blacks having the highest prevalence.
Etiology and Pathophysiology
- Deficiency usually develops from one of five mechanisms: reduced intake, diminished absorption, increased use, increased demand, or increased excretion
- Chronic disease states: HIV, malabsorption (i.e., celiac sprue, short bowel syndrome), chronic liver and kidney disease, alcoholism, malignancies, pernicious anemia, inborn errors of metabolism
- Bariatric surgeries: gastric bypass, gastrectomy, small or large bowel resection
- Related to certain drugs: prednisone, phenytoin, isoniazid, protease inhibitors, methotrexate, phenobarbital, alcohol, nitrous oxide, H2 receptor antagonists, metformin, colchicine, cholestyramine, 5-fluorouracil, 6-mercaptopurine, azathioprine, chloramphenicol, proton pump inhibitors, chronically used antibiotics, penicillamine, hydralazine
- Malnutrition, imbalanced nutrition, obesity, fad diets, extreme vegetarianism, total parenteral nutrition, bulimia/anorexia, other eating disorders, parasitic infection
- Cystic fibrosis
- Hartnup disease, A-β-lipoproteinemia
- Rare genetic predisposition
- Autoimmune disease (i.e., pernicious anemia)
- Congenital enzyme deficiencies (i.e., biotinidase or holocarboxylase synthetase deficiency)
- Transcobalamin II deficiency
- Ataxia with vitamin E deficiency (AVED)
Poverty, malnutrition, chronic excessive alcohol intake, chronic disease states, advanced age, dietary restrictions, bariatric surgery, certain medications, and exclusively breastfed infants
- Ingesting large and varied amounts of vitamin supplements increases risk of toxicity and drug–drug interactions and is not recommended.
- Antioxidant supplements have not been shown to impact cancer incidence; increased mortality risk seen in some studies (2)
- Avoid restrictive diets.
- USPSTF recommends against low-dose supplementation with vitamin D (<400 IU) and calcium (<1,000 mg) to reduce fracture risk in community-dwelling postmenopausal women (3).
- USPSTF concludes insufficient evidence of benefits and harms of daily supplementation with doses >400 IU of vitamin D and >1,000 mg of calcium for primary prevention of fractures in community-dwelling, postmenopausal women (3).
- USPSTF also concludes that current evidence is insufficient to assess the balance of the benefits and harms of vitamin D and calcium supplementation, for primary prevention of fractures in men and premenopausal women (3).
- USPSTF recommends against using β-carotene or vitamin E supplements for the prevention of cardiovascular disease or cancer (2).
- All infants should receive 400 IU/day of vitamin D soon after birth if exclusively or partially breastfed (5).
Commonly Associated Conditions
Anemia, neuropathies, dermatitis, visual disturbances
There's more to see -- the rest of this topic is available only to subscribers.
Domino, Frank J., et al., editors. "Vitamin Deficiency." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116645/all/Vitamin_Deficiency.
Vitamin Deficiency. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116645/all/Vitamin_Deficiency. Accessed June 4, 2023.
Vitamin Deficiency. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116645/all/Vitamin_Deficiency
Vitamin Deficiency [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 June 04]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116645/all/Vitamin_Deficiency.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Vitamin Deficiency ID - 116645 ED - Domino,Frank J, ED - Baldor,Robert A, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116645/all/Vitamin_Deficiency PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -