Vitamins are required constituents of the human diet since they are inadequately synthesized or not synthesized in the human body. Only small amounts of these substances are needed to carry out essential biochemical reactions (e.g., by acting as coenzymes or prosthetic groups). Overt vitamin or trace mineral deficiencies are rare in Western countries due to a plentiful, varied, and inexpensive food supply; however, multiple nutrient deficiencies may appear together in persons who are chronically ill or alcoholic. After gastric bypass surgery, patients are at high risk for multiple nutrient deficiencies. Moreover, subclinical vitamin and trace mineral deficiencies, as diagnosed by laboratory testing, are quite common in the normal population, especially in the geriatric age group.
Victims of famine, emergency-affected and displaced populations, and refugees are at increased risk for protein-energy malnutrition and classic micronutrient deficiencies (vitamin A, iron, iodine) as well as for thiamine (beriberi), riboflavin, vitamin C (scurvy), and niacin (pellagra) overt deficiencies.
Body stores of vitamins and minerals vary tremendously. For example, vitamin B12 and vitamin A stores are large, and an adult may not become deficient for 1 or more years after being on a deficient diet. However, folate and thiamine may become depleted within weeks among those eating a deficient diet. Therapeutic modalities can deplete essential nutrients from the body; for example, hemodialysis removes water-soluble vitamins, which must be replaced by supplementation.
There are several roles for vitamins and trace minerals in diseases: (1) deficiencies of vitamins and minerals may be caused by disease states such as malabsorption; (2) both deficiency and excess of vitamins and minerals can cause disease in and of themselves (e.g., vitamin Aintoxication and liver disease); and (3) vitamins and minerals in high doses may be used as drugs (e.g., niacin for hypercholesterolemia). The hematologic-related vitamins and minerals (Chaps. 103, 105) either are not considered or are considered only briefly in this chapter, as are the bone-related vitamins and minerals (vitamin D, calcium, phosphorus; Chap. 352), since they are covered elsewhere (Tables 74-1 and 74-2 and Fig. 74-1).
Table 74-1 Principal Clinical Findings of Vitamin Malnutrition |Favorite Table|Download (.pdf)
Table 74-1 Principal Clinical Findings of Vitamin Malnutrition
Dietary Level per Day Associated with Overt Deficiency in Adults
Contributing Factors to Deficiency
Beriberi: neuropathy, muscle weakness and wasting, cardiomegaly, edema, ophthalmoplegia, confabulation
<0.3 mg/1000 kcal
Alcoholism, chronic diuretic use, hyperemesis
Magenta tongue, angular stomatitis, seborrhea, cheilosis
Pellagra: pigmented rash of sun-exposed areas, bright red tongue, diarrhea, apathy, memory loss, disorientation
<9.0 niacin equivalents
Alcoholism, vitamin B6 deficiency, riboflavin deficiency, tryptophan deficiency
Seborrhea, glossitis, convulsions, neuropathy, depression, confusion, microcytic anemia
Megaloblastic anemia, atrophic glossitis, depression, ↑ homocysteine
Alcoholism, sulfasalazine, pyrimethamine, triamterene
Megaloblastic anemia, loss of vibratory and position sense, abnormal gait, dementia, impotence, loss of ...