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Micronutrients: At–Risk Populations
Certain groups are more likely to have micronutrient deficiencies and may require dietary changes or supplementation.
- Alcohol abuse. Low blood levels of vitamin B, vitamin C, vitamin E, carotenoids, and selenium have been found in alcohol–dependent patients. Folic acid intake may be especially important for alcohol consumers. For example, individuals who consume alcohol appear to be at twice the risk for breast cancer when folic acid intakes are below recommendations, compared with those with higher intakes.
A Western dietary pattern. Individuals who eat a typical Western diet generally have reduced intakes of several micronutrients, compared with individuals who primarily eat plant–based diets. In a European study of more than 65,000 men and women, individuals avoiding meat and other animal products had much higher intakes of fiber, folic acid, and vitamins C and E, compared with meat–eaters. Other surveys have showed that vegetarians generally have higher intake of vitamins C and E, potassium, and dietary fiber, compared with meat–eaters. Further, pregnant vegetarian women had significantly lower risk for folic acid deficiency than women who ate meat. - Smokers. Smokers often have poorer diets in general than nonsmoking individuals, and generally consume fewer fruits and vegetables and more saturated fat. Also, smokers have significantly lower blood levels of carotenoids and vitamin C.
- Inappropriately restricted diets. Nutritional deficiency can result from overly strict dietary restrictions, particularly those that eliminate the most nutrient–rich foods (e.g., vegetables, fruits, and whole grains). Individuals who consume low–carbohydrate, high–meat diets may have vitamin C intakes that are nearly 50 percent lower than those of persons eating more plant–based diets.
- Elderly persons, particularly those in hospitals or long–term–care facilities, and vegetarians are at risk for deficiency of vitamins D and B12. Poor intakes in these and other groups have led to the suggestion that all adults take a multiple vitamin daily.
- Medications may interact with nutrients to cause deficiencies. o Folic acid deficiency may occur due to treatment with many seizure medications (e.g., phenytoin, carbamazepine, phenobarbital, and valproic acid).
- Vitamin B12 absorption decreases as a result of long–term acid reflux therapy (e.g., proton pump inhibitors) and treatment with the diabetes drug metformin.
- Low potassium commonly occurs due to diuretics, amphotericin B, corticosteroids, and insulin. Excessively high potassium can occur due to use of heparin and certain diuretics (e.g., spironolactone).
- Thiamine deficiency may occur due to diuretic use.
- Magnesium deficiency frequently results from diuretics, amphotericin B, certain antibiotics, and cyclosporine.
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