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Micronutrients in Health and Disease: Vitamin Deficiency States

Vitamin B12. Vitamin B12 deficiency affects 10% to15% of individuals over age 60, mainly due to poor absorption.5 (See Megaloblastic Anemia.)

Vitamin C.  Deficiency of vitamin C, which manifests as scurvy in its most severe form, is a condition most clinicians would presume to be long gone. Nevertheless, vitamin C deficiency or depletion was found in 5% to 17% of participants in the Third National Health and Nutrition Examination Survey6; in 30% of a sample of hospice patients7; in 68% of a population of hospitalized elderly patients8; and in individuals who eat meat–based diets and avoid fruits and vegetables.9 In smokers, the risk for vitamin C deficiency is roughly 4 times greater than in nonsmokers.6

Vitamin D. Soft and deformed bones characterize rickets, a vitamin D deficiency disease that affects infants and children. Although rickets is presumed to be an infrequent problem in the United States due to vitamin D fortification of milk, these efforts have not been entirely successful, and resurgence of this disease has occurred for a number of reasons. The natural source of vitamin D is sun exposure. However, life in urban areas or at extremes of latitude makes sunlight a less predictable source. Vitamin D is present in few foods, many of which people do not eat for reasons of preference or health (eg, oily fish, egg yolk). This has prompted the American Academy of Pediatrics to recommend 400 international units (IU) of supplemental vitamin D for infants, children, and adolescents ingesting less than 500 mL per day of vitamin D–fortified formula or milk.10

Intakes that are considered either deficient or insufficient have also been found in young women and elderly persons who lack sun exposure.11 These low intakes are a risk factor for autoimmune disease and some cancers.12 Certain drugs (eg, phenytoin, phenobarbital) can also decrease blood levels of vitamin D, resulting in both osteopenia and osteomalacia.13

Some evidence suggests that a “functional” vitamin D deficiency state may be caused by a high calcium intake due to dairy intake and calcium supplements, and may influence the risk for prostate cancer. Although higher calcium intake was not appreciably associated with total or nonadvanced prostate cancer, men with intakes of 1,500 to 1,999 mg per day of calcium had nearly double the risk for advanced and fatal prostate cancer. Men consuming 2,000 mg per day or more had a risk almost 2–and–a–half times greater, compared with men whose long–term calcium intakes were 500 to 749 mg per day. These risks have been attributed to elevated blood calcium concentrations that decrease production of the active form of vitamin D (calcitriol), which under normal circumstances inhibits cellular proliferation, promotes differentiation, and regulates the invasiveness, angiogenesis, and metastatic potential of prostate cancer cells.14

Multiple vitamin formulas typically contain some vitamin D. An additional supplement may be needed for individuals with low serum vitamin D levels and individuals with higher requirements, such as those over 70 years.15

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