Causes of Vitamin A and E Deficiencies
Yes, vitamin A and E deficiencies are important causes of specific clinical syndromes, particularly in patients with fat malabsorption, and require prompt recognition and treatment to prevent serious complications including blindness and neurological damage. 1
Primary Causes of Fat-Soluble Vitamin Deficiencies
Malabsorptive Conditions
- Bariatric surgery (especially malabsorptive procedures like biliopancreatic diversion, duodenal switch, and Roux-en-Y gastric bypass) is a major cause of vitamin A and E deficiencies due to reduced fat absorption 1, 2
- Intestinal failure and conditions causing severe fat malabsorption (fat absorption <15% of total energy) lead to progressive depletion of fat-soluble vitamins 3
- Chronic pancreatitis and biliary obstruction impair fat digestion and absorption 3
Dietary Insufficiency
- Inadequate dietary intake is the primary cause in developing countries, affecting approximately 127 million preschool-aged children and 7 million pregnant women globally for vitamin A 4
- Restrictive diets without appropriate supplementation, particularly following bariatric surgery 1, 2
Non-Compliance with Supplementation
- Poor adherence to prescribed multivitamins after bariatric surgery is a critical factor, as demonstrated by cases of symptomatic deficiency including night blindness 2
- Failure to attend follow-up appointments for monitoring prevents early detection and correction 2
Clinical Manifestations Requiring Urgent Recognition
Vitamin A Deficiency
- Night blindness (nyctalopia) is the earliest and most characteristic symptom 1, 5
- Xerophthalmia (dry eyes) progressing to corneal damage and permanent blindness if untreated 1, 4
- Reduced male fertility and potential fetal abnormalities in pregnancy 1
- Increased mortality risk in children, with reductions of 19-54% in child mortality following vitamin A treatment 4
Vitamin E Deficiency
- Peripheral neuropathy with sensory and motor symptoms 1
- Muscle weakness and hypotonia 1
- Ataxia and gait disturbances 1
Treatment Protocols
Vitamin A Deficiency in Adults
- Administer 10,000-25,000 IU oral vitamin A daily for 1-2 weeks for clinical improvement 1, 5
- Recheck vitamin A levels at 3 months after initiating treatment 1, 5
- Refer to specialist for intramuscular injections if oral supplementation fails or if night blindness is present 1, 5
- Refer adolescents with vitamin A deficiency to specialists for management 1
Vitamin E Deficiency
- Treat with oral vitamin E 100-400 IU daily for maintenance and repletion 1
- Monitor serum levels and continue treatment until normalization 1
- Adjust for serum lipids when interpreting vitamin E nutritional status 1
- Refer to specialist for intramuscular injections if oral supplementation is ineffective 1
Critical Monitoring Considerations
High-Risk Populations Requiring Surveillance
- All patients post-bariatric surgery, especially those with malabsorptive procedures (BPD/DS, RYGB, OAGB/MGB with biliopancreatic limb >150 cm) 1
- Patients with fat absorption ratios <25% of total energy intake 3
- Pregnant and lactating women due to increased metabolic demands 4
Important Caveats
- Large vitamin E doses can exacerbate vitamin K deficiency and affect blood coagulation, requiring careful monitoring 1
- Vitamin K assessment should be performed when fat-soluble vitamin deficiency is established, particularly with hepatopathy, coagulopathy, or osteoporosis 1
- Vitamin A toxicity is possible with prolonged high doses (acute toxicity >150,000 μg; chronic toxicity ~30,000 μg/day), presenting with increased intracranial pressure, bone abnormalities, and dermatitis 5