Essential Micronutrients for Healthy Adults
For healthy adults without kidney disease, the essential micronutrients include all water-soluble vitamins (B-complex vitamins and vitamin C), fat-soluble vitamins (A, D, E, K), and essential minerals including iron, zinc, iodine, selenium, calcium, magnesium, phosphorus, and potassium. 1
Core Micronutrient Categories
Water-Soluble Vitamins
- B-complex vitamins (thiamine, riboflavin, niacin, B6, B12, folate, pantothenic acid, biotin) are essential and must be obtained through diet as they are not stored in significant amounts 2
- Vitamin C is required at minimum 90 mg/day for men and 75 mg/day for women 2
- These vitamins function as cofactors in numerous metabolic pathways and tissue mechanisms 3
Fat-Soluble Vitamins
- Vitamin A is essential for vision, immune function, and cellular differentiation 2
- Vitamin D (cholecalciferol or ergocalciferol) is critical for bone health, immune function, and numerous physiological processes 2
- Vitamin E serves as an antioxidant protecting cell membranes 2
- Vitamin K is necessary for blood clotting and bone metabolism 2
Essential Minerals and Trace Elements
- Iron is one of the most commonly deficient micronutrients and essential for oxygen transport 1
- Zinc plays roles in immune function, wound healing, and protein synthesis 2, 1
- Iodine is critical for thyroid hormone production 1
- Selenium functions in antioxidant defense systems 2
- Calcium, magnesium, and phosphorus are essential for bone health and numerous cellular functions 2
- Potassium is vital for cardiac and neuromuscular function 2
Micronutrient Acquisition Strategy
Dietary Sources First
- Prioritize obtaining micronutrients through natural food sources and a healthy eating pattern that includes vitamin-dense foods 4
- Consume a diverse diet with higher plant-based foods compared to animal-based foods and lower ultraprocessed foods 2
- Include fresh vegetables, whole grains, nuts, legumes, low-fat dairy products, and cold-water fish 5
Supplementation Considerations
- Daily multivitamin supplementation may be beneficial for patients who do not consistently consume a well-balanced diet 1
- Large-scale randomized trials show no overall benefit of multivitamins for the majority of healthy patients 1
- Supplements should provide approximately one recommended daily allowance (RDA) of water-soluble vitamins, but larger amounts are not appropriate or beneficial 3
High-Risk Groups Requiring Attention
Populations at Increased Risk of Deficiency
- Older adults due to decreased absorption and intake 1
- Pregnant patients with increased requirements 1
- Patients with alcohol use disorder affecting absorption and metabolism 1
- Vegetarian or vegan patients at risk for B12, iron, and zinc deficiency 1
- Patients restricting calorie intake for weight management 1
- Patients with medical conditions or long-term drug use altering nutrient absorption, metabolism, or excretion 1
Most Commonly Deficient Micronutrients
- Vitamin D, iron, vitamin A, zinc, folate, and iodine are the micronutrients most commonly requiring supplementation 1
Critical Safety Considerations
Avoiding Toxicity
- Higher than recommended doses of supplements can cause adverse effects 1
- Patients should take only recommended dosages and consult their physician if adverse effects occur 1
- Consult drug labels and pharmacists about potential supplement interactions with medications or other supplements 1
Specific Vitamin Precautions
- Excessive vitamin A and E supplementation carries toxicity risk and should be avoided without specific indication 2
- Vitamin K supplementation should be avoided in patients receiving anticoagulants like warfarin 2
Monitoring Approach
Assessment Strategy
- Periodic assessment of dietary intake is warranted to identify potential deficiencies 4
- Testing for circulating levels is typically performed only for folate, B12, and 25-hydroxyvitamin D, as other vitamin assays may not be available or may not correlate well with body stores 4
- The most reliable assays examine tissue mechanisms that rely on vitamins as cofactors 3