What are the effects of micronutrient deficiency?

From the Guidelines

Patients with micronutrient deficiencies should be regularly checked for deficiencies, at least once per year, on a clinical level as well as by laboratory measurements, when appropriate and available, to prevent complications such as anaemia, impaired linear growth, and poor bone health. To address micronutrient deficiency, a comprehensive approach including dietary improvements, appropriate supplementation, and regular health monitoring is recommended 1. Focus on consuming a varied diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats to naturally obtain micronutrients. Common deficiencies include iron, vitamin D, vitamin B12, folate, and zinc, which can be supplemented with ferrous sulfate 325mg daily, vitamin D 1000-2000 IU daily, vitamin B12 1000mcg daily, folate 400-800mcg daily, and zinc 15-30mg daily if deficient 1.

Key Considerations

• Supplementation should be targeted to specific deficiencies confirmed through blood testing rather than taking multiple supplements unnecessarily 1.
• Certain populations are at higher risk, including pregnant women, older adults, those with digestive disorders, vegetarians/vegans, and people with limited food access 1.
• Micronutrient deficiencies can cause various health problems including fatigue, weakened immunity, poor wound healing, and cognitive issues 1.
• The body requires these micronutrients in small amounts because they serve as cofactors for enzymes, support metabolic processes, enable proper cell function, and protect against oxidative damage 1.

Monitoring and Prevention

• Regular medical check-ups with appropriate blood tests can help identify and address specific deficiencies before they cause significant health problems 1.
• At times when nutrition support is offered, multivitamin and micronutrient supplements should also be offered to ensure an appropriately balanced nutritional intake and avoid the risk of refeeding syndrome 1.
• Recent research has focused on vitamin D, which and its receptor may have some immunomodulatory properties, further highlighting the need for specific attention to micronutrient status in patients with IBD 1.

From the FDA Drug Label

Vitamin B12 is essential to growth, cell reproduction, hematopoiesis, and nucleoprotein and myelin synthesis. In people with normal absorption, deficiencies have been reported only in strict vegetarians who consume no products of animal origin (including no milk products or eggs). The main cause of vitamin B12 deficiency is inadequate dietary intake, particularly in strict vegetarians who do not consume animal products.

• Key factors that contribute to vitamin B12 deficiency include:
  • Dietary habits: lack of animal products in the diet
  • Malabsorption: conditions such as pernicious anemia that affect the absorption of vitamin B12 2

From the Research

Causes of Micronutrient Deficiency

• Micronutrient deficiencies can occur due to various factors, including restricting calorie intake, poor appetite, illness, eliminating food groups, or consuming a diet low in micronutrient-rich foods 3
• Patient groups at risk of micronutrient deficiency include older adults, pregnant patients, patients with alcohol use disorder, patients with vegetarian or vegan diets, and patients with increased requirements due to medical conditions or long-term drug use 3

Common Micronutrient Deficiencies

• The most common micronutrients that require supplementation are vitamin D, iron, vitamin A, zinc, folate, and iodine 3
• Vitamin B12 and iron deficiencies are common problems in general internal medicine, causing non-specific symptoms 4
• Combined deficiency of vitamin B12 and iron can be challenging to diagnose, especially in patients with iron deficiency anemia 5

Diagnosis and Treatment

• Laboratory assessment of micronutrient deficiency can be complicated by the acute phase response, and clinical benefit is most likely in those who are severely depleted and at risk of complications 6
• Treatment of iron deficiency anemia with pharmacological iron can increase serum folate and vitamin B12 levels, even in patients with baseline low levels of serum vitamin B12 7
• A diagnostic model based on age and homocysteine assessment can help differentiate iron deficiency anemia from combined cobalamin and iron deficiency anemia 5

Prevention and Management

• A daily multivitamin may be beneficial for patients who do not consistently consume a well-balanced diet, but higher than recommended doses can cause adverse effects 3
• Patients should be advised to take recommended dosages of supplements and consult their physician if they notice any adverse effects 3
• Healthcare practitioners should be aware of the changes in metabolic pathways, including vitamin B12, folate, and lipids, that occur during iron therapy 7