Vitamin E deficiency is a disease caused by a lack of vitamin E. Pathology develops with insufficient intake of food, impaired absorption from the intestine, transport to tissues. It is characterized by muscle weakness and hypotension, hemolytic anemia, coordination disorders, decreased proprioceptive sensitivity, menstrual cycle changes and decreased potency. The diagnosis is established on the basis of the clinical picture and the results of a blood test for vitamin content. Treatment includes correction of the diet and taking tocopherol preparations.
ICD 10
E56.0 Vitamin E deficiency
Meaning
Vitamin E is a group of chemical compounds consisting of 4 tocopherols and 4 tocotrienols. Often the term “tocopherol” is used as a synonym for vitamin E. The daily requirement of children is 6-8 IU, men – 10 IU, women – 8-9 IU, pregnant and nursing mothers – 10-12 IU. With a lack of vitamin, vitamin deficiency develops. Clinically manifested forms of vitamin E deficiency are rare, however, according to laboratory studies, the prevalence of mild vitamin deficiency is 60-80%. Children, pregnant and elderly people, as well as residents of the northern regions are most susceptible to the disease.
Causes of vitamin E deficiency
Vitamin E is not synthesized by the body. Its source is food. The high content is determined in vegetable oil, sprouted wheat and corn grains, legumes, eggs, seafood and greens. Vitamin absorption occurs in the small intestine. Tocopherol penetrates into the lymphatic vessels, passes into the bloodstream with the help of transport proteins and is carried to the organs. Vitamin is fat-soluble, able to accumulate in liver, muscle, nervous and adipose tissue. Vitamin E deficiency develops when the supply of vitamin to cells is disrupted. The reason may be:
- Nutritional deficiency of vitamin. The body’s own reserves of tocopherol last for 1-3 months, so a temporary shortage in nutrition is compensated. Vitamin deficiency is possible with prolonged fasting.
- Reduced absorbability. Vitamin is absorbed from the small intestine along with fats. With celiac disease, Crohn’s disease, ulcerative colitis and cystic fibrosis, malabsorption syndrome occurs, the absorption of nutrients decreases.
- Lack of bile. The presence of bile acids is necessary for the absorption of tocopherol. Reducing the formation of bile or the inability to secrete it into the intestine is one of the causes of vitamin deficiency.
- Violation of vitamin transport. Tocopherol is transported through the lymphatic and blood vessels with the help of transport proteins. With a decrease in their amount, the vitamin ceases to enter the tissues, vitamin deficiency manifests itself.
Pathogenesis
Entering the cells, tocopherol is embedded in the phospholipid layer of membranes, where it performs an antioxidant function – it inhibits the peroxidation of unsaturated fatty acids by attaching unpaired electrons of active radicals containing oxygen. Thanks to this process, cell membranes are protected from the effects of free radicals. Thus, vitamin E deficiency is accompanied by a deficiency of antioxidants, destruction of cell membranes. First of all, myocytes and neurons suffer – cells that have a large area of membranes and support intensive oxidation processes. Therefore, the most common signs of tocopherol deficiency are hypotension and muscle weakness, movement disorders and sensitivity.
Other functions of the vitamin are prevention of erythrocyte hemolysis, participation in hemoglobin production, maintenance of gene expression, reduction of prostacycline synthesis by endothelial cells and thromboxanes by platelets. With vitamin deficiency, the process of hematopoiesis is disrupted, hemolytic anemia develops. Tissues are damaged, the cells of which are rapidly renewed – liver, kidneys, male sex glands, embryo. The process of platelet attachment to the inner walls of blood vessels increases, which increases the risk of atherosclerosis and thrombosis.
Vitamin E deficiency symptoms
Vitamin E deficiency clinically debuts with muscle hypotension and weakness. This symptom extends to all types of muscle fibers – skeletal and smooth. Patients experience lethargy, their motor activity decreases, the previously habitual physical activity becomes unbearable. The tone of the smooth muscles of the internal organs decreases, as a result, the pulse, heart rate and respiration are reduced, constipation occurs due to deterioration of intestinal peristalsis.
Damage to the tissues of the nervous system is manifested by coordination disorders, speech disorders, a decrease in vibrational and proprioreceptive (internal muscle) sensitivity. Complex motor complexes, not fully mastered skills, are the first to disintegrate. It becomes more difficult for patients to write, use small objects, pronounce long words. Children lag behind in speech and motor development, have a body weight deficit, are physically weak. In newborns, vitamin E deficiency is the cause of seborrhea and rickets, in premature infants – retinopathy.
The symptom of vitamin E deficiency is anemia. Its characteristic signs are pallor, jaundice of the skin and mucous membranes, general weakness, fatigue, shortness of breath, convulsions and changes in body temperature. In women, the menstrual cycle is disrupted, with the onset of pregnancy, the risk of miscarriage increases, especially in the early stages. In men, potency and reproductive function are reduced. Tocopherol is necessary for the absorption of vitamin A, so its deficiency provokes vitamin A deficiency, manifested by hair loss, “chicken blindness“, dry skin and frequent infectious diseases.
Complications
With prolonged vitamin E deficiency, disorders of the neuromuscular system increase. Slight coordination disorders develop into ataxia, movements become inaccurate, inconsistent, a sense of balance is lost when standing and walking. Visual acuity decreases, visual paresis develops as a result of damage to the myelin sheath and the posterior cord of the spinal cord. Prolonged vitamin deficiency accelerates the aging process of the body, increases the risk of cancer and atherosclerosis. In experimental conditions on animals, it was proved that the absence of tocopherol leads to testicular atrophy, fetal resorption, softening of the brain, fatty infiltration and liver necrosis.
Diagnostics
Suspicion of vitamin E deficiency occurs with the development of ataxia, sensory and motor neuropathy, dysarthria, hemolytic anemia, miscarriage, visual disorders. The diagnosis is also carried out as part of a comprehensive study of the vitamin profile in low-weight newborns, pregnant women, women during lactation, patients with malabsorption syndrome, diseases of the liver, gallbladder and its ducts. The diagnosis is made by neurologists, neonatologists and gastroenterologists. The main research methods are:
- Clinical survey. Patients complain of muscle weakness, pain, tingling and other unpleasant sensations in the extremities, weakness, convulsions. In the conversation, the doctor clarifies the peculiarities of nutrition, the presence of diseases of the gastrointestinal tract.
- Neurological examination. Reduced muscle tone is determined, in severe cases – muscle dystrophy. Possible unsteadiness of gait, awkwardness and inaccuracy of movements, balance disorders.
- Blood test. Blood plasma is being examined. In the presence of vitamin deficiency, the vitamin E index in children and adolescents under 18 years of age is less than 3.8 mcg / ml, in adults – less than 5.5 mcg / ml.
Vitamin E deficiency treatment
With primary vitamin E deficiency caused by insufficient vitamin content in food, a correction of the diet is carried out. Foods rich in tocopherols and tocotrienols are introduced into the diet: corn, sunflower and olive oils, peas, beans, beans, oatmeal, buckwheat, eggs, mackerel, pike perch, nuts, cabbage and leafy vegetables. Additionally, oral vitamin intake may be prescribed. Therapy of secondary vitamin deficiency associated with impaired absorption and transport of tocopherol is based on intramuscular administration of vitamin E. At the same time, concomitant diseases of the digestive system are being treated.
Prognosis and prevention
With timely treatment and the absence of complications, vitamin deficiency is completely eliminated within 1-2 months. The prognosis is favorable. Since vitamin E is found in many foods, healthy people need only a full diet to prevent its deficiency. Prophylactic administration of tocopherol in the form of medications is indicated for premature infants, pregnant women, mothers during lactation, patients with intestinal diseases, malabsorption syndrome, disorders of bile formation and excretion.
Literature
- Kim HK, Han SN. Vitamin E: Regulatory role on gene and protein expression and metabolomics profiles. IUBMB Life. 2019 Apr;71(4):442-455. – link
- Suzuki H, Kume A, Herbas MS. Potential of Vitamin E Deficiency, Induced by Inhibition of α-Tocopherol Efflux, in Murine Malaria Infection. Int J Mol Sci. 2018 Dec 24;20(1) link
- Jilani T, Iqbal MP. Vitamin E deficiency in South Asian population and the therapeutic use of alpha-tocopherol (Vitamin E) for correction of anemia. Pak J Med Sci. 2018 Nov-Dec;34(6):1571-1575. link
- Khadangi F, Azzi A. Vitamin E – The Next 100 Years. IUBMB Life. 2019 Apr;71(4):411-415. – link
- Sapiejka E, Krzyżanowska-Jankowska P, Wenska-Chyży E, Szczepanik M, Walkowiak D, Cofta S, Pogorzelski A, Skorupa W, Walkowiak J. Vitamin E status and its determinants in patients with cystic fibrosis. Adv Med Sci. 2018 Sep;63(2):341-346. – link