Vitamins for Chronic Disease Prevention in Adults

Clinical Applications

Journal of the American Medical Association, Vol. 287 No. 23, June 19, 2002, pages 3127-3129
Robert H. Fletcher, MD, MSc; Kathleen M. Fairfield, MD, DrPH
These authors are from Harvard’s Medical School
FROM ABSTRACT

Vitamin deficiency syndromes such as scurvy and beriberi are uncommon in Western societies.

However, suboptimal intake of some vitamins, above levels causing classic vitamin deficiency, is a risk factor for chronic diseases and common in the general population, especially the elderly.

Suboptimal folic acid levels, along with suboptimal levels of vitamins B6 and B12, are a risk factor for cardiovascular disease, neural tube defects, and colon and breast cancer; low levels of vitamin D contribute to osteopenia and fractures; and low levels of the antioxidant vitamins (vitamins A, E, and C) may increase risk for several chronic diseases.

Vitamins for Chronic Disease Prevention in Adults Clinical Applications 

Pending strong evidence of effectiveness from randomized trials, it appears prudent for all adults to take vitamin supplements.

The evidence base for tailoring the contents of multivitamins to specific characteristics of patient’s, such as age, sex, and physical activity, and for testing vitamin levels to guide specific supplementation practices is limited.

Physicians should make specific efforts to learn about their patients' use of vitamins to ensure that they are taking vitamins they should, such as folate supplementation or women in the childbearing years, and avoiding dangerous practices such as high doses of vitamin A during pregnancy or massive doses of fat-soluble vitamins at ny age.

THESE AUTHORS ALSO NOTE:
“In the absence of specific predisposing conditions, a usual North American diet is sufficient to prevent overt vitamin deficiency diseases such as scurvy, pellagra, and eriberi.”

“However, insufficient vitamin intake is apparently a cause of chronic diseases.” "Recent evidence has shown that suboptimal levels of vitamins, even well above hose causing deficiency syndromes, are risk factors for chronic diseases such as cardiovascular disease, cancer, and osteoporosis.”
“A large proportion of the general population is apparently at increased risk for this reason.”

SUBOPTIMAL AMOUNTS of VITAMINS
Suboptimal levels of a vitamin can be defined as those associated with abnormalities of metabolism that can be corrected by supplementation with that vitamin.”

Measurements of vitamin levels in blood, serum, or red blood cells, are not a reliable guide to the risk factors for chronic diseases. [IMPORTANT]

Supplementation can substantially reduced serum homocysteine levels in elderly patients with normal serum folate concentrations. [IMPORTANT]

It is conclusive that folate during the first trimester of pregnancy reduces the risk of neural tube defects.

It is conclusive that vitamin D supplementation, along with calcium, reduces the risk of fractures in elderly women with osteoporosis.

“The high prevalence of suboptimal vitamin levels implies that the usual US diet provides an insufficient amount of these vitamins.”

“Fruits and vegetables are the main dietary source of many vitamins, and health experts have long recommended at least 5 daily servings.” A recent survey showed that only 20% to 30% of the population actually meet this goal.”

Vitamins are also lost during cooking, chilling, storage, and reheating of foods. Alcohol increases folate requirements and aging is associated with decreased absorption.