Abstract
Abstract. Vitamin E is a lipid soluble antioxidant which mainly circulates as α-tocopherol in the human plasma. Its deficiency is associated with ataxia, neuropathy, anaemia and several other health conditions. Although substantial data on vitamin E status has been published worldwide, there is paucity of data on the extent of deficiency from most Asian countries, including India. Part of the problem is lack of validated biomarkers for vitamin E and no consensus on cut offs for defining deficiency and sufficiency. Thus, interpretation of the data on the vitamin E status is difficult. Limited available data from 31 studies on vitamin E status in healthy people from Asia, the most populated continent, has been collated for the purpose of this review. Broadly, the results suggest inadequate vitamin E status in most age groups, with the prevalence of deficiency reaching 67%, 80%, 56% and 72% in infants, children and adolescents, adults, elderly and pregnant women, respectively, based on varying cut offs. The findings are not surprising as both, vitamin E intakes and its status have not received too much attention in the past. Lack of conclusive data accentuates the need for more research on the vitamin E status across all age groups and to define age, gender and physiological state specific cut offs for vitamin E levels.
References
1 (2005) Plasma retinol and a-tocopherol status of the Taiwanese elderly population. Asia Pac J Clin Nutr. 14, 256.
2 (2011) Vitamin E deficiency in developing countries. Food Nutr Bull. 32, 124–143.
3 (2016) Tocopherols and tocotrienols in common and emerging dietary sources: occurrence, applications, and health benefits. Int J Mol Sci. 17, 1745.
4 (2004) Ataxia with isolated vitamin E deficiency: neurological phenotype, clinical follow-up and novel mutations in TTPA gene in Italian families. Neurol Sci. 25, 130–137.
5 (2016) A systematic review of global alpha-tocopherol status as assessed by nutritional intake levels and blood serum concentrations. Int J Vitam Nutr Res. 85, 261–281.
6 (1997) Vitamin E supplementation and in vivo immune response in healthy elderly subjects. A randomized controlled trial. JAMA. 277, 1380–1386.
7 (1988) Serum vitamin E and risk of cancer among Finnish men during a 10 year follow up. Am J Epidemiol. 127, 28–41.
8 (2009) Vitamin E and cancer. Nutr Cancer. 61, 875–878.
9 (2005) Vitamin E levels, cognitive impairment and dementia in older persons: the InCHIANTI study. Neurobiol Aging. 26, 987–994.
10 (2018) Vitamin E as a treatment for nonalcoholic fatty liver disease: reality or myth? Antioxidants. 7, 12.
11 (2002) Dietary intake of antioxidants and risk of Alzheimer disease. JAMA. 287, 3223–3229.
12 (2014) Vitamin E inadequacy in humans: causes and consequences. Adv Nutr. 5, 503–514.
13 (2007) Alpha-Tocopherol Transfer Protein (α-TTP): Insights from alpha-tocopherol transfer protein knockout mice. Nutr Res Pract. 1, 247–253.
14 (2012) Vitamin E. Adv Nutr. 3, 330–1.
15 (2016) Vitamin supplementation for preventing miscarriage. Cochrane Database Syst Rev. Cd004073.
16 (1995) Cardiovascular disease and vitamins. Concurrent correction of ‘suboptimal’ plasma antioxidant levels may, as important part of ‘optimal’ nutrition, help to prevent early stages of cardiovascular disease and cancer, respectively. Bibl Nutr Dieta. 52, 75–91.
17 (2010) Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis. N Engl J Med. 362, 1675–1685.
18 (2015) Vitamin E has a beneficial effect on nonalcoholic fatty liver disease: a meta-analysis of randomized controlled trials. Nutrition. 31, 923–30.
19 (2005) Vitamins A and E: metabolism, roles and transfer to offspring. Br J Nutr. 93, 153–175.
20 . (2000) Panel on Dietary Antioxidants and Related Compounds. Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids. Washington (DC): National Academies Press (US). Vitamin E. Available from: http://www.ncbi.nlm.nih.gov/books/NBK225461/ (accessed on 15th July 2016)
21 (2007) Age and gender-related reference values for serum dl-alpha-tocopherol and all-trans-retinol levels in Saudi population. Int J Vitam Nutr Res. 77, 326–335.
22 (1997) Reference values for retinol, tocopherol, and main carotenoids in serum of control and insulin-dependent diabetic Spanish subjects. Clin Chem. 43, 1066–1071.
23 (2006) The value of measuring serum cholesterol-adjusted vitamin E in routine practice. Ann Clin Biochem. 43, 130–134.
24 (2005) Principles of Nutritional Assessment (2nd ed.). New York, NY: Oxford University Press.
25 (1986) The use of different lipids to express serum tocopherol: lipid ratios for the measurement of vitamin E status. Ann Clin Biochem. 23, 514–520.
26 (2015) A plasma alpha-tocopherome can be identified from proteins associated with vitamin E status in school-aged children of Nepal. J Nutr. 145, 2646–2656.
27 (2014) The role of vitamin E in human health and some diseases. Sultan Qaboos Univ Med J. 14, 157–165.
28 (2009) Concentrations of antioxidant vitamins in maternal and cord serum and their effect on birth outcomes. J Nutr Sci Vitaminol (Tokyo). 55, 1–8.
29 (2003) Micronutrient status of primary school girls in rural and urban areas of South Vietnam. Asia Pac J Clin Nutr. 12, 178–85.
30 (2001) Plasma retinol and alpha-tocopherol level and growth indices of 7 months old healthy Thai infants in Bangkok. Southeast Asian J Trop Med Public Health. 32, 408–12.
31 (2006) Selenium and vitamins status in Saudi children. Clin Chim Acta. 368, 99–109.
32 (2004) Vitamin E status and its dietary determinants in Taiwanese–results of the Nutrition and Health Survey in Taiwan 1993–1996. Eur J Nutr. 43, 86–92.
33 (2008) Vitamin E inadequacy observed in a group of 2- to 6-year-old children living in Kwangju, Republic of Korea. Int J Vitam Nutr Res. 78, 148–55.
34 (2010) Assessment of the relationship of vitamin D with serum antioxidant vitamins E and A and their deficiencies in Iranian pregnant women. Saudi Med J. 31, 1119–23.
35 (2015) First-trimester plasma tocopherols are associated with risk of miscarriage in rural Bangladesh. Am J Clin Nutr. 101, 294–301.
36 (2005) Micronutrient deficiencies in early pregnancy are common, concurrent, and vary by season among rural Nepali pregnant women. J Nutr. 135, 1106–12.
37 (2013) Plasma zinc, vitamin B(12) and α-tocopherol are positively and plasma γ-tocopherol is negatively associated with Hb concentration in early pregnancy in north-west Bangladesh. Public Health Nutr. 16, 1354–1361.
38 (2013) Serum levels of some micronutrients and congenital malformations: a prospective cohort study in healthy saudi-arabian first-trimester pregnant women. Int J Vitam Nutr Res. 83, 346–54.
39 (2006) Nutritional status of pregnant women in Northeast Thailand. Asia Pac J Clin Nutr. 15, 329–34.
40 (2015) Vitamin E status of 20- to 59-year-old adults living in the Seoul metropolitan area of South Korea. Nutr Res Pract. 9, 192–198.
41 (2001) Nutritional status of vitamin A, E, C, B1, B2, B6, nicotinic acid, B12, folate, and beta-carotene in young women. J Nutr Sci Vitaminol (Tokyo). 47, 20–27.
42 (2002) Simultaneous analysis of retinol, beta-carotene and tocopherol levels in serum of Vietnamese populations with different incomes. Asia Pac J Clin Nutr. 11, 92–97.
43 (2008) Serum micronutrient and micromineral concentrations and ratios in healthy Omani subjects. Med Princ Pract. 17, 334–339.
44 (2002) Serum concentrations of micronutrient antioxidants in an adult Arab population. Asia Pac J Clin Nutr. 11, 22–27.
45 (2003) Serum antioxidant vitamin levels of people in Khon Kaen, northeastern Thailand. Asian Pac J Cancer Prev. 4, 147–52.
46 (2006) Vitamins A and E status in an urban Lebanese population: a case study at Dar Al-Fatwa area, Beirut. Int J Vitam Nutr Res. 76, 3–8.
47 (2007) The levels of lycopene, alpha-tocopherol and a marker of oxidative stress in healthy northeast Thai elderly. Asia Pac J Clin Nutr. 16, 27–30.
48 (2007) Epidemiological survey of vitamin deficiencies in older Thai adults: implications for national policy planning. Public Health Nutr. 10, 65–70.
49 (2013) Bioavailability of vitamin E in humans: an update. Nutr Rev. 71, 319–331.
50 (2017) Vitamin E bioavailability: mechanisms of intestinal absorption in the spotlight. Antioxidants (Basel). 6, 95.
51 (2016) Complexity of vitamin E metabolism. World J Biol Chem. 7, 14–43.
52 (2008) Vitamin E in human health and disease. Crit Rev Clin Lab Sci. 45, 417–50.
53 (2001) Ataxia with isolated vitamin E deficiency: case report and review of the literature. J Pediatr Gastroenterol Nutr. 33, 206–210.
54 (1972) Relationship between tocopherol and serum lipid levels for the determination of nutritional adequacy. Ann NY Acad Sci. 203, 223–236.
55 (2016) Vitamin status among breastfed infants in Bhaktapur, Nepal. Nutrients. 8, 149.
56 (2014) Micronutrient deficiencies are common in 6- to 8-year-old children of rural Nepal, with prevalence estimates modestly affected by inflammation. J Nutr. 144, 979–987.
57 (2007) Status of selenium, vitamin E, and vitamin A among Saudi adults: potential links with common endemic diseases. J Environ Pathol Toxicol Oncol. 26, 221–43.
58 (2007) Serum beta-carotene, lycopene and alpha-tocopherol levels of healthy people in northeast Thailand. Asia Pac J Clin Nutr. 16, 47–51.
59 (2014) Associations of serum retinol, alpha-tocopherol, and gamma-tocopherol with biomarkers among healthy Japanese men. Int J Environ Res Public Health. 11, 1647–60.
60 (2016) Association of dietary and serum vitamin E with bone mineral density in middle-aged and elderly Chinese adults: a cross-sectional study. Br J Nutr. 115, 113–20.