Insufficiency of B vitamins with its possible clinical implications

Abstract

Vitamin deficiency causes classical deficiency diseases such as beriberi and rickets. Vitamin insufficiency, which is milder than deficiency, is a risk for various chronic diseases, but its significance has not been recognized in Japan. Vitamin D insufficiency is quite common in Japan, and a serious risk for osteoporotic fracture through its unbeneficial effect on bone and muscle. Insufficiency of B vitamins has been little studied. However, hyperhomocysteinemia caused by the insufficiency of vitamin B 12 or folate is a risk for cardiovascular disease, osteoporotic fracture, and cognitive impairment. Additionally, we have recently reported that vitamin B 1 insufficiency is a risk for heart failure in the elderly. The effect of improvement of nutritional status including vitamins is less marked compared to drug treatment, but it costs far less, and is suited for the primary prevention of diseases. Randomized controlled trial is considered the study with the most robust evidence in the evaluation of drug treatment, but more emphasis should be put on the well-designed cohort studies in evaluating the role of nutrients. Vitamin insufficiency is quite prevalent, and vitamin requirement is much higher for its prevention than for the prevention of deficiency.

Vitamin D in the Dietary Reference Intakes for Japanese (DRIs) 2020

“…Recently, increasing attention has been paid on vitamin insufficiency. Insufficiency is milder than deficiency, and does not cause the diseases described above, but renders one at an increased risk for various diseases (6). In deficiency, phenotypic changes occur in the affected subjects, and diagnosis can be made individually.…”

“…Since the most essential role of vitamin D is to enhance the intestinal absorption of calcium and phosphate, its deficiency causes the mineralization defect; rickets and osteomalacia. In insufficiency, although the mineralization defect does not occur, impaired intestinal absorption of calcium evokes secondary hyperparathyroidism to maintain the serum calcium level, leading to the negative calcium balance, osteoporosis, and increased fracture risk (6).…”

Insufficiency of B vitamins with its possible clinical implications

“…We read the review ( 1 ) by Tanaka et al and agree that vitamin insufficiency is the cause of various diseases.…”

Response to Letter: Insufficiency of B vitamins with its possible clinical implications

“…Onishi and Ishida have commented on our recent review ( 1 ) that vitamin B 1 deficiency is a health problem in cancer patients. Our review, however, has by no means focused on the secondary causes of vitamin deficiency, but is intended to review the significance of vitamin deficiency/insufficiency from the viewpoint of public health with the hope to be of help for the future determination of Dietary Reference Intakes (DRI), which proposes reference values of desirable dietary intake of energy and nutrients for Japanese people to maintain and promote their health status.…”

“…Our scope is that primary vitamin deficiency disease such as beriberi and rickets have now become far less common, but even vitamin insufficiency, milder than deficiency, is a significant risk for various diseases, and of great societal importance. ( 1 )…”