Vitamins and minerals play a crucial role in carrying out various metabolic reactions in the body and also maintaining structural integrity. Inadequate intake of these nutrients leads to deficiencies in the body which will be detrimental in the long run.
Individuals who follow Western diets generally have reduced intakes of several micronutrients compared with individuals who follow a plant-based whole food eating pattern.
- Potential causes for micronutrient deficiencies include
- Alcohol abuse
- High carb diet
- Restrictive diets
- Regular intake of diabetes and hypertension drugs
- Other drug interactions1
Vitamin D deficiency is a public health problem worldwide which if not addressed on time leads to escalated medical costs. Poor dietary intake, lack of exposure to sunlight, skin pigmentation, use of sunscreens, and fully covering oneself with a cloth while stepping out are the risk factors to develop deficiency.
Severe vitamin D deficiency is defined as serum 25-hydroxyvitamin D (25(OH)D) concentrations <10 ng/mL and may sustain impaired bone mineralization (rickets/osteomalacia), while those with a value less than approximately 30 ng/mL are identified as insufficient and may sustain long-term adverse health consequences. The minimum optimum level of vitamin D in general 25-80 ng/mL. A level above 80 ng/mL results in toxicity 2,3,4,5.
Calcium is the most abundant and one of the most important minerals in the body. It is essential for cell signaling and the proper functioning of muscles, nerves, and the heart. Calcium is needed for blood clotting and is crucial for the formation, density, and maintenance of bones and teeth. Adequate intake of calcium has shown many health benefits such as lower blood pressure among young adults, prevention of osteoporosis and colorectal adenomas, lower cholesterol values, reduction of hypertensive disorders in pregnant mothers, and her offspring6. A serum calcium level of 8.6-10.3 mg/dl is considered normal7.
Vitamin B12 is an important component for the production of red blood cells and the maintenance of a healthy nervous system. Severe deficiency is associated with megaloblastic anemia whereas a mild deficiency may result in mood disturbances and ataxia-degenerative disease of the nervous system. Normal ranges of vitamin B12 are 200 to 1000 pg/mL. For the elderly, a threshold of 300 to 350 pg/mL is considered desirable. A range of 100-200 pg/mL may result in insufficiency whereas a level below 100pg/mL leads to severe deficiency3,4,5,8.
Anemia occurs due to a lack of red blood cells in the blood which decreases the ability to carry enough oxygen. Deficiency of iron and B12 cause anemia, though iron deficiency anemia is more prevalent. A host of factors contributes to this condition such as malnutrition, malabsorption, poor dietary practices, inadequate food intake.
In the year 2015, WHO has reported that 20% of maternal deaths are attributed to anemia alone. Anemia is more prevalent in females of reproductive age of 15 to 49 years8.
The most commonly used strategies for micronutrient deficiency control are supplementation and fortification because they are cost-effective and to some extent, relatively easy to deliver. A balanced diet with enough emphasis on foods from all the food groups will be eventually helpful in controlling and preventing micronutrient deficiencies. Optimizing nutritional status is one of the key responsibilities of clinical care providers9.
Different tests help to diagnose anemia
- Normal ranges of Hemoglobin (Hb) for males are 140-175 g/L and for females 123-153 g/L respectively.
- Likewise, the red blood cell count range for males is 4.5-5.9 x 1012/L, and for females is 4.1-5.1 x 1012/L. A level below this may result in deficiency3,4,5,10.
- Normal blood levels of iron will be 10 to 30 mmol/L.
- Normal levels of ferritin will be 40 to 300 for men and 20 to 200 mg/L for women11,12,13.
Micronutrients in Health and Disease | Nutrition Guide for Clinicians
Faiza Abdul Aziz Qari, Practical Approach for the Prevention and Management of Vitamin D Deficiency in Adults, J Family Med Prim Care. 2013 Oct-Dec; 2(4):315-318.
Smith et al, Lab tests online; American Association for Clinical Chemistry (AACC), 2001-2020.
Wintrobe's Clinical Hematology. 14th ed. Greer J, editor. Philadelphia, PA: Wolters Kluwer: 2019.
Henry's Clinical Diagnosis and Management by Laboratory Methods. 22nd ed. McPherson R, Pincus M, eds. Philadelphia, PA: Elsevier Saunders; 2011.
Cormick G, Belizan JM. Calcium Intake and Health. 2019 Jul 15;11(7):1606.
Christopher R. McCudden , Calcium | AACC.org.
Hanna, S., Lachover, L., & Rajarethinam, R. P. (2009). Vitamin B12 Deficiency and Depression in the Elderly: Review and Case Report, Primary care companion to the Journal of clinical psychiatry, 11(5),269-270.
WHO. The global prevalence of anemia in 2011. Geneva: World Health Organization;2015
Allen, Lindsay. (2003). Interventions for Micronutrient Deficiency Control in Developing Countries: Past, Present and Future. The Journal of nutrition.
Iron-Deficiency Anemia | NHLBI, NIH