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Scientific Review

Kathleen M. Fairfield, MD,DrPH; Robert H. Fletcher, MD,MSc

JAMA. 2002;287:3116-3126.

Context  Although vitamin deficiency is encountered infrequently in developed countries, inadequate intake of several vitamins is associated with chronic disease.

Objective  To review the clinically important vitamins with regard to their biological effects, food sources, deficiency syndromes, potential for toxicity, and relationship to chronic disease.

Data Sources and Study Selection  We searched MEDLINE for English-language articles about vitamins in relation to chronic diseases and their references published from 1966 through January 11, 2002.

Data Extraction  We reviewed articles jointly for the most clinically important information, emphasizing randomized trials where available.

Data Synthesis  Our review of 9 vitamins showed that elderly people, vegans, alcohol-dependent individuals, and patients with malabsorption are at higher risk of inadequate intake or absorption of several vitamins. Excessive doses of vitamin A during early pregnancy and fat-soluble vitamins taken anytime may result in adverse outcomes. Inadequate folate status is associated with neural tube defect and some cancers. Folate and vitamins B₆ and B₁₂ are required for homocysteine metabolism and are associated with coronary heart disease risk. Vitamin E and lycopene may decrease the risk of prostate cancer. Vitamin D is associated with decreased occurrence of fractures when taken with calcium.

Conclusions  Some groups of patients are at higher risk for vitamin deficiency and suboptimal vitamin status. Many physicians may be unaware of common food sources of vitamins or unsure which vitamins they should recommend for their patients. Vitamin excess is possible with supplementation, particularly for fat-soluble vitamins. Inadequate intake of several vitamins has been linked to chronic diseases, including coronary heart disease, cancer, and osteoporosis.

Author Affiliations: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, and Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School (Dr Fairfield); Department of Ambulatory Care and Prevention, Harvard Medical School/Harvard Pilgrim Health Care, and Department of Epidemiology, Harvard School of Public Health (Dr Fletcher), Boston, Mass.

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