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Clinical Applications

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

JAMA. 2002;287:3127-3129.

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. Most people do not consume an optimal amount of all vitamins by diet alone. 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 patients 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 for 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 any age.

Author Affiliations: Department of Ambulatory Care and Prevention, Harvard Medical School/Harvard Pilgrim Health Care, and Department of Epidemiology, Harvard School of Public Health (Dr Fletcher); 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), Boston, Mass.

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