Abstract
Abundant in almonds, vegetable oils, and cereals, Vitamin E's functions are complicated. First discovered in 1922, it was thought to play a role in fertility. However, it offers more. For instance, it is thought to be beneficial for fatty liver disease, macular degeneration, and neuroprotective. However, these need further research. Its deficiency may result in spinocerebellar ataxia. Being fat soluble, its absorption is dependent on lipase. Consequently, it is prone to various etiologies that cause lipase deficiency. These include chronic pancreatitis, cystic fibrosis, pancreatic malignancy, liver cholestasis, and small bowel resection. Although rarely required, oral and intramuscular replacement are available. The former is preferred whilst the latter allows for less frequent administration albeit more invasive. It interacts with other micronutrients as elaborated in the body of this passage. In summary, Vitamin E plays an important role in one's health and its deficiency can be devastating.
Causes and Management of Nutritional Deficiency Disorders
TopBiochemical Assessment
The best measure of vitamin E is serum α-tocopherol. However, the level should be interpreted based on the lipid and protein levels. In the case of hyperlipidaemia, effective vitamin E level can be estimated with the following formula (Albahrani & Greaves, 2016):
Figure 1.
Effective Vitamin E levels
TopAt Risk Groups
Being one of the fat-soluble vitamins, it is not surprising that vitamin E absorption is thus dependent upon proper functioning of the gastrointestinal tract, especially the components that promote fat digestion and absorption. Specifically, its absorption requires the work of lipase (enzyme that digests fats), bile salts (help solubilize dietary lipids and micelles production), pancreatic function (produces lipase), intact intestinal mucosae, liver, and the lymphatic system. Thus, the at-risk populations are those with alcohol misuse disorders (due to chronic pancreatitis), pancreatic malignancy with or without subsequent pancreatectomy, cystic fibrosis, liver cholestasis and history of small bowel resection (Kemnic & Coleman, 2023). Another group that is also affected by vitamin E deficiency is the premature infants. It is long known that vitamin E deficiency causes haemolytic anaemia in this population (Ritchie et al., 1968).
There are also genetic disorders that can lead to deficiency. For example, mutation in the alpha-tocopherol transfer protein (ATTP) (Ben Hamida et al., 1993) and Abetalipoproteinaemia – a condition due to mutations in the microsomal triglyceride transfer protein (Tanyel & Mancano, 1997).