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 B₁₂ or folate is a risk for cardiovascular disease, osteoporotic fracture, and cognitive impairment. Additionally, we have recently reported that vitamin B₁ 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.

Keywords: cardiovascular disease; heart failure; hyperhomocysteinemia; osteoporotic fracture; vitamin insufficiency.

Fig. 1

Metabolism of vitamin D.

Fig. 2

Indices employed in DRIs (dietary reference intakes) for Japanese (classified).

Fig. 3

Methionine metabolism and Hcy.

Fig. 4

Hypothesis. Vicious cycle between vitamin B₁ insufficiency and congestive heart failure.