Reduced fat-soluble vitamins if poor gut

Fat-Soluble Vitamins A, D, E, and K: Review of the Literature and Points of Interest for the Clinician - June 2024

J. Clin. Med. 2024, 13(13), 3641; https://doi.org/10.3390/jcm13133641
by Emmanuel Andrès 1,*ORCID,Noel Lorenzo-Villalba 1,Jean-Edouard Terrade 1 andManuel Méndez-Bailon 2ORCID

• 1Département de Médecine Interne, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 67000 Strasbourg, France
• 2 Servicio de Medicina Interna, Facultad de Medicina, Instituto de Investigación Sanitaria del Hospital San Carlos, Hospital Clínico San Carlos, Universidad Complutense de Madrid, 28040 Madrid, Spain

Fat-soluble vitamins, including vitamins A, D, E, and K, are energy-free molecules that are essential to the body’s functioning and life. Their intake is almost exclusively exogenous, i.e., dietary. As a result, fat-soluble vitamin deficiencies are rarer in industrialized countries than in countries with limited resources. Certain groups of people are particularly affected, such as newborns or growing children, pregnant or breastfeeding women, and elderly or isolated individuals. Deficiencies in vitamins A, D, E, and K are also relatively frequent in subjects with digestive tract disorders, liver diseases, chronic pathologies, or in intensive care patients. Deficiencies or excesses of fat-soluble vitamins are responsible for a variety of more or less specific clinical pictures. Certain syndromes are typical of fat-soluble vitamin deficiency, such as the combination of ophthalmological and immunity impairments in the case of vitamin A deficiency or hemorrhagic syndrome and osteopenia in the case of vitamin E deficiency. This is also the case for osteomalacia, muscular weakness, even falls, and rickets in the case of vitamin D deficiency. Diagnosis of a deficiency in one of the fat-soluble vitamins relies on blood tests, which are not always essential for routine use. In this context, a therapeutic test may be proposed. Treatment of deficiencies requires vitamin supplementation, a well-balanced diet, and treatment of the cause.
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Clipped from PDF: Digestive Tract Disorders and Malabsorption

Gastrointestinal disorders impairing fat absorption can lead to malabsorption of fatsoluble vitamins [1,4]. Examples include

• celiac disease,
• Crohn’s disease,
• ulcerative colitis,
• Whipple’s disease,
• chronic pancreatitis (e.g., cystic fibrosis), and
• chronic cholestasis (e.g.,primary biliary cirrhosis).

Several surgical procedures can also affect the absorption of fats and fat-soluble vitamins, such as bowel resections, gastrectomy (even partial), and bariatric surgery, regardless of the surgical setup (sleeve gastrectomy, gastric bypass, or biliopancreatic bypass) [5–8].
Gastrointestinal disorders can impair fat absorption through a variety of mechanisms, including a reduced surface area for absorption, with damage to intestinal villi (e.g., in celiac disease, Crohn’s disease) or intestinal resection (e.g., in short bowel syndrome) [1,4].
They can also affect fat absorption through decreased digestive enzyme production (e.g., in chronic pancreatitis, cystic fibrosis); bile salt disruption with damage to the ileum (e.g., in Crohn’s disease, short bowel syndrome); and intestinal dysbiosis (disturbance of intestinal
flora) [1,4].

VitaminDWiki – Overview Gut and vitamin D contains gut-friendly information