How Do Vitamin or Mineral Deficiencies Affect Wellbeing?
This blog post is based on a poster presented at Experimental Biology 2016 in San Diego, CA, USA on 5th April 2016.
Some vitamin and mineral deficiencies have symptoms that are well defined enough for us to give the disease that they cause a name: think of scurvy for vitamin C deficiency, pellagra for vitamin B3 deficiency (which is classically described as the four Ds: diarrhea, dermatitis, dementia, then death), rickets for vitamin D deficiency in childhood, and beriberi for thiamin deficiency. Others are “silent”, such as vitamin D deficiency in adulthood, which weakens bones but has no overt symptoms. Still others have non-specific symptoms, such as the general fatigue that is found with any of the vitamins or minerals that affect red blood cell production (vitamins B6, B12, folate, riboflavin, iron), or slow wound healing with vitamin A deficiency. Part of my own self-care if I am feeling run down is to take a multivitamin tablet, to make sure that I do not have any dietary gaps that could be contributing to my sense of fatigue. I was interested in whether there was any effect of vitamin and mineral deficiencies on how people feel using NHANES data.
NHANES has a question that has been asked in the Current Health Status questionnaire in every cycle from 2001 to 2014. The question is “Would you say your health is excellent/very good/good/fair or poor?”. I compared the answer with various socio-demographic categories, and an aggregated measure of vitamin and mineral deficiencies that I have been developing, and was used last year in two posters, 586.2 and 250.4 in the FASEB journal.
About one third of the US population rates their health as “very good” and a further third as “good”. Then, around 12-13% rate their health as either “excellent” or “fair”, and 2-3% rate their health as “poor”. If the answers to the question are given a number of 1 for “excellent” to 5 for “fair”, mean subjective health rating is 2.57. When looking at socio-demographic categories, there was no significant difference in health rating found between men and women, however non-Hispanic Whites rate their health significantly better than the other major racial/ethnic groups in the US, subjective health improves as household income rises, and people with a college education generally feel better than people with a lower educational status.
The most common vitamin deficiencies in the US population are vitamin B6, iodine, vitamin D, vitamin C, and anemia, which is often caused by iron deficiency, and I also included vitamin B12, vitamin E, vitamin A and folate deficiency in my aggregated score of vitamin or mineral deficiencies. Around one in three adults is deficient in at least one vitamin or mineral. People who did not have a vitamin or mineral deficiency had the best subjective health rating (2.47) compared to people with one, two or more than three deficiencies (2.70, 2.87 and 3.04). As this relationship appeared to be linear, I ran linear regression analysis to be able to determine whether the effects of age, race/ethnicity, household income, education or BMI were able to explain the relationship, or whether it was due to deficiencies. Adding these co-factors to the regression model affected the relationship (the effect size was halved), but it remained highly significant. It seems that having a vitamin or mineral deficiency affects how people feel, outside of the effects of other factors like age, low household income or BMI.
It would be interesting to look further into this data to see which vitamins and minerals have the largest effect on wellbeing. A further question is whether the extent of deficiency (e.g. a vitamin status that is sub-clinically deficient compared to frank deficiency) has an effect.
J.K. Bird, E.D. Ciappio, M.I. McBurney. Vitamin and Mineral Deficiencies Are Associated with Subjective Health Status. Poster D131. Session I. 1154.29. https://www.researchgate.net/publication/299747945
Julia Bird, Eric Ciappio, and Rachel Murphy. Adult Full Spectrum Multivitamin/Multimineral Supplement Users Have a Lower Prevalence of Vitamin and Mineral Deficiencies. FASEB J April 2015 29:586.2 http://www.fasebj.org/content/29/1_Supplement/586.2.short
Rachel Murphy, Eric Ciappio, and Julia Bird. Lower Prevalence Of Vitamin And Mineral Deficiencies Among Adolescent Users Of Full Spectrum Multivitamin/Multimineral Supplements. FASEB J April 2015 29:250.4 http://www.fasebj.org/content/29/1_Supplement/250.4.short