Inadequate intake of vitamin E, disorders causing fat malabsorption, and in rare cases a defective liver metabolism are the main causes of Vitamin F deficiency¹.

Symptoms of Vitamin E deficiency

The main symptoms of vitamin E deficiency are haemolyticanaemia and neurologic deficits¹.

The patients with vitamin E deficiency may present with ataxia symptoms, difficulty with upward gaze, and hyporeflexia. Muscle weakness and visual-field constriction are also seen as not so common symptoms. The most severe symptoms linked to vitamin E deficiency are blindness, dementia, and cardiac arrhythmias².

Diagnosis of vitamin E deficiency

A full neurological assessment is recommended along with a standard physical examination if vitamin E deficiency is suspected. Patients presenting early may show hyporeflexia, reduced night vision, loss/decreased vibratory sense, but normal cognition².

A more moderate stage of this deficiency may show limb,truncal ataxia, profuse muscle weakness, and limited upward gaze. The late presentation may show cardiac arrhythmias and possible blindness with reduced cognition. One of the most common findingsis ataxia².

Evaluation test

A low alpha-tocopherol level or reduced serum alpha-tocopherol to serum lipids measurement is the key to diagnosis.

In adults, alpha-tocopherol levels should be below 5 mcg/mL. A pediatric patient with abetalipoproteinemia will have serum alpha-tocopherol concentrations that are not identifiable^{1, 2}.

Treatment

Oral vitamin E supplementation after addressing the underlying cause of the deficiency. Besides, a diet change can help supplementation, increase intake of leafy vegetables, whole grains, nuts, seeds, vegetable oil, and fortified cereals².

Though typically presented in the diet, adults need 15 mg of vitamin E daily. A supplement of 15 to 25 mg/Kg once per day or mixed tocopherol 200 IU can both be used². The recommended daily allowance is given below²:

1. Age 0 to 6 months: 3 mg
2. Age 6 to 12 months: 4 mg
3. Age 1 to 3 years: 6 mg
4. Age 4 to 10 years: 7 mg
5. Adults and elderly patients: 10 mg

References:

1. Johnson LE. Vitamin E deficiency. MERCK Manual Professional version. August 2019. Accessed from: https://www.merckmanuals.com/professional/nutritional-disorders/vitamin-deficiency-dependency-and-toxicity/vitamin-e-deficiency Accessed on 12/11/2020
2. Kemnic RT, Coleman M. Vitamin E deficiency. StatPearls [Internet]. July 10, 2020. Accessed from: https://www.ncbi.nlm.nih.gov/books/NBK519051/ Accessed on 12/11/2020