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Fairfield KM, Fletcher RH. Vitamins for Chronic Disease Prevention in Adults: Scientific Review. JAMA. 2002;287(23):3116–3126. doi:10.1001/jama.287.23.3116
Author Affiliations: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, and Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School (Dr Fairfield); Department of Ambulatory Care and Prevention, Harvard Medical School/Harvard Pilgrim Health Care, and Department of Epidemiology, Harvard School of Public Health (Dr Fletcher), Boston, Mass.
Scientific Review and Clinical Applications Section
Editor: Wendy Levinson, MD, Contributing Editor
Context Although vitamin deficiency is encountered infrequently in developed
countries, inadequate intake of several vitamins is associated with chronic
Objective To review the clinically important vitamins with regard to their biological
effects, food sources, deficiency syndromes, potential for toxicity, and relationship
to chronic disease.
Data Sources and Study Selection We searched MEDLINE for English-language articles about vitamins in
relation to chronic diseases and their references published from 1966 through
January 11, 2002.
Data Extraction We reviewed articles jointly for the most clinically important information,
emphasizing randomized trials where available.
Data Synthesis Our review of 9 vitamins showed that elderly people, vegans, alcohol-dependent
individuals, and patients with malabsorption are at higher risk of inadequate
intake or absorption of several vitamins. Excessive doses of vitamin A during
early pregnancy and fat-soluble vitamins taken anytime may result in adverse
outcomes. Inadequate folate status is associated with neural tube defect and
some cancers. Folate and vitamins B6 and B12 are required
for homocysteine metabolism and are associated with coronary heart disease
risk. Vitamin E and lycopene may decrease the risk of prostate cancer. Vitamin
D is associated with decreased occurrence of fractures when taken with calcium.
Conclusions Some groups of patients are at higher risk for vitamin deficiency and
suboptimal vitamin status. Many physicians may be unaware of common food sources
of vitamins or unsure which vitamins they should recommend for their patients.
Vitamin excess is possible with supplementation, particularly for fat-soluble
vitamins. Inadequate intake of several vitamins has been linked to chronic
diseases, including coronary heart disease, cancer, and osteoporosis.
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