Vitamin E deficiency in South Asian population and the therapeutic use of alpha-tocopherol (Vitamin E) for correction of anemia

Tanveer Jilani, Mohammad Perwaiz Iqbal, Tanveer Jilani, Mohammad Perwaiz Iqbal

Abstract

Mild to moderate vitamin E deficiency because of inadequate consumption of vitamin E-rich foods and intestinal fat malabsorption is common in growing children, women of reproductive age and elderly South Asian population. Severe vitamin E deficiency may lead to peripheral and motor neurodegenerative diseases (e.g ataxia and motor skeletal myopathy), impaired immune response and free radical-induced hemolytic anemias. Vitamin E insufficiency and/or deficiency status in the general Pakistani population has not been sufficiently investigated. Moreover, there are challenges in determining vitamin E status in apparently healthy humans due to variations in their age, sources of consumed vitamin E and plasma lipid levels. Oxidative stress-induced reactive oxygen species have been shown to cause ineffective erythropoiesis and enhanced lysis of erythrocytes in some of the experimental animals and humans. Several studies on patients with various types of inherited hemolytic anemias, chronic renal disease, premature low birth infants and apparently healthy humans have shown that vitamin E might be therapeutically effective in the prevention and/ or treatment of anemia in these subjects.

Keywords: Alpha tocopherol; Anemia; South Asian population; Vitamin E deficiency.

Conflict of interest statement

Conflict of interest: The authors declare that there are no conflicts of interest.

References

    1. Peter S, Moser U, Pilz S, Eggersdorfer M, Weber P. The challenge of setting appropriate intake recommendations for vitamin E:Considerations on status and functionality to define nutrient requirements. Int J Vitamin Nutr Res. 2013;83(2):129–136. doi:10.1024/0300-9831/a000153.
    1. McBurney MI, Yu EA, Ciappio ED, Bird JK, Eggersdorfer M, Mehta S. Suboptimal serum α-tocopherol concentrations observed among younger adults and those depending exclusively upon food sources. PLoS One. 2015;10(8):e0135510. doi:10.1371/journal.prone.0135510.
    1. Dror DK, Lindsay HA. Vitamin E deficiency in developing countries. Food Nutr Bull. 2011;32(2):124–143. .
    1. Radhakrihnan AK, Mahalingam D, Selvaduray KR, Nesaretnam K. Supplementation with natural forms of vitamin E augments antigen-specific TH-1-type immune response to tetanus toxoid. Biomed Res Int. 2013;2013:782067. .
    1. Harikrishnan G, Kurup AR. Ataxia due to isolated vitamin E deficiency from South Asia. J Assoc Physicians India. 2016;64(1):135.
    1. Mansoor S, Ahmad A. Progressive ataxia due to alpha-tocopherol deficiency in Pakistan. Iranian J Neurol. 2016;15(2):103–105.
    1. Sun Y, Ma A, Li Y, Han X, Wang Q, Liang H. Vitamin E supplementation protects erythrocyte membranes from oxidative stress in healthy Chinese middle-aged and elderly people. Nutr Res. 2012;32(5):328–334. doi:10.1016/j.nutres.2012.03.012.
    1. Gomez-Pomar E, Hatfield E, Garlitz K, Westgate PM, Bada HS. Vitamin E in preterm infant:A forgotten cause of hemolytic anemia. Am J Perinatol. 2018;35(3):305–310. doi:10.1055/s-0037-1607283.
    1. Shah AA, Khand F, Khand TU. Effect of smoking on serum xanthine oxidase, malondialdehyde, ascorbic acid and α-tocopherol levels in healthy male subjects. Pak J Med Sci. 2015;3(1):146–149. doi:.
    1. QL YJ, Niu QL, Zhu XL, Zhao XZ, Yang WW, Wang XJ. Relationship between deficiencies in vitamin A and E and occurrence of infectious diseases among children. Eur Rev Med Pharmacol Sci. 2016;20:5009–5012.
    1. Traber MG. Vitamin E inadequacy in humans:causes and consequences. Adv Nutr. 2014:503–514. .
    1. Kalra V, Grover JK, Ahuja GK, Gulati S, Kalra N. Vitamin E administration and reversal of neurological deficits in protein-energy malnutrition. J Trop Pediat. 2001;47:39–45. doi:10.1093/tropej/47.1.39.
    1. Shamim AA, Schulze KJ, Merrill RD, Kabir A, Christian P, Shaikh S, et al. First trimester plasma tocopherols are associated with risk of miscarriage in rural Bangladesh. Am J Clin Nutr. 2015;101:294–301. doi:10.3945/ajcn.114.094920.
    1. Shamim AA, Kabir A, Merrill RD, Ali H, Rashid M, Schulze K, et al. Plasma zinc, vitamin B(12) and α-tocopherol are positively and plasma-tocopherol is negatively associated with Hb concentration in early pregnancy in north-west Bangladesh. Pub Health Nutr. 2013;16(8):1354–1361. doi:10.1017/S1368980013000475.
    1. Lohia N, Udipi S, Ghugre P, Deshpande K. Serum retinol, alpha-tocopherol, and lipid peroxide concentrations in low-income Indian pregnant mothers. Int J Vitam Nutr Res. 2009;79(3):142–51. doi:10.1024/0300-9831.79.3.142.
    1. Assantachai P, Lekhakula S. Epidemiological survey of vitamin deficiencies in older Thai adults:implications for national policy planning. Pub Health Nutr. 2007;10(1):65–70. doi:10.1017/S136898000720494X.
    1. Casal S, Amaral J, Oliveria B. Effects of food thermal processing on vitamin E contents. In: Braunstein M. H, editor. Vitamin E:New Research. New York: Nova Science Publishers, Inc; 2006. pp. 39–59.
    1. Mehbooali N, Iqbal MP. A simple micro method for determination of plasma levels of alpha tocopherol (Vitamin E) in Pakistani normal adults. Pak J Pharm Sci. 2008;21(4):361–365.
    1. Smit EN, Dijkstra JM, Schnater TA, Seerat E, Muskiet FAJ, Boersma ER. Effects of malnutrition on erythrocyte fatty acid composition and plasma vitamin E levels of Pakistani children. Acta Paediatr. 1997;86:690–695.
    1. Lebold KM, Ang A, Traber MG, Arab L. Urinary alpha-carboxyethyl hydroxychroman can be used as a predictor of alpha-tocopherol adequacy, as demonstrated in Energetics Study. Am J Clin Nutr. 2012;96:801–809. doi:10.3945/ajcn.114.094920.
    1. Traber MG, Leanard SW, Traber DL, Traber LD, Gallaghar J, Bobe G, et al. α-Tocopherol adipose tissue stores are depleted after burn injury in pediatric patients. Am J Clin Nutr. 2010;92:1378–1384. doi:10.3945/ajcn.2010.30017.
    1. Zwieten R, Verhoeven AJ, Roos D. Inborn defects in the antioxidant systems of human red blood cells. Free Rad Biol Med. 2014;67:377–386. doi:10.1016/j.freeradbiomed.2013.11.022.
    1. Nirjala LM, Murth YK. Antioxidant enzymes and oxidative stress in the erythrocytes of iron deficiency anemic patients supplemented with vitamins. Iranian Biomed J. 2014;18(2):82–87. doi:10.6091/ibj.1228.2013.
    1. Marat T. Amelioration of glucose induced hemolysis of human erythrocytes by vitamin E. Chem Biol Interact. 2011;193(2):149–153. doi:10.1016/j.cbi.2011.06.004.
    1. Hamdy MM, Mosallam DS, Jamal AM, Rabie WA. Selenium and Vitamin E as antioxidants in chronic hemolytic anemia:Are they deficient?A case-control study in a group of Egyptian children. J Adv Res. 2015;6(6):1071–1077. doi:10.1016/j.jare.2015.01.002.
    1. George MI, Adegoke AO. Effect of vitamin E on haematological parameters in albino rats treated with gasoline. J Sci Res. 2012;4(2):437–444. doi:.
    1. Gogu SR, Lertora JJ, George WJ, Hyslop NE, Agarwal KC. Protection of zidovudine-induced toxicity against murine erythroid progenitor cells by vitamin E. Exp Hematol. 1991;19:649–652.
    1. Ren H, Ghebremeskel K, Okpala I, Lee A, Ibegbulam O, Crawford M. Patients with sickle cell disease have reduced blood antioxidant protection. Int J Vitam Nutr Res. 2008;78:139–147. doi:10.1024/0300-9831.78-3.139.
    1. Jaja SI, Aigbe PE, Gbenebitse S, Temiye EO. Changes in erythrocytes following supplementation with alpha-tocopherol in children suffering from sickle cell anaemia. Niger Postgrad Med J. 2005;12:110–114.
    1. Sutipornpalangkul W, Morales N P, Unchern S, Sanvarinda Y, Chantharaksri U, and Fucharoen S. Vitamin E supplement improves erythrocyte membrane fluidity of thalassemia:an ESR spin labeling study. J Med Assoc Thai. 2012;95(1):29–36.
    1. Eldamhougy S, Elhelw Z, Yamamah G, Hussein L, Fayyad I, Fawzy D. The vitamin E status among glucose-6 phosphate dehydrogenase deficient patients and effectiveness of oral vitamin E. Int J Vitam Nutr Res. 1988;58:184–188.
    1. Rusu A, Rusu F, Zalutchi D, Muresan A, Caprioara MG, Kasco I. The influence of vitamin E supplementation on erythropoietin responsiveness in chronic hemodialysis patients with low levels of erythrocyte superoxide dismutase. Int J Urol Nephrol. 2013;45:495–501. doi:10.1007/S11255-012-01753.
    1. Roozbeh J, Shahriyari B, Akmali M, Vessal G, Pakfetrat M, Raees GA, Afshariani R, Hasheminasab M, Ghahramani N. Comparative effects of silymarin and vitamin E supplementation on oxidative stress markers and hemoglobin levels among patients on hemodialysis. Ren Fail. 2011;33(2):118–123. doi:10.3109/08↚2X.2010.541579.
    1. Cruz DN, De Cal M, Garzotto F, Brendolan A, Nalesso D, Corradi V, Ronco C. Effect of vitamin E-coated dialysis membranes on anemia in patients with chronic kidney disease:an Italian multicenter study. Int J Artif Organs. 2008;31:545–552.
    1. El-Azab S, Morsy H, El-Adawy E, Seleem A. Does vitamin E influences oxidative stress and renal anemia in hemodialysed patients? The Internet J Nutr Wellness. 2007;6(1):1–8.
    1. Brion LP, Bell EF, Raghuveer TS. Vitamin E supplementation for prevention of morbidity and mortality in preterm infants. Cochrane Database Syst Rev. 2003;4:CD003665. doi:10.1002/14651858.CD003665.
    1. Arnon S, Regev RH, Bauer S, Kestenbaum SR, Shiff Y, Bental Y, et al. Vitamin E levels during early iron supplementation in preterm infants. Am J Perinatol. 2009;26:387–392. doi:10.1055/S-00291214233.
    1. Jilani T, Moiz B, Iqbal MP. Vitamin E supplementation enhances hemoglobin and erythropoietin levels in mildly anemic adults. Acta Haematologica. 2008;119:45–47. doi:10.1159/000115784.
    1. Jilani T, Azam I, Moiz B, Mehboobali N, Iqbal MP. Positive association of vitamin E supplementation with hemoglobin levels in mildly anemic healthy Pakistani adults. Int J Vitam Nutr Res. 2015;85(1-2):30–49. doi:10.1024/0300-9831/a000222.
    1. Hashmi MA, Hashmi IA, editors. Hashmi's Textbook of Medical Biochemistry. Sixth edition. Karachi: Paramount Book (Pvt.) Ltd; 2017. 214 pp.
    1. Traber MG. How much vitamin E?Just enough! Am J Clin Nutr. 2006;84(5):959–960. doi:10.1093/ajcn/84.5.959.
    1. Wright ME, Lawson KA, Weinstein SJ, Pietinen P, Taylor PR, Virtamo J, et al. Higher baseline serum concentrations of vitamin E are associated with lower total and cause-specific mortality in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Am J Clin Nutr. 2006;84(5):1200–1207. doi:10.1093/ajcn/84.5.1200.

Source: PubMed

3
Abonneren