Which client is at greatest risk for developing vitamin deficiencies?

November 14, 2025 •

4 min read

According to the World Health Organization (WHO), almost 2 billion people worldwide are at risk of micronutrient deficiencies. Understanding which client is at greatest risk for developing vitamin deficiencies is crucial for targeted health interventions and preventive care. A client's risk is determined by a complex interplay of factors, including diet, lifestyle, age, and underlying health conditions.

Quick Summary

This article examines the primary risk factors for vitamin deficiencies, focusing on vulnerable populations such as older adults, individuals with alcoholism, and patients who have undergone bariatric surgery. It explains how physiological changes, poor dietary intake, and malabsorption can lead to severe nutrient depletion and the associated health consequences. The guide emphasizes the importance of identifying and addressing these risk factors for better health outcomes.

Key Points

Older Adults: Experience reduced nutrient absorption (especially B12), decreased appetite, and potential drug-nutrient interactions, making them highly susceptible to deficiencies.
Bariatric Surgery Patients: Face a lifelong risk of malabsorption following gastric procedures, requiring strict supplementation and monitoring for deficiencies like B12, iron, calcium, and fat-soluble vitamins.
Chronic Alcoholics: Suffer from both inadequate dietary intake and alcohol's interference with nutrient metabolism, commonly leading to deficiencies in thiamine, folate, and other B-vitamins.
Celiac Disease Patients: Experience malabsorption due to gluten-induced damage to the small intestine, putting them at risk for iron, folate, B12, and vitamin D deficiencies.
Pregnant and Lactating Women: Have higher nutritional needs, making them susceptible to deficiencies in iron, folate, and B vitamins.
Vegans and Strict Vegetarians: Restrict animal products, increasing their risk of B12, iron, and zinc deficiencies.
Long-term Medications: Certain drugs can hinder nutrient absorption or increase excretion, raising the risk of deficiency in users.

Identifying High-Risk Clients for Vitamin Deficiencies

While anyone can experience a vitamin deficiency, certain individuals face a significantly higher risk due to specific health and lifestyle factors. Identifying the clients most vulnerable to nutrient depletion is the first step toward effective prevention and treatment.

The Physiological Vulnerability of Older Adults

Older adults are among the most susceptible to vitamin deficiencies, with some studies suggesting that up to 20% of those aged 60 and over may be deficient in at least one vitamin. Several age-related changes contribute to this increased risk:

Reduced Nutrient Absorption: As people age, stomach acid production can decrease, impairing the absorption of essential nutrients like vitamin B12.
Dietary Changes: Reduced appetite, difficulty chewing, or changes in taste can lead to a lower intake of nutritious foods.
Chronic Health Conditions: Conditions such as kidney disease or heart disease, which are more prevalent in older adults, can further disrupt nutrient metabolism.
Medication Use: Polypharmacy is common in this population, and many medications can interfere with vitamin absorption and metabolism.
Social and Economic Factors: Fixed incomes and social isolation can limit access to fresh, healthy foods, exacerbating poor nutritional intake.

The Impact of Bariatric Surgery

Clients who have undergone bariatric surgery, particularly malabsorptive procedures like Roux-en-Y gastric bypass (RYGB), face a profound and lifelong risk of vitamin deficiencies. These surgeries alter the gastrointestinal tract, significantly reducing nutrient absorption. Key deficiencies include:

Vitamin B12: Absorption of B12 relies on intrinsic factor, which is produced in the stomach and bypassed in many bariatric procedures.
Iron: The duodenum and proximal jejunum, where most iron is absorbed, are bypassed in RYGB, leading to a high incidence of iron deficiency anemia.
Fat-Soluble Vitamins (A, D, E, K): These vitamins require fat for absorption, which is impaired after surgery.
Folate and Thiamine: Reduced food intake and malabsorption put patients at risk for deficiencies in these crucial B-vitamins.
Calcium and Zinc: Altered gut absorption and dietary restrictions necessitate careful supplementation and monitoring.

The Devastating Effects of Chronic Alcoholism

Chronic alcoholism is a major cause of vitamin deficiencies due to both inadequate dietary intake and alcohol's direct interference with nutrient absorption and metabolism. Alcoholism can cause deficiencies in a wide range of vitamins, but some are particularly common and can lead to severe health consequences:

Thiamine (Vitamin B1): Thiamine deficiency is frequent and can lead to Wernicke-Korsakoff syndrome, a serious neurological disorder.
Folate: Alcohol can interfere with folate absorption, storage, and metabolism, leading to megaloblastic anemia.
Fat-Soluble Vitamins: Chronic alcohol use is associated with liver damage, which impairs the storage and metabolism of vitamins A, D, E, and K.
Other B-Vitamins: Alcohol impacts the absorption and utilization of other B vitamins, including B6 and B12.

The Malabsorption of Celiac Disease

Celiac disease is an autoimmune condition where gluten consumption damages the small intestine lining, leading to malabsorption and significant vitamin deficiencies. While a gluten-free diet can resolve the issue, newly diagnosed and untreated clients are at high risk for low levels of:

Iron: The damage to the small intestine impairs iron absorption, and iron deficiency anemia is a common initial symptom.
Folate and Vitamin B12: Malabsorption can affect folate absorption in the duodenum and B12 absorption in the ileum, especially in severe cases.
Vitamin D and Calcium: Impaired fat absorption and gut damage can lead to low levels of vitamin D and calcium, increasing the risk of osteoporosis.

Comparison of Risk Factors for Vitamin Deficiencies


Risk Group	Primary Cause	Common Deficiencies	Associated Health Risks
Older Adults	Age-related physiological changes; reduced intake; polypharmacy	B12, D, Folate, Iron	Cognitive decline, osteoporosis, anemia
Bariatric Surgery Patients	Altered gastrointestinal anatomy leading to malabsorption	B12, Iron, Calcium, D, A, E, K, Thiamine, Folate	Anemia, osteoporosis, neuropathy
Chronic Alcoholics	Poor diet; impaired absorption, storage, and metabolism by alcohol	Thiamine, Folate, B6, B12, A, D	Wernicke-Korsakoff syndrome, liver disease, anemia
Celiac Disease Patients	Gluten-induced damage to the intestinal lining causing malabsorption	Iron, Folate, B12, D, Calcium, Zinc	Anemia, osteoporosis, neurological issues
Vegans/Strict Vegetarians	Exclusion of animal products from the diet	B12, D, Iron, Zinc	Anemia, nerve damage, bone density issues

Conclusion: Prioritizing Assessment for Vulnerable Groups

The client at greatest risk for developing vitamin deficiencies cannot be narrowed down to a single group, as multiple populations face significant nutritional challenges. However, older adults, individuals with chronic alcoholism, and post-bariatric surgery patients are consistently cited as being particularly vulnerable due to a combination of poor intake, impaired absorption, and specific metabolic issues. Chronic intestinal conditions like celiac disease also carry a high risk of malabsorption. For healthcare professionals, recognizing these high-risk groups and implementing proactive screening and supplementation strategies is essential. By providing tailored dietary advice, promoting supplements where necessary, and conducting regular monitoring, it is possible to mitigate the severe health impacts of vitamin deficiencies in these vulnerable clients. It is crucial to remember that nutritional risks are often compounded by comorbidities and lifestyle, requiring a comprehensive, individualized approach to care.

Frequently Asked Questions

The primary cause is a combination of age-related physiological changes, such as decreased stomach acid and reduced nutrient absorption, along with potential factors like decreased appetite, chronic diseases, and medication use.

Bariatric surgery, particularly malabsorptive types like Roux-en-Y gastric bypass, alters the digestive tract, which severely limits the body's ability to absorb vitamins and minerals from food.

Chronic alcohol consumption affects the body in two ways: it leads to poor dietary intake and directly interferes with the absorption, storage, and metabolism of various vitamins.

Common deficiencies post-gastric bypass include vitamin B12, iron, calcium, vitamin D, and other fat-soluble vitamins (A, E, K), all of which require regular supplementation.

Yes, untreated celiac disease damages the lining of the small intestine, leading to malabsorption that can cause deficiencies in iron, folate, vitamin D, and B12.

Certain medications can interfere with nutrient absorption or increase the excretion of vitamins. For example, some drugs can disrupt the absorption of vitamin B12.

While a well-planned vegan diet can be healthy, it eliminates animal products, which are the primary source of vitamin B12. Therefore, vegans are at a higher risk of deficiency and often need supplementation.