Which group is most likely to suffer from vitamin E deficiency? An in-depth guide

October 21, 2025 •

5 min read

According to health professionals, frank vitamin E deficiency is extremely rare in healthy adults but is more common in certain high-risk populations. Understanding which group is most likely to suffer from vitamin E deficiency is crucial for early detection and prevention, as inadequate levels are almost always caused by an underlying medical condition rather than poor diet alone.

Quick Summary

Premature infants, individuals with chronic fat malabsorption disorders, and those with rare genetic conditions face the highest risk of vitamin E deficiency, which impairs neurological function.

Key Points

Highest Risk Groups: Premature and low birth weight infants, individuals with fat malabsorption conditions like cystic fibrosis, and those with rare genetic disorders (e.g., AVED) are at the highest risk.
Fat-Solubility: Vitamin E is a fat-soluble vitamin, so adequate dietary fat is essential for its absorption in the small intestine.
Malabsorption is a Major Cause: In adults, deficiency is almost always caused by an underlying disorder that impairs fat absorption, not by an inadequate diet alone.
Neurological Consequences: Untreated deficiency can lead to severe and progressive neurological symptoms, including ataxia, muscle weakness, and vision problems.
Medical Management is Key: Treatment for at-risk individuals typically involves lifelong supplementation under a doctor's care, with supplementation often beginning early in life.
Dietary Intake vs. Underlying Issues: While a healthy diet with nuts, seeds, and leafy greens is important, it cannot correct deficiencies caused by absorption issues or genetic conditions.

Who is at the highest risk for vitamin E deficiency?

While it is unlikely for a healthy person to develop a vitamin E deficiency from a diet low in the nutrient, several populations are at a significantly higher risk due to underlying conditions that prevent proper absorption or storage. These groups primarily include premature infants, people with fat malabsorption disorders, and individuals with specific inherited genetic conditions.

Premature and low birth weight infants

Newborns naturally have lower vitamin E reserves compared to older children and adults. This is because only a small amount of vitamin E is able to cross the placenta during fetal development. For infants born prematurely, this issue is compounded by their low birth weight and immature digestive tract, which further impairs their ability to absorb fat-soluble vitamins. An immature liver can also contribute to the problem. This can lead to serious complications such as hemolytic anemia, a condition where red blood cells are destroyed, and in very severe cases, intraventricular hemorrhage.

Fat malabsorption disorders

Vitamin E is a fat-soluble vitamin, meaning it requires dietary fat for proper absorption in the small intestine. Conditions that disrupt the body's ability to digest or absorb fat are a major cause of vitamin E deficiency in adults and older children. These include:

Cystic Fibrosis: The disease affects the pancreas, which is essential for secreting enzymes needed to break down and absorb fats. This places individuals with cystic fibrosis at a high risk of vitamin E deficiency.
Crohn's Disease and Other Inflammatory Bowel Diseases: Chronic inflammation in the digestive tract can interfere with the absorption of nutrients, including vitamin E.
Chronic Liver Disease or Cholestasis: Conditions affecting the liver or bile ducts can lead to poor bile secretion, which is necessary for fat and vitamin E absorption.
Chronic Pancreatitis: Similar to cystic fibrosis, damage to the pancreas impairs enzyme production, leading to malabsorption.
Short Bowel Syndrome: A condition where a significant portion of the small intestine has been removed, severely limiting the surface area available for nutrient absorption.
Bariatric Surgery: Some weight-loss surgeries can alter fat absorption, requiring careful long-term nutritional monitoring and supplementation.

Inherited genetic conditions

Less commonly, vitamin E deficiency is caused by rare genetic disorders that specifically interfere with the body’s vitamin E metabolism and transport.

Ataxia with Vitamin E Deficiency (AVED): This autosomal recessive disorder affects the alpha-tocopherol transfer protein ($α$-TTP) in the liver, which is responsible for transporting vitamin E to body tissues. This leads to a severe deficiency and progressive neurological damage.
Abetalipoproteinemia: A rare inherited disorder that results in poor absorption of dietary fat due to an error in lipoprotein production and transport. This leads to extremely low levels of vitamin E and can cause severe neurological problems.

Why is vitamin E absorption so crucial?

Vitamin E acts as a powerful antioxidant, protecting the body's cells from damage caused by free radicals. To carry out this function, it must be properly absorbed into the body. Because it is a fat-soluble vitamin, it requires the presence of dietary fats for efficient absorption in the small intestine. The absorbed vitamin E is then transported through the lymphatic system and stored primarily in the liver and adipose tissue. In individuals with malabsorption issues, this process is disrupted, preventing the body from maintaining adequate vitamin E stores, even if their dietary intake is sufficient.

Symptoms and complications of vitamin E deficiency

Early symptoms of vitamin E deficiency can be mild and non-specific, making diagnosis difficult. However, over time, a prolonged deficiency can lead to severe and potentially irreversible neurological damage. Key symptoms and complications include:

Neurological problems: The most prominent symptoms involve the nervous system. A deficiency can cause peripheral neuropathy (nerve damage leading to numbness and tingling), loss of coordination (ataxia), and muscle weakness.
Vision deterioration: A vitamin E deficiency can weaken light receptors in the retina, potentially leading to retinopathy, which can cause vision loss over time.
Impaired immune function: The immune system's response can be weakened, making the individual more susceptible to infections.
Hemolytic anemia: This blood disorder, where red blood cells are destroyed prematurely, is a particular risk for premature infants with a deficiency.

Diagnosing and treating vitamin E deficiency

Diagnosing vitamin E deficiency involves a combination of assessing the patient's symptoms, medical history, and conducting blood tests.

Blood Tests: The most direct method is measuring the serum alpha-tocopherol level. In adults with normal lipid levels, a low alpha-tocopherol level is a reliable indicator. However, because vitamin E circulates in the blood bound to lipoproteins, a more accurate measure in patients with abnormal lipid levels (e.g., hyperlipidemia) is the ratio of serum alpha-tocopherol to total serum lipids.

Treatment depends on the underlying cause. While dietary changes may be sufficient for mild deficiencies in otherwise healthy individuals, those with malabsorption disorders or genetic conditions often require supplementation. Treatment plans can vary:

For fat malabsorption: Supplementation is necessary, and sometimes water-soluble forms of vitamin E are used to bypass the need for adequate fat digestion. This often involves medical guidance on appropriate intake.
For genetic disorders (e.g., AVED): Lifelong supplementation is required to prevent or halt the progression of neurological symptoms. Early detection and treatment are crucial to prevent irreversible damage. This also requires medical guidance on appropriate intake.

Foods rich in vitamin E

For individuals with a normal ability to absorb nutrients, incorporating vitamin E-rich foods into their diet is the best way to maintain healthy levels. The following foods are excellent sources:

Oils: Wheat germ oil, sunflower oil, safflower oil.
Nuts and Seeds: Sunflower seeds, almonds, hazelnuts, peanuts.
Green Leafy Vegetables: Spinach, broccoli, turnip greens.
Fruits: Avocado, mango, kiwi fruit.

Comparison of high-risk groups


Risk Group	Primary Cause	Typical Onset	Common Symptoms	Treatment Approach
Premature Infants	Limited placental transfer of vitamin E; immature digestive system.	At or shortly after birth.	Hemolytic anemia, muscle weakness, retinopathy.	Targeted supplementation, often via fortified milk or intravenous routes, under medical supervision.
Fat Malabsorption	Conditions like cystic fibrosis, Crohn's, and liver disease preventing fat absorption.	Insidious, taking years to develop clinically evident symptoms in adults.	Neurological deficits (ataxia, neuropathy), muscle weakness, vision problems.	Often lifelong oral supplementation, sometimes using water-soluble forms, under medical guidance.
Genetic Disorders	Defects in vitamin E transport proteins, such as in AVED.	Childhood or adolescence (e.g., AVED onset between 5 and 15 years).	Progressive ataxia, neurological impairment, visual disturbances.	Lifelong supplementation under medical supervision; early intervention can halt progression.

Conclusion

While a diet low in vitamin E is rarely the sole cause of deficiency in healthy adults, certain populations face a significantly elevated risk due to physiological or pathological reasons. Premature infants, individuals with chronic fat malabsorption conditions, and those with specific genetic disorders are the groups most likely to suffer from vitamin E deficiency, often requiring lifelong medical management and supplementation under healthcare professional guidance. For all at-risk individuals, early detection and appropriate treatment are critical to prevent the progression of severe and often irreversible neurological complications. For more information, consult the National Institutes of Health Office of Dietary Supplements fact sheet on Vitamin E.

Frequently Asked Questions

The groups most likely to suffer from vitamin E deficiency are premature and very low birth weight infants, individuals with fat malabsorption disorders such as cystic fibrosis, and those with rare genetic conditions like Ataxia with Vitamin E Deficiency (AVED).

No, vitamin E deficiency is extremely rare in healthy individuals within developed countries. When it does occur, it is almost always due to an underlying medical issue that prevents proper absorption or metabolism, rather than a poor diet.

Cystic fibrosis is a disease that impairs the pancreas's ability to secrete the enzymes needed to digest fat. Since vitamin E is a fat-soluble vitamin, this leads to poor absorption and a high risk of deficiency.

Common symptoms often include neurological issues such as muscle weakness, difficulty with coordination and walking (ataxia), vision problems, numbness and tingling in the extremities, and a weakened immune system.

Yes, if a severe deficiency is left untreated for a prolonged period, it can lead to irreversible neurological damage. Early diagnosis and consistent treatment under medical supervision are essential to prevent the progression of symptoms.

For those with malabsorption disorders or genetic conditions, treatment typically involves lifelong supplementation with vitamin E under medical guidance. Depending on the condition, doctors may prescribe special, water-soluble forms of the vitamin.

While increasing intake of vitamin E-rich foods like nuts, seeds, vegetable oils, and leafy greens is beneficial for overall health, dietary changes alone are usually not sufficient to correct a deficiency caused by an underlying medical condition. In these cases, medical intervention is necessary.