Which of the following population groups is at the greatest risk for vitamin E deficiency?

November 23, 2025 •

4 min read

Studies consistently show that premature infants, especially those with very low birth weight, are at an elevated risk of developing a vitamin E deficiency. This article explores which of the following population groups is at the greatest risk for vitamin E deficiency, breaking down the underlying reasons and key risk factors.

Quick Summary

Premature, low birth weight infants are most susceptible to vitamin E deficiency, primarily due to limited placental transfer, low body fat stores, and immature digestive systems. Individuals with fat malabsorption disorders, such as cystic fibrosis or Crohn's disease, also face significant risk. This overview explains the specific vulnerabilities of these groups and other contributing health issues.

Key Points

Premature Infants: The highest-risk group for vitamin E deficiency due to low placental transfer and limited body fat reserves.
Fat Malabsorption: Conditions like cystic fibrosis, Crohn's disease, and liver disorders prevent the absorption of fat-soluble vitamins, including vitamin E.
Rare Genetic Conditions: Inherited disorders such as AVED or abetalipoproteinemia impair the body's ability to utilize or transport vitamin E.
Neurological Symptoms: Common signs of deficiency include muscle weakness, loss of coordination (ataxia), and impaired reflexes, resulting from nerve damage.
Hemolytic Anemia: In premature infants, vitamin E deficiency can cause a serious form of anemia where red blood cells are destroyed.
Diagnosis and Management: Deficiency is typically confirmed by blood tests, and treatment involves appropriate supplementation, often in high doses for certain conditions.

Premature Infants: The Highest Risk Population

According to medical and nutritional experts, premature infants, particularly those born with a very low birth weight (under 1500 grams or 3.3 pounds), are the population group at the greatest risk for developing a vitamin E deficiency. The primary reasons for this extreme vulnerability are physiological and directly related to their developmental stage.

Limited Placental Transfer: In the third trimester of pregnancy, the majority of a fetus's vitamin E stores are acquired. For infants born prematurely, this crucial period is cut short, leaving them with significantly low vitamin E reserves at birth.
Low Body Fat Stores: Vitamin E is a fat-soluble vitamin and is stored primarily in the body's fatty tissue. Premature infants have limited body fat, meaning they have minimal storage capacity for the vitamin.
Immature Digestive System: The absorption of vitamin E from the diet requires adequate bile salt secretion and a mature digestive tract, both of which can be underdeveloped in preterm infants. This immaturity impairs their ability to absorb the limited vitamin E they do receive from breast milk or formula.

Fat Malabsorption Disorders

Outside of the newborn population, vitamin E deficiency is rarely caused by a poor diet alone but is almost always linked to underlying conditions that hinder the proper digestion or absorption of fat. Vitamin E, being fat-soluble, cannot be absorbed efficiently without dietary fat.

Several medical conditions fall into this category:

Cystic Fibrosis: This genetic disorder affects the cells that produce mucus, sweat, and digestive juices, leading to digestive enzymes being unable to reach the small intestine. This results in poor fat absorption and subsequent vitamin E deficiency.
Crohn's Disease: An inflammatory bowel disease, Crohn's can cause inflammation throughout the digestive tract, severely disrupting the absorption of nutrients, including fat and fat-soluble vitamins like E.
Chronic Pancreatitis: Inflammation of the pancreas reduces the secretion of enzymes needed for digestion, leading to fat malabsorption and deficiency.
Chronic Cholestatic Liver Disease: Conditions that impede the flow of bile from the liver into the digestive tract can significantly impair fat and vitamin E absorption.
Bariatric Surgery: Surgical procedures designed for weight loss can lead to fat malabsorption and increase the risk of vitamin E deficiency in the long term, especially without proper supplementation.

Comparison of High-Risk Populations


Risk Group	Primary Cause of Deficiency	Severity and Common Onset	Key Symptoms
Premature Infants	Low placental transfer and immature digestion	Severe, soon after birth (within weeks)	Hemolytic anemia, retinopathy, muscle weakness
Fat Malabsorption	Inability to absorb dietary fat	Progressive, developing over time	Neurological issues like ataxia and neuropathy
Genetic Disorders	Defective metabolism/transport of vitamin E	Progressive, starting in childhood or adolescence	Severe neuropathy, ataxia, vision problems

Rare Genetic Disorders

Inherited conditions, while less common, can cause severe and profound vitamin E deficiency by impairing the body's ability to transport and utilize the vitamin, even if fat absorption is normal.

Ataxia with Vitamin E Deficiency (AVED): This autosomal recessive neurodegenerative disease is caused by a mutation in the gene for the alpha-tocopherol transfer protein (α-TTP). This defect prevents the liver from properly incorporating vitamin E into lipoproteins for transport throughout the body.
Abetalipoproteinemia: A rare inherited disorder of fat metabolism, this condition prevents the normal absorption of dietary fat and, consequently, vitamin E.

Symptoms of Deficiency

Deficiency of vitamin E can lead to a range of symptoms, which are often neurological due to the vitamin's role in protecting nerve cells from oxidative damage.

Common symptoms include:

Neurological: Muscle weakness, impaired coordination (ataxia), loss of deep tendon reflexes, and difficulty walking.
Ocular: Vision problems, including retinopathy, which can affect the light receptors in the eye.
Hematological: Hemolytic anemia, particularly in premature infants, where red blood cells are damaged by oxidative stress.
Other: Weakened immune response, which can increase susceptibility to illness.

Conclusion

While a vitamin E deficiency is uncommon in healthy individuals with a balanced diet, certain populations are at a significantly higher risk due to physiological or pathological reasons. Premature, low birth weight infants are the most vulnerable, with risks stemming from limited placental transfer and immature bodily systems. Other high-risk groups include those with underlying conditions that cause fat malabsorption, such as cystic fibrosis, as well as those with rare genetic disorders affecting vitamin E transport. For these at-risk groups, monitoring and appropriate supplementation under medical supervision are often necessary to prevent serious health complications, especially neurological damage and hemolytic anemia. Understanding these risk factors is crucial for early detection and intervention.

For more detailed information on vitamin E, consult the Office of Dietary Supplements at the National Institutes of Health(https://ods.od.nih.gov/factsheets/VitaminE-Consumer/).

Frequently Asked Questions

Premature infants have low vitamin E reserves because only small amounts of the vitamin cross the placenta during fetal development. Since they miss the crucial final trimester for storage, they are born with very limited supplies.

Conditions that impair fat absorption include cystic fibrosis, Crohn's disease, chronic pancreatitis, and chronic cholestatic liver disease. These issues prevent the digestive system from properly absorbing fat-soluble vitamins.

Rare genetic conditions, such as ataxia with vitamin E deficiency (AVED) and abetalipoproteinemia, interfere with the body's ability to transport or metabolize vitamin E, leading to severe deficiency regardless of dietary intake.

Symptoms can include neurological problems like muscle weakness, poor coordination (ataxia), loss of feeling, and vision deterioration. In premature infants, a serious form of anemia and retinopathy of prematurity can also occur.

Vitamin E deficiency is very rare in healthy adults. It is typically not caused by a dietary issue but is almost always linked to an underlying medical condition that prevents the proper absorption of fat.

Yes, some research suggests that a lack of vitamin E can impair the immune system, potentially inhibiting the function of immune cells. Older adults may be particularly at risk for this effect.

Treatment for vitamin E deficiency typically involves oral supplementation. The specific dosage and form of the vitamin may vary depending on the underlying cause and severity of the deficiency.

Diagnosis of vitamin E deficiency is based on symptoms, a physical examination, and blood tests to measure the alpha-tocopherol level, which is the most active form of the vitamin in the body.