Who is most at risk for vitamin E deficiency?

November 24, 2025 •

4 min read

While true vitamin E deficiency is uncommon in healthy adults, it is a significant concern for specific populations. This fat-soluble vitamin plays a crucial role as an antioxidant, and insufficient levels can lead to serious neurological and immune system issues. Understanding who is most at risk for vitamin E deficiency is essential for early diagnosis and prevention.

Quick Summary

Premature infants, individuals with fat malabsorption disorders like cystic fibrosis or Crohn's disease, and people with rare genetic conditions are the most susceptible to vitamin E deficiency. Inadequate intake of dietary fat or certain liver and pancreatic diseases can also hinder vitamin E absorption and increase risk.

Key Points

Premature infants are highly susceptible: Due to low placental transfer of vitamin E and immature digestive systems, preterm babies are at significant risk of deficiency and related complications.
Malabsorption disorders are a leading cause: Conditions such as cystic fibrosis, Crohn's disease, and chronic liver or pancreatic diseases prevent the body from absorbing fat and, consequently, fat-soluble vitamins like E.
Rare genetic defects can be a factor: Inherited disorders like ataxia with vitamin E deficiency (AVED) directly impair the transport of vitamin E in the body, leading to severe neurological damage.
A diet extremely low in fat can be a cause: In developed countries, dietary deficiency is rare, but a diet that severely restricts fat intake can hinder vitamin E absorption over time.
Neurological symptoms are a key indicator: Common signs of deficiency, especially in progressive cases, include muscle weakness, coordination and walking difficulties (ataxia), vision problems, and tingling or numbness.
Treatment involves targeted supplementation: For at-risk individuals, correcting the deficiency requires addressing the underlying cause and taking high-dose oral supplements, often under medical supervision.

Who Is Most Susceptible to Vitamin E Deficiency?

In healthy individuals, a varied diet provides sufficient vitamin E, and the body's ability to store the vitamin in fat tissue makes true deficiency rare. However, in at-risk populations, deficiency is primarily caused not by poor diet alone, but by issues preventing the body from properly absorbing and utilizing this crucial fat-soluble vitamin. The most vulnerable groups include premature infants, individuals with fat malabsorption syndromes, and those with certain genetic disorders.

Premature and Low-Birth-Weight Infants

Premature babies are particularly susceptible to low vitamin E levels for several reasons. During fetal development, only small amounts of vitamin E are transferred across the placenta, leaving preterm newborns with low reserves. An immature digestive tract can further hinder fat and vitamin E absorption. This deficiency can lead to serious complications such as hemolytic anemia, a condition where red blood cells are destroyed, and retinopathy of prematurity, which involves abnormal growth of blood vessels in the eyes. Supplemental vitamin E is often necessary for these vulnerable infants to prevent these disorders.

Fat Malabsorption Disorders

Vitamin E is a fat-soluble vitamin, meaning it requires dietary fat for proper absorption. Any condition that interferes with fat digestion and absorption significantly raises the risk of vitamin E deficiency. Such conditions include:

Cystic Fibrosis: This genetic disease affects the mucus and sweat glands, causing mucus to block the ducts of the pancreas. The blockage prevents digestive enzymes, including those needed for fat absorption, from reaching the small intestine.
Crohn's Disease: A chronic inflammatory bowel disease that can affect any part of the digestive tract. Inflammation can damage the intestinal lining, impairing nutrient absorption.
Chronic Liver Disease and Cholestasis: Liver diseases, especially those affecting bile flow (cholestasis), can decrease the production of bile, which is necessary for fat absorption.
Chronic Pancreatitis: The pancreas produces enzymes crucial for fat digestion. Inflammation of the pancreas (pancreatitis) can compromise this function.
Celiac Disease: An immune reaction to gluten that damages the lining of the small intestine over time, leading to poor nutrient absorption.
Short Bowel Syndrome: This condition occurs when a significant portion of the small intestine is surgically removed, often leading to nutrient malabsorption.
Bariatric Surgery: Certain weight-loss surgeries can alter the digestive tract in a way that reduces nutrient absorption, including vitamin E.

Rare Genetic Disorders

Certain genetic conditions can directly impact the body's ability to transport or utilize vitamin E, even if fat absorption is normal. These include:

Ataxia with Vitamin E Deficiency (AVED): This rare, inherited neurodegenerative disorder is caused by a mutation in the gene for the alpha-tocopherol transfer protein ($α$-TTP). This protein is responsible for transferring vitamin E from the liver to other parts of the body. Without a functional $α$-TTP, vitamin E levels plummet, causing severe neurological problems.
Abetalipoproteinemia: A rare inherited disorder that causes poor absorption of dietary fats and fat-soluble vitamins, including vitamin E. This leads to extremely low vitamin E levels and a range of neurological issues.

Comparison of Risk Factors


Risk Factor Group	Primary Cause of Deficiency	Severity of Deficiency	Common Symptoms	Required Intervention
Premature Infants	Low placental transfer and immature digestion	Severe; high risk of complications	Hemolytic anemia, retinopathy, muscle weakness	Supplementation to prevent disorders
Fat Malabsorption	Conditions like cystic fibrosis, Crohn's	Depends on the severity of the underlying condition	Neurological issues like ataxia, muscle weakness over time	Treating the underlying condition and oral supplements
Genetic Disorders	Defective vitamin E transport (AVED) or lipid metabolism (abetalipoproteinemia)	Extremely severe; chronic and progressive	Severe neurological damage, ataxia, vision loss	Very high-dose vitamin E supplementation, often for life
Very Low-Fat Diet	Inadequate dietary intake and impaired absorption	Typically less severe, but can become problematic over time	Can lead to deficiency if fat intake is extremely low; uncommon in developed countries	Dietary modification to include more healthy fats

Strategies for Prevention and Management

For individuals at high risk, treatment and prevention require a focused, medical-guided approach. While dietary adjustments are helpful for those with low dietary intake, they are often insufficient for those with underlying conditions. Treatment typically involves high-dose vitamin E supplements, sometimes in water-soluble forms for better absorption. Regular monitoring of vitamin E levels is critical for managing genetic and malabsorption-related deficiencies.

For premature infants, supplementation begins shortly after birth to build up crucial reserves and protect against complications like hemolytic anemia. Individuals with chronic conditions like cystic fibrosis require consistent, high-dose supplementation tailored to their specific needs.

If you believe you or a loved one may be at risk for vitamin E deficiency, it is crucial to consult a healthcare provider. Diagnosis involves a physical examination, a review of medical history, and blood tests to measure serum alpha-tocopherol levels. Early and appropriate intervention can prevent or mitigate long-term damage associated with a severe deficiency.

For more detailed information on the health professional perspective, visit the National Institutes of Health Office of Dietary Supplements website. National Institutes of Health Office of Dietary Supplements: Vitamin E

Conclusion

Vitamin E deficiency is a serious but relatively rare condition in the general population, most often caused by underlying medical or genetic issues rather than simple dietary insufficiency. Premature infants, individuals with chronic fat malabsorption diseases, and those with specific genetic mutations are the primary populations facing this health risk. Early diagnosis through medical evaluation and blood testing is vital, as is consistent, medically-supervised supplementation to manage the condition and prevent irreversible neurological damage. Regular monitoring and tailored intervention are the cornerstones of effective management for those most susceptible to vitamin E deficiency.

Frequently Asked Questions

Vitamin E deficiency is a condition where the body does not have enough of the fat-soluble vitamin E, which acts as an antioxidant and is crucial for nervous system function. It is most often caused by an inability to absorb fat rather than a poor diet.

The groups most at risk include premature infants, individuals with fat malabsorption disorders such as cystic fibrosis, Crohn's disease, or liver disease, and people with rare genetic conditions like ataxia with vitamin E deficiency (AVED).

In countries with low rates of food insecurity, it's very uncommon for a diet alone to cause a deficiency. However, a diet that is extremely low in fat for an extended period can eventually lead to poor vitamin E absorption.

Early signs often include neurological symptoms such as muscle weakness, impaired coordination (ataxia), difficulty with walking, and sometimes a loss of reflexes.

Yes, if left untreated, severe deficiency can lead to serious and potentially irreversible complications, including nerve damage, vision problems, and hemolytic anemia, especially in infants.

Diagnosis is typically based on a physical examination, evaluating a person's medical history for risk factors, and confirming low serum alpha-tocopherol levels through a blood test.

Treatment involves addressing the underlying cause, if possible, and prescribing oral vitamin E supplements. Higher doses or special formulations may be needed for severe malabsorption or genetic disorders.