Who is most at risk for vitamin E? Understanding Deficiency

October 23, 2025 •

3 min read

While a vitamin E deficiency is very rare in healthy individuals, it is most often caused by underlying disorders that impair the body's ability to absorb fat. Understanding who is most at risk for vitamin E deficiency is critical for early diagnosis, treatment, and preventing serious neurological and blood-related complications.

Quick Summary

A vitamin E deficiency primarily impacts those with conditions hindering fat absorption, certain rare genetic disorders, and premature infants. Proper management requires addressing the root cause.

Key Points

Fat Malabsorption: The leading cause of deficiency in developed countries is a medical condition that impairs fat absorption, such as cystic fibrosis, celiac disease, or chronic liver disorders.
Genetic Factors: Rare inherited disorders like abetalipoproteinemia and Ataxia with Vitamin E Deficiency (AVED) can cause a deficit even with proper fat absorption.
Premature Infants: Born with low vitamin E reserves, premature babies are at a higher risk of developing a deficiency.
Subtle Onset: Vitamin E deficiency often develops slowly, and symptoms like neurological and vision problems may take years to appear.
Supplementation: Treatment for at-risk individuals typically involves monitored, high-dose vitamin E supplements, but should be managed by a healthcare professional due to potential risks.
Dietary Prevention: For the general population, eating a balanced diet rich in vegetable oils, nuts, and seeds is usually enough to prevent a deficiency.

The Crucial Role of Vitamin E

Vitamin E is a fat-soluble vitamin and a powerful antioxidant that protects the body's cells from oxidative damage caused by free radicals. This protective function is vital for maintaining a strong immune system, healthy vision, and proper neurological function. It is absorbed in the small intestine, a process that requires the presence of dietary fat. This absorption pathway explains why most at-risk populations share a common problem: compromised fat absorption. The body stores vitamin E in adipose (fat) tissue, which is why a deficiency typically takes years to develop in adults and is much more likely to affect infants or those with long-term conditions.

Primary Risk Factors for Vitamin E Deficiency

Certain health conditions and life stages significantly increase an individual's susceptibility to vitamin E deficiency, even with an adequate dietary intake. These risk factors can be broadly categorized into fat malabsorption syndromes, genetic predispositions, and certain pediatric populations.

Fat Malabsorption Disorders

Any disease that interferes with the digestion or absorption of fat can lead to a deficiency of fat-soluble vitamins, including vitamin E. This includes conditions like Cystic Fibrosis, Chronic Cholestatic Liver Disease, Celiac Disease, Crohn's Disease, Pancreatitis, and those who have undergone Bariatric Surgery. These conditions impair the breakdown or absorption of fats, directly impacting the body's ability to absorb vitamin E.

Rare Genetic Disorders

Some genetic conditions directly interfere with the transport or metabolism of vitamin E, bypassing issues with fat absorption entirely. These include Abetalipoproteinemia, a rare disorder affecting fat metabolism and the production of fat-transporting proteins, leading to very low vitamin E levels. Another is Ataxia with Vitamin E Deficiency (AVED), caused by a gene mutation that prevents the body from properly transporting and utilizing vitamin E.

Vulnerable Pediatric Population

Premature, low-birth-weight infants are particularly susceptible to vitamin E deficiency. A significant amount of vitamin E is transferred from mother to fetus during the final weeks of pregnancy, so infants born prematurely have lower reserves. This can result in hemolytic anemia and potentially contribute to conditions like retinopathy.

Comparing High-Risk Populations for Vitamin E Deficiency


Population Group	Primary Cause of Deficiency	Typical Onset of Symptoms	Key Neurological Symptoms	Primary Treatment Approach
Fat Malabsorption (e.g., CF, Celiac)	Impaired intestinal absorption of fat	Varies; often takes years to deplete stores	Neuropathy, ataxia, muscle weakness, vision problems	Treating underlying disease, high-dose oral supplementation with pancreatic enzyme replacement therapy (PERT) if applicable
Genetic Disorders (Abetalipoproteinemia)	Inability to produce fat-transporting proteins	Infancy	Ataxia, poor muscle coordination, retinopathy, nerve damage	Lifelong, high-dose supplementation, often very aggressive
Genetic Disorders (AVED)	Defective vitamin E transfer protein	Childhood or early adulthood	Progressive ataxia, muscle weakness, loss of reflexes	Lifelong, high-dose oral supplementation
Premature Infants	Low vitamin E reserves at birth	Within weeks of birth	Hemolytic anemia, muscle weakness, retinopathy of prematurity	Supplemental vitamin E, sometimes administered parenterally

Signs and Symptoms of Vitamin E Deficiency

Symptoms of vitamin E deficiency typically affect the nervous system and blood and often develop gradually. These can include difficulty with coordination (ataxia), loss of reflexes, muscle weakness, and loss of sensation. Vision problems like retinopathy and a weakened immune system are also possible. In infants, hemolytic anemia can occur.

Conclusion: Management and Prevention

Individuals with conditions causing fat malabsorption or a family history of related disorders should be proactive. Management involves treating the underlying disease and often includes monitored vitamin E supplementation. High-dose supplements require caution due to potential risks, especially for those on blood thinners. A balanced diet rich in vitamin E from sources like vegetable oils, nuts, and seeds is generally sufficient for preventing deficiency in the general population. Consulting a healthcare professional is essential for personalized advice, particularly for those at higher risk. More information can be found at the NIH Office of Dietary Supplements.

Frequently Asked Questions

A vitamin E deficiency is extremely rare in healthy people and is typically caused by inadequate dietary intake only in regions with high food insecurity. In countries with low food insecurity, the deficiency is almost always linked to an underlying medical condition.

Vitamin E is a fat-soluble vitamin, meaning it requires dietary fat for proper absorption in the small intestine. Disorders that hinder the digestion or absorption of fat, such as cystic fibrosis or Crohn's disease, prevent the body from taking in sufficient vitamin E.

Premature, low-birth-weight infants are born with low reserves of vitamin E because the vitamin is mostly transferred from the mother to the fetus late in pregnancy. Their risk is higher for conditions like hemolytic anemia and retinopathy.

Symptoms can include muscle weakness, loss of coordination (ataxia), vision problems, and a weakened immune response. In infants, hemolytic anemia and bleeding in the brain are possible.

Yes, a diet that is extremely low in fat can lead to a deficiency of fat-soluble vitamins, including vitamin E, because some dietary fat is necessary for their absorption.

Taking high-dose supplemental vitamin E can increase the risk of bleeding, especially for those on blood-thinning medication. Any high-dose supplementation should only be done under the direction of a healthcare provider.

Diagnosis typically involves a physical exam, a review of medical history, and blood tests to measure the vitamin E levels in the blood. For adults with abnormal lipid levels, the ratio of serum alpha-tocopherol to lipids is the most accurate indicator.