Fat-Soluble Vitamins A, D, E, and K: Review of the Literature and Points of Interest for the Clinician

Deficiency in vitamins A, D, E and K produces recognizable clinical pictures, treatment of a confirmed deficiency requires supplementation alongside a balanced diet, and excess intake can cause hypervitaminosis with serious complications.
Summary

This narrative review covers how the body handles vitamins A, D, E and K, who tends to run low, and how clinicians identify and treat a shortfall. It draws on human studies published in the previous five years plus older reference material. The authors conclude that a varied diet covers most people, that supplements are for confirmed deficiency, and that taking too much of these vitamins can cause harm.

Context Note
The review favors diet first and limits supplementation to confirmed deficiency. It also warns about hypervitaminosis.

Study breakdown

Why this study was done

Vitamins A, D, E and K are fat-soluble, meaning the body absorbs them along with dietary fat. Intake is almost entirely from food, apart from vitamin D, which the skin also makes when exposed to ultraviolet B light. The authors are internal medicine doctors in Strasbourg and Madrid. They argue that shortfalls in these four vitamins are often missed in ordinary practice, because clinicians do not always recognize the clinical picture or the underlying cause. They gathered recent literature into one reference covering what these vitamins do, what a deficiency looks like, what causes one, and how it is diagnosed and treated.

How it was run

This is a narrative review, not a trial. Nobody was given anything and no outcomes were measured. The authors searched PubMed through Medline with a five year time limit, restricted to human studies in English and French, using terms including "fat-soluble vitamin deficiency", "clinical manifestations", "etiology" and "treatment". They also screened reference lists via Google Scholar and drew on older papers, textbooks and reports from academic societies. Studies were chosen by the authors, with no formal quality scoring and no pooling of results.

What they found

Recommended adult intakes reported are:

  • Vitamin A: 700 to 900 micrograms of retinol equivalents daily for men, 600 to 700 for women. The review's table gives a toxic dose of 3000 retinol equivalents per day.
  • Vitamin D: 600 to 800 international units daily. For prevention, about 400 IU between ages 51 and 70 and 600 IU after 70, rising to 800 to 1000 IU when sun exposure is low.
  • Vitamin E: 15 to 30 mg daily, with a toxic dose of 1000 IU per day.
  • Vitamin K: 90 to 120 micrograms daily for men, 70 to 90 for women.

The review cites World Health Organization figures of around 250 million vitamin A deficient children worldwide. Treatment regimens for diagnosed deficiency are 100,000 IU per day of vitamin A for 3 days then 50,000 IU per day for 2 weeks; cholecalciferol at 3000 to 10,000 IU per day, averaging 5000, for 1 to 2 months, or a loading dose of 60,000 to 150,000 IU then 2000 IU per day; and vitamin E at 50 to 2000 IU per day. Vitamin K treatment is limited to newborns and to reversing anticoagulant overdose.

Limitations

This is a narrative review with no pre-registered protocol, no risk-of-bias assessment and no statistical pooling, so it carries less weight than a systematic review. The authors state plainly that the treatment regimens they list are mostly based on studies that do not meet evidence-based medicine criteria. They note that few solid data exist from industrialized countries, particularly for vitamins E and K. On vitamin D and disease risk they say the evidence is largely epidemiological, that association does not imply cause, and that most prevention trials have been inconclusive. The paper reports no external funding and the authors declare no conflicts of interest.

What it means in practice

This is a clinical reference about deficiency states, written for doctors. Those at risk include newborns, growing children, pregnant and breastfeeding women, older and isolated people, and patients with digestive disease, liver disease or chronic illness. The doses listed are curative doses for a diagnosed deficiency under medical supervision, and that does not automatically extend to healthy or younger people. The review does not show that well nourished people gain anything from taking more of these vitamins. It warns about the opposite risk: hypervitaminosis from long-term high doses and hidden sources, and over-testing for vitamin D in routine care.

Study Type
Review
Published
2024
Journal of Clinical Medicine
Participants
Not applicable, narrative review
Dose Studied
Not applicable
Health Focus
Bone Health
Immunity
Ingredients
Vitamin A
Vitamin D
Vitamin E
Vitamin K2

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