Vitamin C deficiency identified in adult hospital patients

Most people would think vitamin C deficiency is a historical condition, associated with sailing crusades in the 13th century, where sailors were struck down with weakness and bleeding from the teeth and nostrils.

However, our recent Monash-led review has found that almost three in 10 adult hospital patients in high-income countries may have the deficiency.

Clinical signs of scurvy were present in some.

We examined 22 studies with patients from Australia, New Zealand, South Korea, the US, Canada, the UK, France, and Germany. The results are now published in Nutrition Reviews.

The numbers show that 27.7% of 2494 adult hospital inpatients had vitamin C deficiency, using the World Health Organisation reference standards.

The study involved Monash’s Department of Nutrition, Dietetics and Food, and the School of Clinical Sciences within the Faculty of Medicine, Nursing and Health Sciences.

A wide range of patient groups and inpatient settings were included within the review. The overall prevalence of vitamin C deficiency varied across studies, ranging from 4.2% to 50.8%.

We identified that higher rates of vitamin C deficiency were present in patients with severe acute illness, and in patients who have poor nutrition status.

Being retired, and excessive alcohol and tobacco use, were identified as independent risk factors for vitamin C deficiency.

We were also able to identify that vitamin C deficiency was associated with important clinical outcomes for hospital patients, including increased risk of moderate to severe frailty and cognitive impairment.

Scurvy symptoms present

Six studies also reported on the presence of scurvy signs and symptoms, the clinical manifestation of vitamin C deficiency.

Scurvy signs were very low in two studies that performed physical assessment on whole study groups, ranging from 0-12%, but unsurprisingly much higher in the two studies that examined only patients with vitamin C deficiency status.

It’s important to add that low participant numbers in these studies limited conclusions in the review regarding the prevalence of scurvy in adult hospital patients in high-income countries.

These findings also confirm that vitamin C deficiency is more common in hospital patients, compared with community populations within high-income countries.

Higher prevalence in hospital patients may be related to people with vitamin C deficiency in the community being more highly represented within the hospital setting, or the impact of acute illness or hospitalisation on vitamin C status, or a combination.

Humans can’t synthesise vitamin C, so must rely on food such as strawberries, kiwifruit, oranges, kale, broccoli, brussels sprouts, and red or green capsicums – or vitamin C supplementation at home and in hospital–- in order to maintain adequate vitamin C levels in the body.

Vitamin C is important – it has significant functions during hospitalisation that help patients recover from acute illness, such as supporting iron absorption and red blood cell formation, collagen synthesis, and promoting resistance to infection, and reducing inflammation, to name a few.

Assessment uncommon in hospitals

Yet, despite its importance, assessment of patients’ vitamin C status during hospitalisation is relatively uncommon within high-income countries.

This is because there’s an assumption vitamin C deficiency is unlikely, due to widespread availability of vitamin C-rich foods and access to vitamin C supplements in wealthier communities.

However, with growing interest in vitamin C deficiency in community settings, there’s emerging evidence towards investigating the prevalence and impact of vitamin C deficiency in hospital patients.

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We hope our findings in this scoping review will increase awareness in healthcare that vitamin C deficiency does exist in adult hospitalised patients within high-income countries.

The body of evidence in this field is growing, which will ultimately help inform future policies for prevention, screening, diagnosis and treatment of vitamin C deficiency within acute healthcare.

For the past 50 years, there’s been a significant focus on the identification, prevention and treatment of protein energy malnutrition in hospital patients.

The findings of this review remind healthcare professionals to not forget about micronutrient deficiencies such as vitamin C and their clinical consequences.