Risk groups of Vitamin C insufficiency

Vitamin C (more properly called ascorbic acid) is one of the most important water-soluble vitamins for human health. It is directly concerned with immune function, collagen synthesis, wound healing, iron absorption, and antioxidant protection. Although overt deficiency of vitamin C, producing scurvy has become quite rare in modern societies, inadequacy-intake below Recommended Dietary Allowance but above that required to prevent scurvy still remains a serious public health concern for some population groups. 

This training manual will advise on who are the major at-risk groups of vitamin C inadequacy, the underlying reasons, and how people can fulfill their nutritional needs through dietary practices and supplements.

What Is Vitamin C Inadequacy?

Vitamin C inadequacy denotes intakes below the RDA and above a level that would be termed true deficiency and scurvy (somewhere around 10 mg per day for prolonged periods). This level would still be able to produce signs and symptoms of interference with health but certainly would not be able to produce symptoms like scurvy. Some of these would be simply symptoms of vitamin C inadequacy:

Impaired immune function

Increased oxidative stress

Delayed wound healing

Reduced absorption of iron

Tiredness or lethargy

It is essential to distinguish between deficiency and inadequacy. The former refers to the occurrence of a medical condition (scurvy), while the latter characterizes a nutritional inadequacy that could have adverse long-term effects on health and well-being.

1. Smokers and Passive Smokers

Why Smokers Need More Vitamin C

Smokers turn out to have been among the most studied at-risk groups. The production of free radicals in large quantities by smoking is one process that brings about the increased oxidative stress in the body. As an antioxidant, vitamin C is consumed more in smokers compared to non-smokers, leading to lower plasma and leukocyte (white blood cell) levels of vitamin C in smokers.

Research has evidenced the following in smokers:

Reduction in blood levels of vitamin C

Increased requirement for antioxidant protection

Further depletion of vitamin C stores even when an average or moderate intake is taken

Increased Daily Needs

For this reason, the IOM recommends 35 mg of extra intake of vitamin C for smokers on top of whatever other tobacco products they might be ingesting. If the RDA for an adult male is 90 mg/day, the amount of vitamin C required for a smoker must not be less than 125 mg/day.

Impact of Passive Smoking on Others 

Secondhand smoke exposure at home, the workplace, or public places would result in a reduction of vitamin C in nonsmokers. Thus, while an RDA is not made for passive smokers, the IOM states that such people should at least ensure that they meet set RDAs while keeping a constant check on their vitamin C intake. 

2. Infants Fed Evaporated or Boiled Milk

The Danger in the Feeding Practice

Most babies in developed countries are breastfed or given formula milk. Both provide adequate vitamin C. Some caregivers, however, may think that boiled or evaporated cow behind the milk is a safe and nutritious alternative and so prefer these to breastfeeding.

This is a problem for two reasons:

Cow's milk contains almost no vitamin C.

Boiling or evaporating the milk destroys whatever little vitamin C is present.

Due to the high sensitivity of vitamin C to heat, there might be poor or nil intake, especially among those infants completely dependent on this food source for nourishment. 

Consequences for Infants

For infants fed boiled or evaporated milk and whose diet is not supplemented accordingly, the risk for vitamin C deficiency or for outright scurvy is greatly increased. Manifestations in infants may include 

Irritability

Poor weight gain

Swollen joints

Anemia or low blood counts

Delayed healing of wounds

Cut abridged if doctor-directed supplementation is required in due of assuring infants under 12 months of age are strenuously advised to avoid the use of unmodified cow milk.

Individuals with a Deficiency in Diet Variety- 

Here Are People Who Belong to Their Category:

Sources rich in vitamin C include all fruits and vegetables, of which citrus, berries, bell peppers, broccoli, and dark green leafy vegetables are most richest in vitamin C. As most people eat a mixed diet, it is not unusual to be on the plus side of the RDA for vitamin C, but through poor diet, a few subpopulations may have the potential possibility of eating insufficiently to maintain vitamin C levels: 

For example:

Older individuals who have no one to live with or do so in care homes 

Poor people who cannot get fresh fruits and vegetables 

Substance abusers (alcohol and drugs) 

Very restricted diet 

People with some forms of major mental illness (for example, schizophrenia and depression) 

Selective eaters, aversive to food, children 

The Danger of Just One-Food Diet

One-food diet could lead to deficiency in micronutrients, and vitamin C is the first to get lost: if this diet contains any minor portion of vitamin C or some set of foods that does, MNPC-9 will readily inform a person that he or she is nowhere approaching satisfying the minimal requirement, at least under conditions of consistency and significance below that for any other intake of vitamin C and fruits. 

For example, processed foods with animal-based products contain almost no vitamin C. If one eats too much of them, it can cause a dangerous deficiency in the long run. 

4. Individuals with Absorption Disorders and Chronic Illness 

Among some medical disorders and treatments, vitamin C is not absorbed or used effectively in the body despite adequate intake: 

a. Gut-Related Disorders 

Crohn's disease, 

celiac disease, 

short bowel syndrome, 

and chronic diarrhea 

- Are usually not able to absorb Vitamin C across the gut barrier, which would otherwise accumulate in blood and tissue as a consequence of good dietary intake. 

b. Cancer and Cachexia 

The presence of a combination of a relatively high metabolic demand with low food intake and absorption of nutrients is responsible for severely depleted Vitamin C levels in patients with advanced cancer or cachexia, causing an even more complicated immune suppression and fatigue. 

c. Kidney Disease and Dialysis 

A typical finding among end-stage renal disease (ESRD) patients on chronic hemodialysis is low plasma Vitamin C levels. Reasons include: 

- Elimination of Vitamin C during dialysis procedure 

- Restricting diet not to include food sources of Vitamin C during dialysis 

- Antioxidant ability getting compromised 

Such individuals require carefully managed medical supervision on supplementation to achieve optimal Vitamin C levels again without compromising the kidney through oxalate buildup.

How Much Vitamin C Do We Need? 

The amount considered to be the Recommended Dietary Allowance (RDA) of vitamin C varies by age, sex, and physiological condition:

Group                RDA (mg/day)  

Adult men           90

Adult women       75 

Pregnant women     85 

Lactating women   120

Smokers (add to base RDA)       +35 

Children (1-3)   15  

Children (4-8)  25 

Children (9-13)  45 

Adolescents (14-18)  65-75  

Note that these values are designed to provide adequate normal physiological functions, with an adequate antioxidant status. However, these may need to be increased when the individual is undergoing stress, suffering from illness, or is injured. 

Best Sources of Vitamin C

Fruits and vegetables containing vitamin C should be incorporated into the diet every day to avoid insufficiency and deficiency. The following are the best sources:

Food            Vitamin C (mg per serving)

Red bell pepper (½ cup)                   95

Orange (1 medium)                          70

Kiwi (1 medium)                             64

Broccoli (½ cup cooked)                          51

Strawberries (½ cup)                        49

Brussels sprouts (½ cup)                        48

Grapefruit juice (¾ cup)                       70

Papaya (1 cup)                                  88

Are you in need of vitamins? Supplementation must be taken when such conditions arise, and more vitamin C supplementation is likely to be required during at-risk populations. These are the requisite forms in which vitamin C supplements occur, including:

Tablets

Capsules

Chewable

Gummy

Powder

Most vitamin-C supplements in over the counter contain doses ranging between 250 and 1000 mg, far above the recommended daily allowance of about a few hundred milligrams. The vitamin is also water-soluble, requiring the urine to receive excess amounts from the body. However, very high doses can cause a few problems, such as: 

Diarrhea 

Abdominal cramps 

Kidney stones may develop in vulnerable individuals. 

Adults- 2000 mg/day is the upper intake limit. 

Conclusion: Keep Informed to Keep Ahead of Risks 

Vitamin deficiency in C is actually a preventable and manageable situation. Most people do eat a varied and balanced diet, which is enough for the vitamin C intake level. These small pockets and scattered population groups have been left off due to the way they have chosen to lead their lives or ill health conditions of their diet practice.

Key Takeaways: 

People who smoke or passively smoke require increasingly more vitamin C because of increased oxidative stress.

A child whose diet consists of evaporated or boiled milk is likely to develop vitamin C deficiency.

Limited dietary variation, even among older adults and among those who have a mental disease, usually means that nutrient needs are seldom met.

Most vitamin C nutritional requirements have to be adhered to by patients suffering from chronic diseases and malabsorption. 

For this and for anyone who knows a person that falls under these at-risk populations, learn ways by which healthcare providers or dietitians can maximize intake in vitamin C. Sometimes, a minor custodial shift nutritionally would work miracles because of the health separation by adding a fruit to breakfast or a bells pepper garnish on the side to a dinner plate.