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Title: Perspective: should vitamin E recommendations for older adults be increased?

Author
item MEYDANI, SIMIN - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item LEWIS, ERIN - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item WU, DAYONG - Jean Mayer Human Nutrition Research Center On Aging At Tufts University

Submitted to: Advances in Nutrition
Publication Type: Review Article
Publication Acceptance Date: 5/15/2018
Publication Date: 8/11/2018
Citation: Meydani, S.N., Lewis, E.D., Wu, D. 2018. Perspective: should vitamin E recommendations for older adults be increased? Advances in Nutrition. 9(5):533-543. https://doi.org/10.1093/advances/nmy035.
DOI: https://doi.org/10.1093/advances/nmy035

Interpretive Summary:

Technical Abstract: Vitamin E functions primarily as a lipid-soluble antioxidant capable of scavenging oxygen species to reduce oxidative stress and protect cell membranes from oxidative damage. Vitamin E is a generic term that describes all naturally occurring, structurally related tocopherols and tocotrienols, each with 4 homologs designated as alpha, beta, gamma and delta. Among them, alpha-tocopherol is the most abundant form of vitamin E in the diet and plasma, and it is also demonstrated as the most biologically active form. For these reasons, alpha-tocopherol is almost exclusively used to make vitamin E supplements (primarily as the synthetic form dl-alpha-tocopherol) and is the form of vitamin E in which the Dietary Reference Intakes (DRIs) are established. The referral of vitamin E for Estimated Average Requirements (EAR), Recommended Dietary Allowances (RDA), and Adequate Intakes (AI) applies only to intake of the 2R-stereoisomeric forms of alpha-tocopherol from food, fortified food and multivitamins, while the Upper Limit (UL) applies to any forms of supplemental alpha-tocopherol. The current DRIs for vitamin E are 12 mg per day (EAR) and 15 mg per day (RDA), for all individuals 14 years of age and older. Although overt vitamin E deficiency, characterized by sensory neuropathy, and increased erythrocyte fragility is rare, it has been reported that more than 60 per cent of adults in the United States are consuming below the EAR. The 2015 Dietary Guidelines Advisory Committee (DGAC) characterized vitamin E as a "shortfall" nutrient, as determined by the EAR. However, as vitamin E under consumption was not linked to biomarkers or health outcomes, it was not considered a nutrient of public health concern. Arguably, rather than focusing on vitamin E dietary insufficiency, the benefits of increasing consumption and improved health outcomes should be the focus, particularly in older adults. Currently, there is no distinction between young and older adults regarding vitamin E recommendations based on the conclusion that there is no evidence that the aging process impairs vitamin E absorption or utilization. However, it is well documented, that older adults (65 years of age and older) have compromised conditions which increase their risk for both infectious and non-infectious chronic diseases compared to younger adults, and which could be impacted by vitamin E status. Furthermore, studies have provided evidence that vitamin E consumption above the current DRI may be beneficial for older adults in dealing with age-associated adversities, particularly related to immune function, inflammatory responses, and resistance to infection. The authors provide evidence for the need to increase vitamin E DRI for older adults based on biological feasibility, improvement of a key biological function (immune and inflammatory responses), and reduction in infection, and recommend that the DRI committee re-evaluate vitamin E requirement in this age group.