Background: Most primates, including humans, belonging to the suborder Haplorrhine lack the innate ability to synthesize ascorbic acid (Vitamin C) and hence exclusively depend on dietary intake (generally plant-based diets) to prevent deficiency. Modern humans’ trend of consuming ultra-processed foods that lack crucial micronutrients places us at risk for developing micronutrient deficiencies. Currently, there is a paucity of evidence for the prevalence of micronutrient deficiencies based on biochemical testing in the United States, particularly among in hospitalized patients, who may have elevated vulnerability based on numerous factors (e.g., comorbidities, socioeconomic status). Vitamin C plays a crucial role in synthesis of collagen, the most abundant protein in the human body. Scurvy, which is the classical presentation of Vitamin C deficiency, has an alarming mortality of 50% in 1 year. Serum testing of vitamin C (less than 0.3 mg/dL) is considered to indicate deficiency. The purpose of this study is to evaluate the trends of vitamin C levels at Grady Memorial Hospital, a safety-net facility in Atlanta, Georgia that serves a large metropolitan area.
Methods: We performed a cross-sectional observational study of all admitted adult patients (age >18) whose serum vitamin C levels were tested at Grady hospital from January 2013 to October 2024 to determine the prevalence of abnormal (high or low) levels. Slicer Dicer was used to obtain patient data from the EPIC electronic medical record. We followed up with a pilot study to look in greater depth at abnormal samples from 1/1/2020 to 12/31/2023 to examine the proportion that were low and the demographic characteristics of those with deficiencies (defined as < 0.3 mg/dL). Microsoft Excel was used to perform descriptive statistics.
Results: Serum vitamin C levels were ordered 1213 times 2013–2024; 340 (28%) samples were labeled abnormal. Among all 284 patients tested for Vitamin C during the pilot study from 1/1/2020 to 12/31/2023, 104 (36.6%) came back “abnormal,” and all but 2 samples tested as deficiently low. Twenty-two samples (7.7%) had a level < 0.1 mg/dL, the lowest level for detecting vitamin C, and 68 samples (23.9%) came back at 0.1 mg/dL. Half of the abnormally low samples were in women (n=51) and half in men (n=51).; 76 patients (73%) self-reported Black or African American race while 18 (17.3%) identified as White or Caucasian. One quarter (n=27, 26%) of patients had a BMI >30; 39 patients (37.5%) had a normal BMI (between 18.5 and 25); and17 (16.3%) patients had BMI < 18.5. 35 (34.3%) patients with low Vitamin C levels are now deceased.
Conclusions: To our knowledge, this is one of the largest data samples of vitamin C testing in admitted patients. Over one in three samples tested for serum vitamin C level lower than the minimum cut-off value. Though vitamin C deficiency in patients may not reflect vitamin C deficiency in the general population, the high prevalence of vitamin C deficiency we observed in adult hospitalized patients is alarming. Also, with one in three patients with low vitamin C levels deceased indicating high mortality rate in malnourished patients with ascorbic acid deficiency. It is important to investigate the risk factors and specific patient populations that are at risk for developing vitamin C deficiency.