Title: Informing Clinical Insights: A Retrospective Analysis to Describe Micronutrient Deficiencies

Purpose/Background:  Medical students learn that micronutrients (vitamins and minerals) play a crucial role in most metabolic and physiological processes. However, many micronutrient deficiencies (MnDs) are not routinely tested for. We postulate that this is in part due to limited or outdated research on the prevalences and clinical manifestations of MnDs. This descriptive retrospective cohort study examines MnD prevalence of an ‘at risk’ patient population, with future studies aiming to correlate MnDs with a defined set of clinical presentations. We show that MnDs are more prevalent than current literature suggests and could potentially be the missing diagnostic link when treating disease states. These findings highlight a call to action for further research and updated medical education.

Methods:  Data from EHR analysis included 583 patients who presented to Grace Health, a FQHC hospital in Battle Creek, Michigan between August 2019 - June 2023. Inclusion criteria consisted of all patients ages 18 to 99 who were identified as being at risk due to evidence of systemic dysfunction and a history of insufficient nutritional intake as defined by the “Healthy Eating Index” and the “National Health and Nutritional Exam Survey.” Automated chart reviews and data retrieval was performed. Associations of MnDs with multiple variables, such as various patient presentations and symptoms, housing status, education level, BMI, activity level, tobacco use, drug use, and other clinical markers were detected.

Results:   432 out of the 583 patients (74%) who met the inclusion criteria and had labs drawn were shown to have one or more MnD. 36.8% of these patients had a vitamin C deficiency, 29% had a vitamin B6 deficiency, 12.1% had a vitamin A deficiency, and 11.3% had a zinc deficiency, with the remainder composing vitamin B1, B3, B5, B9, and B12 deficiencies.

Conclusions:  This descriptive study highlights the significant prevalence of MnDs in an average community, suggesting the prognostic importance of nutritional status nationwide. These results demonstrate that MnDs are only detected if health care providers suspect and test for them. Therefore, this study serves as a platform underpinning the importance of further studies comparing outcomes and prevalence with varied control groups, and on the development and efficacy of routinely used standardized nutritional status indexes, screening tools, and risk stratification scores. At a foundational level, these results emphasize a need for enhancing medical school curriculum to include disease states caused by MnDs and the nutritional education that supports comprehensive patient care.