Prevalence, risk factors, and clinical outcomes of vitamin C deficiency in adult hospitalized patients in high-income countries: a scoping review.

Abstract

BACKGROUND: Assessment for vitaminC deficiency (VCD) is rarely undertaken in an acute hospital setting in high-income countries. However, with growing interest in VCD in community settings, there is emerging evidence investigating the prevalence and impact of VCD during hospitalization. OBJECTIVE(S): In this scoping review, the prevalence of VCD in adult hospitalized patients is explored, patient characteristics are described, and risk factors and clinical outcomes associated with VCD are identified. METHOD(S): A systematic scoping review was conducted in accordance with the PRISMA-ScR framework. The Ovid MEDLINE, Ovid Embase, Scopus, CINAHL Plus, Allied and Complementary Medicine Database, and the Cochrane Library databases were searched for interventional, comparative, and case-series studies that met eligibility criteria, including adult hospital inpatients in high-income countries, as defined by the Organization for Economic Co-operation and Development, that reported VCD prevalence using World Health Organization reference standards. These standards define VCD deficiency as plasma or serum vitamin C level <11.4micromol/L, wholeblood level <17micromol/L, or leukocytes <57nmol/108 cells. RESULT(S): Twenty-three articles were included, representing 22 studies. The cumulative prevalence of VCD was 27.7% (n=2494; 95% confidence interval [CI], 21.3-34.0). High prevalence of VCD was observed in patients with severe acute illness and poor nutritional status. Scurvy was present in 48% to 62% of patients with VCD assessed in 2 studies (n=71). Being retired (P=0.015) and using excessive amounts of alcohol and tobacco (P=0.0003) were independent risk factors for VCD (n=184). Age was not conclusively associated with VCD (n=631). Two studies examined nutrition associations (n=309); results were inconsistent. Clinical outcomes for VCD included increased risk of frailty (adjusted odds ratio, 4.3; 95%CI, 1.33-13.86; P=0.015) and cognitive impairment (adjusted odds ratio, 2.93; 95%CI, 1.05-8.19, P=0.031) (n=160). CONCLUSION(S): VCD is a nutritional challenge facing the healthcare systems of high-income countries. Research focused on early identification and treatment of patients with VCD is warranted. SYSTEMATIC REVIEW REGISTRATION: Open Science Framework ( https://doi.org/10.17605/OSF.IO/AJGHX ).Copyright © The Author(s) 2024. Published by Oxford University Press on behalf of the International Life Sciences Institute.