Riboflavin Deficiency

Etiology

Riboflavin deficiency can result from inadequate dietary intake or endocrine abnormalities. Riboflavin deficiency also correlates with other vitamin B complexes. Riboflavin naturally occurs in foods such as eggs, dairy products, meats, green vegetables, and grains. Riboflavin works as an antioxidant via the glutathione redox cycle. Glutathione works to destroy free radicals and detox the liver, as free radicals can cause to development of several diseases. Riboflavin deficiency can also result from chronic diarrhea, liver disorder, alcoholism, and hemodialysis.[3][4][5] 

Epidemiology

Riboflavin deficiency is extremely rare in the United States. Riboflavin deficiency is most common in developing countries in Asia and Africa. Older adults, alcoholics, and women who take birth control pills are most likely to suffer from riboflavin deficiency since the body cannot absorb much riboflavin when on birth control pills. Riboflavin deficiency can be related to many developmental abnormalities, such as cleft lip and palate, growth retardation, and cardiac disease. Pregnant and lactating women, people with Brown-Vialetto-Van Laere syndrome (BVVL), and vegan people are also at risk of riboflavin deficiency.

Pathophysiology

Research has shown that riboflavin deficiency can alter iron absorption and cause anemia, which leads to fatigue. Riboflavin is involved in red blood cell production and transportation of oxygen to the cells. Improving the amount of riboflavin in the body can increase circulating hemoglobin levels and increase red cell production. Collagen is a protein found in most skin and hair, so riboflavin is necessary to maintain an adequate collagen level. Taking supplements of riboflavin is also a cure for migraines. Research showed that 400 mg of riboflavin a day had demonstrated efficacy in the prevention of migraine headaches in adults, but dosing must be for a minimum of 3 months for good results. This finding is most likely because mitochondrial dysfunction has been shown to play a role in migraines, and riboflavin is a precursor of flavin cofactors of the electron transport chain. According to research, riboflavin supplements can help with mitochondrial complex I deficiency by improving muscle strength, cardiomyopathy, and encephalopathy. A cataract is an eye disorder causing blurry lenses, and taking riboflavin supplements can help prevent cataracts.

Along with cataracts, riboflavin can help other eye disorders such as glaucoma and keratoconus. Riboflavin drops are usually added to the patient’s corneal surface to increase its strength. Taking riboflavin supplements can also reduce homocysteine levels and blood pressure. According to research, lowering homocysteine by 25% can lower the risk of coronary heart disease and stroke. Homocysteine is an amino acid that the body manufactures from methionine, obtained through nutritional factors.

Toxicokinetics

Severe riboflavin deficiency can diminish levels of FAD and FMN and affect the metabolism of other nutrients, especially other B vitamins. Riboflavin is excreted from the body, while only 15% is absorbed. Carbohydrates received from food convert to ATP, which is then used to produce energy in the body. It is essential to consume riboflavin every day, either by food or with supplements. Most riboflavin is absorbed in the small intestine, and excess passes out of the body as urine. Urinary excretion can also decrease with age and stress. Hydrolysis of FAD and FMN to riboflavin done by pyrophosphates and phosphatase must occur in the upper intestine for dietary riboflavin absorption. Individuals who eat nutritional diets may not need supplements; therefore, it is necessary that they consume foods rich in B vitamins along with others. Also, foods provide better absorption of riboflavin when compared to supplements.

History and Physical

Riboflavin deficiency can cause fatigue, swollen throat, blurred vision, and depression. It can affect the skin by causing skin cracks, itching, and dermatitis around the mouth. Hyperemia and edema around the throat, liver degeneration, and hair loss can also occur along with reproductive issues. Usually, people with riboflavin deficiency also have deficiencies of other nutrients. In most cases, riboflavin deficiency is reversible unless it is anatomical changes such as cataracts.

Evaluation

A therapeutic trial confirmed riboflavin deficiency by measuring the rate of urinary excretion of riboflavin. Urinary excretion increases when consuming riboflavin supplements. If urinary riboflavin excretion is lower than 40 micrograms per day, then riboflavin deficiency can occur. Measuring erythrocyte glutathione reductase can aid in detecting riboflavin deficiency. When the enzyme activity coefficient with FAD is 1.4 or higher, it indicates riboflavin deficiency.[6][7][8]

Treatment / Management

Riboflavin supplements come in 25 mg, 50 mg, and 100 mg tablets. According to the National Institutes of Health, the recommended daily nutrient intake of riboflavin is 1.3 mg for men, 1.1 mg for women, 1.3 mg for male adolescents (age 14 to 18), and 1.0 mg for female adolescents (age 14 to 18). Recommendations are that pregnant women take 1.4 mg and breastfeeding women take 1.6 mg. For infants 0 to 6 months old, the dose is 0.3 mg; for 7 to 12 months, it is 0.4 mg; for 1 to 3 years, it is 0.5 mg; for 4 to 8 years old is 0.6 mg; and for 9 to 13 years is 0.9 mg. It is important to take riboflavin supplements with meals because absorption levels increase with food. If oral supplementation is not possible, then injections are an option.[9][10]

Differential Diagnosis

• Anaemia

• Cataracts

• Cleft lip and palate deformities

• Fatigue

• Migraines

• Malignancies

• Night blindness

• Peripheral neuropathy

• Red, itchy eyes