SUMMARY PAPER

Name: Vidal, Ziraili Oriel B. Subject/Class section: Biochemistry-BAB

Course/Year level: BSN-1 Date: Dec. 7, 2022 Score:_______

Reference article:
Article title:
Global Vitamin C Status and Prevalence of Deficiency: A Cause for Concern?
Reference:
Carr, A.C. & Rowe, S. (2020). Global Vitamin C Status and Prevalence of Deficiency: A Cause for Concern?.
Retrieved from: https://doi.org/10.3390/nu120720088

What is the paper about?

The paper highlights the current status of vitamin C availability in different countries around the world and the
prevalence of disease caused by vitamin C deficiency.

What is the aim of the study?

To illustrate the shortage or surplus of the vitamin C status in many countries, particularly low- and middle-
income countries and to provide a comprehensive overview thereof, which will then aid in raising awareness.

Why is it important?
Vitamin C is an essential nutrient that must be obtained through the diet in adequate amounts to prevent
hypovitaminosis C, deficiency and its consequences. This includes the potentially fatal deficiency disease known as
scurvy.
However, in spite of vitamin C's pleiotropic functions in both communicable and non-communicable disease, the
global status and prevalence of vitamin C deficiency have not yet been recorded. This makes the article all the more
significant.

What is the approach/method used to acquire the data?

Data was acquired through describing key papers reporting the status of predominately healthy or randomly
selected groups globally. A thorough literature search was conducted using the PubMed database using the keywords:
vitamin C, ascorbic acid, ascorbate, blood, plasma, serum, concentration, level, status. No restrictions were placed on the
publication date, study location, sex or age of participants.

What is the approach/method used to analyze the data?

Countries were categorized as high, upper middle, lower middle or low income based on the World Bank income
classifications. The population, vitamin C status, deficiency level, hypovitaminosis C prevalence, and the dietary intake
data from each country are then recorded and compiled.
A combination of descriptive data analysis and exploratory data analysis are then used to analyze the said data
and acquire the results.
What are the key findings?
The available evidence indicates that vitamin C hypovitaminosis and deficiency is common in low- and middle-
income countries and although less common, is still not that rare in high income settings.
52,764 assessed individuals from HIC (high-income countries), suggest a mean vitamin C status of approximately

50 µmol/L, which is an adequate amount (>50 µmol/L) and 9,117 assessed individuals from LMIC (low- and middle-
income countries), suggest a mean vitamin C status of approximately 24 µmol/L, which is at the tipping point for
hypovitaminosis C (<23 µmol/L). Despite the mean value of the vitamin C levels of HIC being adequate, about 18% of
the assessed individuals are reported to have Hypovitaminosis C and about 5% to be vitamin C deficient, still quite a
number of people.

Is there any limitation?

The assessment of plasma vitamin C status comes with a number of limitations.

First, methodological issues in the handling and analysis of vitamin C status may be problematic in LMIC due to
lack of adequate infrastructure and resources, particularly in rural settings, which could result in falsely low levels and as
such should be interpreted with some caution.
Intakes (of vitamin C) are also frequently calculated by nutritional tables that rarely factor in the effects of
storage, processing and cooking on vitamins, which contribute to overestimation of intakes.
A further issue is consensus on the cutoffs for inadequacy; vitamin C deficiency is usually defined as plasma
concentrations <11 µmol/L, however, although hypovitaminosis C is often defined as <23 µmol/L, some studies report
‘inadequacy’ as <28 µmol/L (or even <30 or 34 µmol/L), therefore making it difficult to directly compare prevalence
between studies.
Finally, only a small percentage of the world’s countries have been represented, most of which were high- and
upper middle-income countries. This is of concern since there are clearly significant issues with vitamin C status and
prevalence of deficiency in LMIC.

What are the main conclusions and implications in the wider context?
In light of the aforementioned limitations, this study suggests that vitamin C deficiency is likely to be widespread
worldwide—and in low-income groups and low-middle income countries in particular. Despite this, many nations and
populations' vitamin C status has not yet been evaluated. Therefore, additional study is needed to investigate this in
various areas of the world.
Given the growing burden of non-communicable disease in low- and middle-income settings and multiple
infectious diseases showing up everywhere, increasing vitamin C intake could be a low-cost and successful public health
measure in these locations.
Interventions to help optimize vitamin C nutriture worldwide could include: education, increased dietary
recommendations (e.g., by the WHO), reduced tax on fresh fruit and vegetables, encouraging local growing of fruit and
vegetables in LMICs, novel vitamin C tax reductions for products such as soft drinks that are high in vitamin C and
government subsidies for supplementation, and including regular provision to institutionalized individuals (e.g., elderly
and school children).

Any other comments

Since the issue of vitamin C levels and vitamin C deficiency is being overlooked around the world, it is
imperative that researchers focus their attention on this underestimated issue. The authors of this article are doing a great
deed of bringing awareness to this topic and delving into the intricacies of it. Hopefully, further, improved, research
would be done on the topic of vitamin C levels, as it would prove extremely beneficial to the people of the world.