eMedicine Specialties > Endocrinology > Metabolic Disorders
Riboflavin Deficiency
Updated: May 18, 2009
Introduction
Background
Riboflavin, or vitamin B-2, was initially isolated from milk whey in 1879. Originally called lactochrome, it was also once known as vitamin G. Riboflavin is important for energy production, enzyme function, and normal fatty acid and amino acid synthesis and is necessary for the reproduction of glutathione, a free radical scavenger. The water-soluble B factor consists of 2 separate ingredients; one is unstable when heated, while the other remains stable. The less stable factor was named vitamin F (thiamine), while the heat-stable product was labeled vitamin G. They were later renamed vitamins B-1 and B-2, respectively.
Pathophysiology
Riboflavin functions in several different enzyme systems. Two derivatives, riboflavin 5' phosphate (flavin mononucleotide [FMN]) and riboflavin 5' adenosine diphosphate (flavin adenine dinucleotide [FAD]), are the coenzymes that unite with specific apoenzyme proteins to form flavoprotein enzymes. Most of the flavin coenzyme systems help to regulate cellular metabolism, whereas others are specifically involved in carbohydrate or amino acid metabolism systems. Riboflavin also appears to have a role in fat metabolism.
Frequency
United States
Water-soluble riboflavin is not stored in ample amounts; minute reserves are stored in the liver, kidneys, and heart. A constant supply is needed. Deficiency in this vitamin is usually part of a multiple-nutrient deficiency and does not occur in isolation. Some authorities claim that riboflavin deficiency is the most common nutrient deficiency in America.
Milk and other dairy products make the greatest contributions of riboflavin in western diets. Other common dietary sources include cereals, meats, and dark green vegetables (spinach, asparagus, and broccoli). Deficiency can occur with a diet deficient in these riboflavin-rich foods. Glass milk containers promote degradation of the vitamin from exposure to light. Deficiency is uncommon in the United States with fortification of many food including grains and cereals. Daily consumption of breakfast cereal and milk would be expected to maintain an adequate intake of riboflavin.
The condition is more commonly seen in persons with such risk factors as pregnancy,1 lactation, phototherapy for hyperbilirubinemia (in premature infants), advanced age,2 low income, and/or depression. Riboflavin is absorbed in the proximal small intestine. Malabsorption from such conditions as celiac sprue, malignancies, and alcoholism can also promote deficiency of riboflavin. Riboflavin is transported in the bloodstream as a flavin-protein complex, which means that nonavailability of the carrier protein also leads to apparent riboflavin deficiency. Similarly, it is possible for antagonists to interfere with absorption and/or transport and thus create an apparent deficiency at receptor sites.
Clinical
History
Riboflavin deficiency is usually associated with other vitamin B complex deficiencies, and isolated deficiency is rare.3 However, it has been associated with multiple clinical manifestations.
- Riboflavin deficiency most commonly associated with dermatologic conditions, such as the following:
- Cheilosis, or chapping and fissuring of the lips (See image below and Image 1.)
Riboflavin deficiency is often associated with cheilosis (chapping and fissuring of the lips).
- A sore, red tongue
- Oily, scaly skin rashes on the scrotum, vulva and philtrum
- Deficiency can be associated with some developmental abnormalities, such as the following:
- Cleft lip and palate deformities (See image below and Image 2.)
Riboflavin deficiency can be associated with various developmental abnormalities, including cleft lip.
- Growth retardation in infants and children - Results from the National Birth Defects Prevention Study, which included an investigation of 324 infants with transverse limb deficiency (TLD), indicated that low maternal dietary intake of riboflavin is a risk factor for TLD.4
- Congenital heart defects - A study from the Netherlands indicated that a maternal diet that is high in saturated fats and low in riboflavin and nicotinamide may increase the risk for congenital heart defects.5
- Other associations of deficiency include the following:
- Red, itchy eyes
- Night blindness
- Cataracts
- Migraines
- Peripheral neuropathy
- Mild anemia (secondary to interference with iron absorption)
- Fatigue
- Malignancy (esophageal and cervical dysplasia)
More on Riboflavin Deficiency |
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| Differential Diagnoses & Workup: Riboflavin Deficiency |
| Treatment & Medication: Riboflavin Deficiency |
| Follow-up: Riboflavin Deficiency |
| Multimedia: Riboflavin Deficiency |
| References |
| Further Reading |
| Next Page » |
References
Ma AG, Schouten EG, Zhang FZ, et al. Retinol and riboflavin supplementation decreases the prevalence of anemia in Chinese pregnant women taking iron and folic Acid supplements. J Nutr. Oct 2008;138(10):1946-50. [Medline].
Yazdanpanah N, Uitterlinden AG, Zillikens MC, et al. Low dietary riboflavin but not folate predicts increased fracture risk in postmenopausal women homozygous for the MTHFR 677 T allele. J Bone Miner Res. Jan 2008;23(1):86-94. [Medline].
McNulty H, Scott JM. Intake and status of folate and related B-vitamins: considerations and challenges in achieving optimal status. Br J Nutr. Jun 2008;99 Suppl 3:S48-54. [Medline].
Robitaille J, Carmichael SL, Shaw GM, et al. Maternal nutrient intake and risks for transverse and longitudinal limb deficiencies: data from the National Birth Defects Prevention Study, 1997-2003. Birth Defects Res A Clin Mol Teratol. Apr 6 2009;[Medline].
Smedts HP, Rakhshandehroo M, Verkleij-Hagoort AC, et al. Maternal intake of fat, riboflavin and nicotinamide and the risk of having offspring with congenital heart defects. Eur J Nutr. Oct 2008;47(7):357-65. [Medline].
Hoey L, McNulty H, Strain J. Studies of biomarker responses to intervention with riboflavin: a systematic review. Am J Clin Nutr. Apr 29 2009;[Medline].
Powers HJ. Riboflavin (vitamin B-2) and health. Am J Clin Nutr. Jun 2003;77(6):1352-60. [Medline]. [Full Text].
Russell, RM. Vitamin and trace mineral deficiency and excess. In: Kasper DL, Braunwald E, Fauci AS, et al, eds. Harrison's Principles of Internal Medicine. 16th ed. New York, NY: McGraw-Hill; 2005:403-11.
Schoenen J, Lenaerts M, Bastings E. High-dose riboflavin as a prophylactic treatment of migraine: results of an open pilot study. Cephalalgia. Oct 1994;14(5):328-9. [Medline].
Winters LR, Yoon JS, Kalkwarf HJ. Riboflavin requirements and exercise adaptation in older women. Am J Clin Nutr. Sep 1992;56(3):526-32. [Medline]. [Full Text].
Keywords
riboflavin deficiency, vitamin deficiency, riboflavin, vitamin B2, vitamin B-2, B complex, vitamin B complex, vitamin B deficiency, B complex vitamins, vitamin G, riboflavin 5' phosphate, flavin mononucleotide, FMN, riboflavin 5' adenosine diphosphate, flavin adenine dinucleotide, apoenzyme proteins, flavoprotein enzymes, cheilosis, lactochrome, vitamin F, thiamine, vitamin B-1, vitamin B1
