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Prominent Features of Riboflavin Deficiency/Riboflavin vitamin B2, is a water-soluble and heat-stable vitamin that the body uses to metabolize fats, protein, and carbohydrates into glucose for energy. In addition to boosting energy, riboflavin is used as an antioxidant for proper function of the immune system, healthy skin and hair. This is done with the help of two main coenzymes, flavin mononucleotide (FMN) and flavin adenine dinucleotide (FAD). Without an adequate amount of riboflavin, macros like carbohydrates, fats, and proteins cannot be digested and maintain the body. With a healthy digestive system, the body can absorb most of the nutrients from the diet, so it is important to get most of the riboflavin from dietary sources. Riboflavin has a yellow-green fluorescent pigment, which causes urine to turn yellow and that means the body is absorbing riboflavin. Riboflavin also helps convert tryptophan to niacin, which activates vitamin B-6. Some diseases that can be prevented with adequate riboflavin are anemia, cataracts, migraines, and thyroid dysfunction. Riboflavin is necessary for normal development, lactation, physical performance, and reproduction.[rx][rx]
Deficiency Symptoms of Riboflavin
- Pregnant/lactating women and infants – Pregnancy demands higher riboflavin intake as it crosses the placenta. If the maternal status is poor during gestation, the infant is likely to be born riboflavin deficient. Breast milk riboflavin content may reflect maternal intake and can be moderately increased by riboflavin concentration of the mother when maternal intake is low.
- Schoolchildren – Riboflavin deficiency among children is demonstrated in many regions of the world where they are deprived of adequate milk and meat in their diet.[rx] Riboflavin deficiency among children in the Western world seems to be largely confined to adolescents, especially girls, because of increased metabolic demand.
- The elderly – There is an increasing requirement of riboflavin with advancing age as a result of decreased efficiency of its absorption by the enterocytes.[rx]
- Athletes – Some studies report that vigorous exercise may deplete riboflavin due to its consumption in the metabolic pathways.[rx]
- Eating disorders – Young women practicing unorthodox eating habits accompanied by excessive exercise in order to lose weight have been shown to have low levels of riboflavin.[rx]
- Migraine prophylaxis – Riboflavin may be effective for the prophylaxis of migraine (not FDA-approved) to minimize the frequency of attacks.[rx]
- Neonates undergoing phototherapy – Hyperbilirubinemia in the neonatal period is often managed with phototherapy. But it has been shown to degrade riboflavin and cause a deficiency in the newborns. A prophylactic daily oral dose of riboflavin prevents the development of the deficiency.[rx]
- Antiretroviral induced lactic acidosis – This rare syndrome is caused by a group of antiretroviral drugs used to treat HIV infection called nonnucleoside reverse transcriptase inhibitors (NNRTI). Discontinuation of the drug along with treatment with riboflavin causes its reversal.[rx]
- Corneal ectasia – This is gradual corneal narrowing caused by an alteration in the collagen matrix in the stroma, resulting in protrusion of the cornea in an irregular pattern. Therapy was aimed at correcting the refractory error until 1990; however, now a radical approach targeting the pathophysiology of the disease by cross-linking the corneal fibers is undertaken where the superficial epithelium is removed, 0.1% riboflavin is applied for 30 minutes, and the cornea is treated with UVA for another 30 minutes. [rx]
Prominent Features of Riboflavin Deficiency
Although clinical features of some vitamin deficiencies are similar and often coexist, the following are more common features of riboflavin deficiency are as follows[rx]:
Lips become red, dry, fissured or ulcerated.
Angular cheilitis is often noted
The tongue gets dry, atrophic, magenta red or sometimes blackish
Seborrheic dermatitis may be present on the face
Scrotum or vulva may get hyperpigmented resembling zinc deficiency
Conjunctivitis can occur
Recommended Daily Allowance for Riboflavin[rx]
Adults (Age 19-70 years): Women: 0.9 – 1.1 mg/dl and Men: 1.1 – 1.3 mg/d. [These values are based on observing clinical evidence of deficiency in intake less than 0.6 mg/d]
Adolescents (Age 10-18 years): 0.9 – 1.3 mg/dl
Children (Age 1-9 years): 0.5 – 0.6 mg/d
Infants (Age: 0-12 mo): 0.3 – 0.4 mg/d
Apart from supplementation in deficiency, it is also prescribed in some clinical situations as follows:
Dosage of Riboflavin
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 14-18). It is recommended that pregnant women take 1.4 mg and breastfeeding women take 1.6 mg. For infants age of 0 to 6 months old is 0.3 mg, 7 to 12 months is 0.4 mg, 1 to 3 years old is 0.5 mg, 4 to 8 years old is 0.6 mg, and 9 to 13 years old is 0.9 mg. It is important to take riboflavin supplements between meals because absorption levels increase with food. If supplements cannot be taken orally, then injections can also be used.[rx][rx]