Vitamin and Mineral Deficiencies Are Associated with Subjective Health Status
Authors: Bird Julia K , Ciappio Eric D , McBurney Michael I 
Published: November 2023

IntroductionBiochemically defined vitamin and mineral deficiencies are common in the US civilian population. The effect of biochemical deficiency on subjective health status is not well characterized.MethodsUsing data from 2003–2006, representative of the US civilian population, biochemical deficiency of vitamins A, B6, B12, C, D, E, folate, iron and iodine were determined based on standard cut‐off points. A deficiency score was assigned based on the number of vitamins and/or minerals that subjects were deficient in. Participant ratings of current health (1=excellent, 2=very good, 3=good, 4=fair or 5=poor) were obtained from the Current Health Status Questionnaire. Data were weighted using Mobile Examination Center weights and analyses took account of the complex, survey design. Analyses were conducted using the surveyfreq, surveymeans and surveyfreq procedures in SAS 9.3.ResultsBiochemical markers of nutrient status were available for 14,310 participants aged 9 or older. 23.9%, 6.6% and 2.1% of participants were deficient in 1, 2 or 3+ vitamins and/or minerals. 12,840 male and female subjects aged 12 years and older provided information on subjective health status. 12.7%, 35.5%, 36.2%, 13.3% and 2.3% of subjects rated health as excellent, very good, good, fair, or poor. Mean health status rating was 2.57 (95% CI: 2.53–2.61). As age increased, subjective health rating became worse. There were significant differences by ethnicity: non‐Hispanic Whites rated their health as 2.50, which was significantly better than non‐Hispanic Blacks (2.73), which was significantly better than Mexican Americans (2.92). Subjective health was better as poverty‐income ratio (PIR), and education increased, and worsened with age and BMI.As incidence of deficiencies increased, subjective ratings of health worsened. Participants with no vitamin or mineral deficiency had a mean subjective health status of 2.47, which was significantly better than the health status of people with 1, 2 or 3+ deficiencies (mean ratings 2.70, 2.87 and 3.04, respectively; p<0.05). In ethnicity categories, participants with 1+ vitamin/mineral deficiencies had a significantly poorer rating of health compared to non‐deficient participants for non‐Hispanic Whites and Blacks, but not for Mexican Americans. For all three PIR categories, deficiency in any vitamin or mineral resulted in a poorer subjective health rating.When subjective health rating was analyzed as a continuous variable by linear regression, the simple model showed a significant linear trend to worse perceived health as the number of deficiencies increased (β=2.47, p<0.0001). PIR, age, race/ethnicity, education and BMI all modified the relationship significantly, but dietary supplement use, gender, current breastfeeding and pregnancy did not. Including significant modifiers of the relationship in the model, the relationship between subjective health status and vitamin or mineral deficiency was somewhat attenuated but remained significant (β=1.50, p<0.0001).ConclusionsPeople with vitamin and mineral deficiencies have a lower self‐reported subjective health status. After accounting for differences in health status according to race/ethnicity, age, BMI, education and PIR, the association between deficiency and poorer perceived health remained.Support or Funding InformationDSM Nutritional Products is a global supplier of vitamins, and vitamin and mineral premixes for the food, animal feed and pharmaceutical industries.