Circumstances Leading to Deficiency

The fact that normal humans have a requirement for biotin has been clearly documented in two situations: prolonged consumption of raw egg white and parenteral nutrition without biotin supplementation in patients with short bowel syndrome and other causes of malabsorption. Based on lymphocyte carboxylase activities and plasma biotin levels, some children with severe protein-energy malnutrition are biotin deficient. Investigators have speculated that the effects of biotin deficiency may be responsible for part of the clinical syndrome of protein-energy malnutrition.

Biotin deficiency has also been reported or inferred in several other clinical circumstances, including long-term anticonvulsant therapy, Leiner's disease, sudden infant death syndrome, renal dialysis, gastrointestinal diseases, and alcoholism. Studies of biotin status during pregnancy and of biotin supplementation during pregnancy provide evidence that a marginal degree of biotin deficiency develops in at least one-third of women during normal pregnancy. Although the degree of biotin deficiency is not severe enough to produce overt manifestations of biotin deficiency, the deficiency is sufficiently severe to produce metabolic derangements. A similar marginal degree of biotin deficiency causes high rates of fetal malformations in some mammals. Moreover, data from a multivitamin supplementation study provide significant albeit indirect evidence that the marginal degree of biotin deficiency that occurs spontaneously in normal human gestation is teratogenic.

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