Vitamin K Deficiency or Anticoagulant Therapy. The UL derived above pertains to individuals in the general population with adequate vitamin K intake. Individuals who are deficient in vitamin K or who are on anticoagulant therapy are at increased risk of coagulation defects. Patients on anticoagulant therapy should be monitored when taking vitamin E supplements as described by Kim and White (1996).

Premature Infants. As discussed above, the small premature infant is particularly vulnerable to the toxic effects of α-tocopherol. For premature infants, the UL of 14 mg/kg/day for adults would be equivalent to a UL of 21 mg/day for infants with birth weights of 1.5 kg. This UL seems prudent and appropriately conservative based on the observation by Phelps et al. (1987). Furthermore, the American Academy of Pediatrics states that “pharmacologic doses of vitamin E for the prevention or treatment of retinopathy of prematurity, bronchopulmonary dysplasia, and intraventricular hemorrhage are not recommended” (AAP, 1998). While it is recognized that hemolytic anemia due to vitamin E deficiency is frequently of concern in premature infants, its management via vitamin E supplementation must be carefully controlled.

Based on distribution data from the 1988 to 1994 Third National Health and Nutrition Examination Survey (NHANES III) (Appendix Table C-5), the highest mean reported intake of vitamin E from food and supplements for all life stage and gender groups was