A patient with prolonged anorexia has not eaten for six weeks. Which pattern of fat-soluble vitamin status would you expect, and why?

• A. All fat-soluble vitamins will be rapidly excreted within days, causing immediate deficiency symptoms across A, D, E, and K during the first week of anorexia.
• B. Because fat-soluble vitamins are not stored, deficiency will present as severe coagulopathy from lack of vitamin K within 48 hours and blindness from vitamin A within the first week.
• C. Only water-soluble vitamin deficiencies matter during fasting; fat-soluble vitamin status is unaffected because endogenous synthesis maintains levels indefinitely despite zero intake.
• D. Vitamin A stores in the liver may maintain serum retinol relatively well for weeks; vitamin D stored in adipose may also persist, but depletion and deficiency signs depend on prior stores—A and D toxicity risk remains if large stores existed before fasting.

Answer: (D)