17 May 2019

You needn’t be at sea to be short of C

Nutrition Research

It’s baaack. Scurvy has been in the news lately, and now an Australian study has found vitamin C-deficiency in an alarming proportion of hospital patients, suggesting malnutrition in the wider community.

Famously a disease of sea-farers, scurvy is a disease that, like syphilis, has been almost unheard of in the past century but is now reappearing. Cases in the community reported in the Australian and US media in recent months appear to stem from malnutrition due to poverty.

In an observational study published in the RACP’s Internal Medicine Journal, a team led by Dr Yogesh Sharma from Flinders University took blood from 150 patients with general medical admissions to the Flinders Medical Centre in Adelaide.

They found hypovitaminosis C, defined as <28mmol/L, in almost 77% of the sample. Almost 42% had severe deficiency with <11mmol/L.

These were higher proportions than found in similar overseas studies, though the authors note that their sample was older, with more than half aged over 71, and vitamin C levels decline with age.

The vitamin C-deficient patients had a median length of stay in hospital two days longer than the rest of the sample.

It takes up to three months of zero vitamin C intake to manifest in the classic symptoms of scurvy – bleeding, fatigue, myalgia and so on – which was not observed in these patients.

Dr Sharma told The Medical Republic that the study could not determine the cause of the deficiency, since hospitalised patients might also have high levels of inflammation, which depletes vitamin C. Hospital food was not measured for its nutritional content so could not be ruled out as a contributor.

But the results did suggest there might be significant deficiency in the community that was leaving people at risk. No data was available, Dr Sharma said, since vitamin C was not measured in Australian national nutrition surveys, and this study made a good argument that it should be.

The paper said most physicians were unaware that a large proportion of hospital patients might be vitamin C-deficient, and that future studies should look at the benefits of supplementation.

Risk factors for scurvy besides age include alcoholism, smoking, social isolation, psychiatric illness, fad diets, malabsorption syndrome and renal replacement therapy, but the study found deficiency in all types of patients.

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4 months 6 days ago
The first time I saw a case of scurvy was in a fellow resident medical officer at Guy’s Hospital in London. This doctor had a mild form of Asperger’s Syndrome. He had not left the hospital in more than a year. He ate only hospital food — the same boiled-to-death fare served up to patients.  In 1975, I diagnosed a case of scurvy. The patient was a homeless man, much addicted to alcohol, whose only food intake was one or two pies a day.  His clinical signs fitted with the diagnosis of scurvy and this was confirmed by his laboratory… Read more »