Materiały źródłowe

• #1 Vitamin C Deficiency – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK493187/

  Vitamin C deficiency affects millions of individuals globally. The prevalence of this deficiency varies based on factors such as age, lifestyle, access to nutritious foods, dietary choices, and underlying medical conditions. Individuals who do not include fruits and vegetables in their diet face an elevated risk of vitamin C deficiency, although several high-risk populations have been identified. Scurvy is most commonly found in countries with endemic malnutrition, but its occurrence is global. Prevalence differs across regions, ranging from as low as 7.1% in the United States to as high as 73.9% in northern India.

• #2 Scurvy: Rediscovering a Forgotten Disease

  https://www.mdpi.com/2079-9721/11/2/78

  Scurvy was traditionally described in sailors in older times, but there have been sporadic cases reported in recent times from underdeveloped regions without adequate nutritional support in at-risk populations. […] Although there is a variation in its global prevalence, the estimated overall prevalence of vitamin C deficiency in the US is about 5.9%, according to the 2017–2018 National Health and Nutrition Examination Survey (NHANES), whose aim was to assess the mean vitamin C serum levels and the prevalence of vitamin C deficiency (defined as a mean serum level of less than 11.4 μmol/L). […] The global incidence of scurvy can vary based on the socio-economic status of a region, with underdeveloped areas such as north India having an incidence as high as 73.9%.

• #3 Scurvy: Symptoms, causes, treatment, and prevention

  https://www.medicalnewstoday.com/articles/155758

  Scurvy has been known since ancient Greek and Egyptian times. […] The most recent documented outbreak was in Afghanistan in 2002, following war and drought. […] Modern cases of scurvy are rare in the United States or Europe due to the wider availability of fresh fruits and vegetables. However, it can still occur in economically exploited regions and some low or middle-income countries. […] Vitamin C deficiency is uncommon, with some sources estimating that it affects around 7.1% of people in the U.S. However, severe vitamin C deficiency is rare due to the widespread availability of vitamin C-rich foods, such as fruits and vegetables. […] Scurvy is caused by an insufficient intake of vitamin C. This may occur if a person is following a very restrictive diet or has a condition that interferes with the body’s ability to absorb vitamin C. It may also be caused by excessive alcohol consumption. […] Most people in the U.S. do not have a deficiency in vitamin C, also known as scurvy. However, it still exists in areas of the country or parts of the world with less access to fresh fruit and vegetables.

• #4 Scurvy (Vitamin C Deficiency): Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/125350-overview

  In a 2021 analysis, data from the National Health and Nutrition Examination Survey (NHANES 2017-2018) assessing the prevalence of vitamin C deficiency in the United States found a 5.9% prevalence, in which only current smoking status had an association with deficiency (gender, age, race, and obesity were accounted for). […] When compared to data from NHANES 2005-2006, there was a mean fall in serum vitamin C level but no significant change in the prevalence of vitamin C deficiency. […] NHANES 2004 showed that men aged 20-39 years and those older than 60 years had a higher prevalence of deficiency than similarly aged women. Overall, 8.2% of men and 6% of women (7.1% overall prevalence) were deficient in vitamin C, which decreased from the NHANES 1994, which showed 14% of men and 10% of women deficient. […] NHANES 2005-2006 showed a lower prevalence of 3.6% of vitamin C deficiency among men and women older than 6 years.

• #5

  https://www.healio.com/news/pediatrics/20240917/scurvy-hospitalizations-have-increased-among-children-in-us

  Hospitalizations for scurvy are on the rise among children in the United States, with a significant increase after 2017, according to data published in Pediatrics. […] Hospitalizations for scurvy increased over time, with a significant uptick after 2017, the researchers wrote. In 2006, there were less than 0.5 scurvy diagnoses per 100,000 hospitalizations. There were nearly two scurvy diagnoses per 100,000 hospitalizations in 2017 and more than four diagnoses per 100,000 hospitalizations in 2021. […] The most common comorbidities reported were autism (60%), iron deficiency (43%) and other neurodevelopmental disorders (19%). […] Male predominance was also notable, Murphy and colleagues wrote. This finding may be related to autism epidemiology, but in post hoc analysis, males predominated in children both with and without autism or neurodevelopmental disorders.

• #6 Tridha Scholars

  https://www.tridhascholars.org/press-release/in-the-united-states-scurvy-on-the-rise.php

  Researchers compile available information on the symptoms, diagnosis, radiological evidence, and treatment of Scurvy, a disease caused by the severe deficiency of vitamin C (ascorbic acid). […] Their findings highlight an alarming trend in the span of just five years, the incidence of Scurvy in children more than tripled from 8.2 to 26.7 cases per 100,000. […] In addition to the above-summarized review of scurvy diagnoses and treatment, the present study further comprises a retrospective investigation of the incidence and risk factors associated with Scurvy in the United States (US). […] Time series analyses revealed that during the course of the five years under study, the incidence of Scurvy increased from 8.2 per 100,000 (2016) to 26.7 per 100,000 children (2020). […] The present study highlights that in a span of just five years between 2016 and 2020, scurvy incidence more than tripled in the documented inpatient population.

• #7 Azthena logo with the word Azthena

  https://www.news-medical.net/news/20240719/Scurvy-on-the-rise-in-the-United-States-Pediatric-cases-triple-in-five-years.aspx

  In a recent review published in the journal JAAOS: Global Research and Reviews, researchers compile available information on the symptoms, diagnosis, radiological evidence, and treatment of Scurvy, a disease caused by the severe deficiency of vitamin C (ascorbic acid). […] Their findings highlight an alarming trend in the span of just five years, the incidence of Scurvy in children more than tripled from 8.2 to 26.7 cases per 100,000. […] This study highlights the need for pediatricians and care providers to be aware of the potential for scurvy diagnoses, especially in patients with risk factors presenting vague musculoskeletal symptoms. […] The present study highlights that in a span of just five years between 2016 and 2020, scurvy incidence more than tripled in the documented inpatient population.

• #7 Azthena logo with the word Azthena

  https://www.news-medical.net/news/20240719/Scurvy-on-the-rise-in-the-United-States-Pediatric-cases-triple-in-five-years.aspx

  These findings suggest that pediatricians, orthopedic physicians, and caregivers need to be aware of the looming risk of rising scurvy incidence and include the disease in their workup differential, potentially saving these children and their families from prolonged hospitalizations, adverse musculoskeletal outcomes, and substantial hospitalization costs.

• #8 Tridha Scholars

  https://www.tridhascholars.org/press-release/in-the-united-states-scurvy-on-the-rise.php

  These findings suggest that pediatricians, orthopedic physicians, and caregivers need to be aware of the looming risk of rising scurvy incidence and include the disease in their workup differential, potentially saving these children and their families from prolonged hospitalizations, adverse musculoskeletal outcomes, and substantial hospitalization costs.

• #9 Scurvy (Vitamin C Deficiency): Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/125350-overview

  Patients at risk include those who have chronic malnutrition, those who are elderly or alcoholic, those who subsist on diets devoid of fresh fruits and vegetables, and men who live alone (widower scurvy). […] Infants and children on restrictive diets because of medical, economic, or social reasons are at risk for scurvy. Occurrence of scurvy is uncommon in those younger than 7 months, although infants fed evaporated or condensed milk formulas may develop this disease. […] Scurvy is a problem when general malnutrition exists, as in some impoverished, underdeveloped third-world countries. […] Scurvy also occurs in epidemic proportions in international refugee camps and in populations that subsist mainly on cereal grains. […] A study of nonhospitalized patients in Paris found that 5% of women and 12% of men were deficient; in those older than 65 years, this proportion increased to 15% of women and 20% of men. […] In a 2024 systematic review of vitamin C deficiency (serum/plasma vitamin C 11.4 mol/L, whole blood level 17 mol/L, or leukocytes 57 nmol/108 cells) in hospitalized adults in high-income countries, Golder et al found a 27.7% cumulative prevalence, which was particularly common in individuals with severe acute disease and poor nutrition.

• #10 Scurvy (Vitamin C Deficiency): Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/125350-overview

  In a 2024 retrospective (2017-2021) observational study at a single hospital in New South Wales, Australia, older people and men were more likely than women to have significant vitamin C deficiency, and individuals living in regions associated with low socioeconomic status were also more likely to have insufficient vitamin C levels (29.9%) or severe deficiency (24.5%). […] In a separate study at various Australian centers, Gunton and Bechara found that half of those attending a foot wound clinic, 59% of those at a diabetic foot infection and vascular surgery center, and 30% of individuals at a periodontal clinic had low or deficient levels of vitamin C. […] In a case series from Thailand that reviewed 28 cases of scurvy in infants and children (10 mo to 9 yr and 7 mo; median age, 29 mo) hospitalized over a 7-year period (1995-2002), investigators noted that prolonged consumption of heated milk (ultra-high temperature [UHT] milk) and inadequate intake of vegetables and fruits were the risk factors for the development of scurvy. […] In tests of plasma vitamin C levels in the low-income/materially deprived population of the United Kingdom, carried out between 2003 and 2005 (433 men; 876 women), the Low Income Diet and Nutrition Survey found evidence of vitamin C deficiency in an estimated 25% of men and 16% of women.

• #11 Scurvy in the Modern World: Extinct or Not?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8958866/

  Scurvy is a nutritional disorder caused by vitamin C deficiency. […] Scurvy primarily affects the skin and soft tissue, presenting with a myriad of clinical manifestations ranging from musculoskeletal to bleeding-related complaints and even sudden death in later stages. […] This case reinforces the need to consider scurvy as one of the differentials for petechial rash and easy bruising apart from bleeding diathesis and vasculitis in the contemporary world, especially in at-risk populations. […] While the global prevalence varies, the estimated prevalence of vitamin C deficiency in the United States (US) is 7.1%. […] High-risk groups for scurvy in the modern world include people prone to malnutrition – psychiatric illness, eating disorders, alcoholism; limited food access – elderly living alone, homelessness, COVID-19 pandemic; or malabsorptive states – gastric bypass, celiac disease, hemodialysis. […] We believe it is important for internists to consider this as a differential, especially in certain high-risk groups.

• #12 A doctor on vitamin C deficiency in the modern age

  https://harvardpublichealth.org/policy-practice/a-doctor-on-vitamin-c-deficiency-in-the-modern-age/

  My patient came to me in agony. […] I often see patients struggling with scurvy, a disease long forgotten by the medical system. […] And scurvy still exists. […] Scurvy now primarily affects populations with limited access to nutritious food, such as people experiencing food insecurity, smokers, those with certain eating disorders, and individuals with malabsorption disorders or severe dietary restrictions. […] Even though my patient had all the signs and symptoms of scurvy, no one in the health care system recognized that he had been struggling with malnutrition for more than 30 years. […] Although scurvy was mostly eradicated centuries ago, its simple cure is once again neglected today, in a system focused on making money with more complicated and costly diagnoses. […] Doctors learn little about nutrition in their medical education, so they often cannot recognize, diagnose, and treat nutritional deficiencies. […] This lack of nutrition testing creates a vicious cycle, where physicians do not recognize these conditions because they are not seeing the data in their patient populations, thus reinforcing the knowledge gap. […] The solution is obvious: testing for vitamin deficiencies and then treating them.

• #13 Hypovitaminosis C (scurvy) | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/hypovitaminosis-c-scurvy-1?embed_domain=hackmd.io%25252F%252540yipuafecsl2jsu8smr5njq%25252Fbnjhjgjghjghjgh&lang=gb

  Scurvy in adults is rare. Young children and older persons are predisposed to scurvy due to their diet or the overheating of food. It does not occur before six months of age because maternal stores are maintained until then. Males and females are equally affected. Patients at risk include elderly males, alcoholics, smokers and those with malabsorptive diseases. […] Other significant manifestations in both children and adults arise from the propensity for bleeding, including intra-articular, retrobulbar, and intracranial haemorrhage.

• #14 Persistent scurvy after vitamin C supplementation in a high-risk patient: a case report – Oles – AME Medical Journal

  https://amj.amegroups.org/article/view/9986/html

  Scurvy is a multi-organ syndrome caused by a deficiency of vitamin C. Although historically significant, scurvy is being increasingly diagnosed in the modern era due to the growing prevalence of risk factors including socioeconomic barriers to quality nutrition, smoking, alcohol consumption, chronic illness, and dialysis. […] High-risk groups deserving particular consideration are those demonstrating socio-economic barriers to healthcare and nutrition, patients with severe chronic illness, and patients on dialysis. […] Scurvy is perceived as an ancient disease but remains more prevalent than expected among high-risk populations due to risk factors including social barriers to quality nutrition, anti-oxidant depleting chronic inflammatory states, and increased vitamin clearance among patients on dialysis.

• #15 Scurvy is common and should be diagnosed and treated.

  https://slate.com/technology/2015/11/scurvy-is-common-and-should-be-diagnosed-and-treated.html

  Deficiency rates were greater for low-income people (10-17 percent), and highest among male smokers (18 percent), likely because smoking affects how the body absorbs vitamin C. […] Churchill and his colleagues are still writing up the results of their scurvy study. Once it’s published, he’s hoping the public health world will follow up with more rigorous, randomized clinical trials, and he’d like to see many more doctors screen their patients for scurvy. […] Unfortunately, getting labeled with a sailor’s disease is not always enough to transform someone’s diet.

• #15 Scurvy is common and should be diagnosed and treated.

  https://slate.com/technology/2015/11/scurvy-is-common-and-should-be-diagnosed-and-treated.html

  Scurvy. People are walking around with an 18th-century disease that could have been prevented with a few orange slices and an hour of nutritional education. […] Over the next five years, the Springfield doctors measured vitamin C levels in about 120 patients who came in with a range of mysterious symptoms, such as fatigue, mood changes, rashes, headaches, or joint pain. […] Since there’s no reason to think Springfield’s population is unique, Churchill’s study suggests that scurvy could be endemic to communities across the country, and largely undiagnosed. […] A Centers for Disease Control and Prevention study suggests this is a serious, underappreciated problem. Researchers collected vitamin C levels from 2003 and 2004 and found that 6 to 8 percent of the general population had scurvy-level deficiencies, with men on the higher end.

• #16 A Narrative Review on Pediatric Scurvy: The Last Twenty Years

  https://www.mdpi.com/2072-6643/14/3/684

  Scurvy is a well-known clinical condition caused by vitamin C deficiency. Although considered a rare disease in high-income countries, it has been recently increasingly reported in children, especially in those with abnormal dietary habits, mental or physical disabilities. […] Updated data on its prevalence in European children are not available. Based on the 2003–2004 cross-sectional study by the National Health and Nutritional Examination Survey in the United States, the prevalence of vitamin C deficiency in the total population, which included subjects aged more than 6 years, was about 7.1%, though the majority were clinically asymptomatic. […] Although its prevalence in childhood is not precisely known in high income countries, certain pediatric populations are at higher risk, specifically children with mental, neurological or physical disabilities, autism, eating disorders, patients on restrictive diets, end-stage renal disease patients on dialysis, patients with gastrointestinal malabsorption, iron overload from multiple transfusions related to sickle cell anemia and patients with inadequate enteral feedings as the sole source of nutrition.

• #17

  https://journals.lww.com/onlinejets/fulltext/2024/17020/scurvy__a_rare_disease_or_a_rare_diagnosis_.2.aspx

  Scurvy, the disease state caused by ascorbic acid deficiency, was once an extremely common disease but is now thought to be a rare disease in postmodern societies. […] The detection of 12 cases of scurvy by one physician over a three-decade period highlights the importance of screening for scurvy in at-risk populations and generates the hypothesis that scurvy is not a rare disease but rather a rare diagnosis. […] There is a paucity of high-quality modern epidemiological studies of Vitamin C hypovitaminosis and the true incidence of scurvy in different settings around the world remains elusive. […] I propose that Reuler et al. were prescient, and that scurvy is currently not a rare disease but, rather, a rare diagnosis. Epidemiological research over decades supports this hypothesis. […] Given that ED visits in the United States exceed 100 million/year, one physician detecting 14 presentations of scurvy in 12 patients over a 3 decades-long internal and emergency medicine career clearly raises the possibility that scurvy is much more common than currently appreciated.

• #18 Case Report: Scurvy in an Incarcerated Man – Clinical Advisor

  https://www.clinicaladvisor.com/features/case-report-scurvy-incarcerated-man/2/

  Scurvy is the clinical manifestation of vitamin C deficiency. In the US, approximately 6% of the population have low concentrations of vitamin C. Risk factors for scurvy include alcohol use disorder, tobacco use, low-income, male gender, hemodialysis, restrictive diets, and overall poor nutritional status. Men are more likely to be vitamin C deficient (7%) compared with women (5%). […] Scurvy may occur when vitamin C intake is below 10 mg per day for many weeks. The human body stores approximately 1500 mg of ascorbic acid, and symptoms of scurvy usually start at levels less than 350 mg. Little vitamin C is stored in the body; small amounts of ascorbic acid are stored in the adrenal glands, pituitary gland, and leukocytes. Thus, plasma concentration of vitamin C is largely related to recent ingestion. […] Scurvy is still present in developed countries including the US. In patients with unexplained petechial rash, gingivitis, leg pain, fatigue, and anemia, it is important to keep vitamin C deficiency (as well as other vitamin deficiencies) in the differential diagnosis.

• #19 Scurvy Outbreak Among South Sudanese Adolescents and Young Men — Kakuma Refugee Camp, Kenya, 2017–2018 | MMWR

  https://www.cdc.gov/mmwr/volumes/68/wr/mm6803a4.htm

  Inadequate access to fresh fruits and vegetables in refugee camps can result in scurvy. […] An outbreak of scurvy occurred among adolescent and young adult male South Sudanese refugees who had been provided electronic cash to supplement their diets. […] It is important to consider these needs when determining the amount of food or cash assistance provided to adolescents and young adult male refugees. […] Scurvy is a relatively rare micronutrient deficiency disease that can occur among refugees dependent on food aid. […] The suspected scurvy cases all occurred in young men from South Sudan who were living and cooking together in one geographic section of the camp. […] On January 26, 2018, serum specimens were collected from three of the patients with suspected scurvy, and test results indicated vitamin C levels of 2.89 mg/L, 3.06 mg/L, and 2.71 mg/L (normal = 214 mg/L); deficiency is defined as a vitamin C level 2mg/L.

• #20 Scurvy Outbreak Among South Sudanese Adolescents and Young Men — Kakuma Refugee Camp, Kenya, 2017–2018 | MMWR

  https://www.cdc.gov/mmwr/volumes/68/wr/mm6803a4.htm

  In 2017, an outbreak of scurvy was identified in Kakuma Refugee Camp; the diagnosis was based on clinical manifestations, dietary history, and response to treatment. […] Scurvy is not new to refugee settings in which a limited amount of fresh foods is available or affordable and has previously been documented in Kakuma Refugee Camp, with outbreaks reported during 1995-1997 and in 2003. […] The geographic clustering of suspected cases likely resulted from the relatively higher number of young men living and cooking together in one area of the camp and sharing their limited food rations and e-cash. […] Provision of food assistance in refugee settings is often based on average household composition, factoring in age, sex, and caloric needs. […] It is important to consider these needs when determining the amount of food or cash assistance provided to adolescents and young adult male refugees.

• #21 A Narrative Review on Pediatric Scurvy: The Last Twenty Years

  https://www.mdpi.com/2072-6643/14/3/684

  In the present narrative review, we summarized the fundamental role and the pathophysiology of vitamin C in the human body and the source of this nutrient. […] The majority of patients (127/166, 76%) had a comorbidity associated with an increased risk of vitamin C deficiency. […] Data about age and gender were reported in 13/15 studies corresponding to 118 patients. Their median age was 42 months (interquartile range—IQR 29-96), ranging from 5 to 132 months. Consistently, with regards to gender distribution, a high preponderance of males (87/118, 74%) was noted. […] Clinical manifestations were assessed in 13 studies and 86 children. The earliest manifestations are nonspecific, including constitutional symptoms such as fever (17%), malaise and asthenia (13%), irritability (10%) and loss of appetite (7%). Notably, 80% of patients had poor nutritional status.

• #22 A Narrative Review on Pediatric Scurvy: The Last Twenty Years

  https://www.mdpi.com/2072-6643/14/3/684

  Difficulty in diagnostic assessment and the differential diagnosis was underlined by several authors: 11 studies reported the interval between clinical onset and diagnosis, ranging from one week to 2 years; when available, the median interval was 2 months, calculated on 9 studies. […] In a consistent percentage of patients (32%), one or more provisional misdiagnoses were made before reaching the correct diagnosis of scurvy. […] The typical radiographic findings usually appear after 3–6 months of vitamin C deficiency; thus, most patients in the early stage of the disease have normal radiographs or findings of diffuse demineralization. […] The increasing number of healthy children with scurvy highlights the necessity for clinicians to consider qualitative nutritional disorders as seriously as quantitative ones, widely described in adolescents.

• #23 Scurvy | Pediatric Orthopaedic Society of North America (POSNA)

  https://posna.org/physician-education/study-guide/scurvy

  Scurvy is rarely observed in developed countries. […] Scurvy may be avoided by adequate daily vitamin C intake: infants 25 mg/day, children 30-40 mg/day, adults 40-75 mg/day.

• #24 New analysis of landmark scurvy study leads to update on vitamin C needs | UW News

  https://www.washington.edu/news/2021/08/16/new-analysis-of-landmark-scurvy-study-leads-to-update-on-vitamin-c-needs/

  The goal of the Sorby investigators was not to determine the required vitamin C intake for optimal health; it was to find out the minimum vitamin C requirements for preventing scurvy. […] In the end, the Sorby researchers said 10 milligrams a day was enough to ward off signs of scurvy. […] Robust parametric analyses of the (Sorby) trial data reveal that an average daily vitamin C intake of 95 mg is required to prevent weak scar strength for 97.5% of the population. Such a vitamin C intake is more than double the daily 45 mg vitamin C intake recommended by the WHO but is consistent with the writing panels for the National Academy of Medicine and (other) countries, they add. […] It is concluded that the failure to reevaluate the data of a landmark trial with novel statistical methods as they became available may have led to a misleading narrative on the vitamin C needs for the prevention and treatment of collagen-related pathologies, the researchers wrote.

• #25 Scurvy | healthdirect

  https://www.healthdirect.gov.au/scurvy

  Scurvy is a health condition that happens when you dont get enough vitamin C from your diet for at least a few months. […] It used to happen on long distance ship travel (when it was hard to find fresh fruit and vegetables), but still happens in Australia today. […] Scurvy is still seen today in people who don’t eat enough fruit and vegetables. […] Talk to your doctor if you think your diet doesnt include enough fruit and vegetables or you have symptoms of scurvy. […] To diagnose scurvy, your doctor will as do an examination and ask questions about diet. […] If you have a diagnosis of scurvy, you will need to replace your vitamin C levels and maintain them. […] Eating a healthy, balanced diet, with plenty of fruit and vegetables, is the best way to prevent scurvy. […] Scurvy, a disease caused by lack of vitamin C, has resurfaced in Australia in Western Sydney.

• #26 SciELO Brazil – Scurvy and food selectivity in childhood: a case report Scurvy and food selectivity in childhood: a case report

  https://www.scielo.br/j/eins/a/rDDKWGkHRRhBj4wpmT7hh8S/

  Scurvy is a nutritional disorder caused by an ascorbic acid deficiency. High-risk groups for scurvy in the modern world include people prone to malnutrition, psychiatric illnesses, eating disorders, limited food access, and malabsorptive states. […] Despite its rarity, symptomatic micronutrient deficiency remains a major public health concern. […] Despite the low prevalence of ascorbic acid deficiency, it remains a differential diagnosis for bleeding disorders and hematologic and rheumatologic diseases, particularly in patients with associated eating disorders. […] Dietary anamnesis is important for the routine monitoring of child growth and development. It helps in the prevention of nutritional deficiencies, early diagnosis of eating disorders, and ensures comprehensive multidisciplinary follow-up for these patients.

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