Title: Micronutrient deficiencies in the UK
Key words: micronutrients, deficiency, children, adolescents, vegetarians, drug addicts, alcoholics, women, child-bearing, South Asian, iron deficiency, anaemia, menstrual loss, serum, ferritin, high-phytate diet, phytate, haem, non-haem, folic acid, homocysteine, supplements, supplementation, Vitamin D, rickets, osteomalacia, chappatis, vitamin B, thiamine, riboflavin, B12, dementia, cognitive dysfunction, vegans, vitamin C, vitamin E, zinc,
Date: Sept 2006
Author: Morgan, G
Micronutrient deficiencies in the UK
Various government sponsored nutritional surveys over the last decade have confirmed the continual presence of micronutrient deficiencies in the community (Gregory et al. 1990, Gregory et al. 1995, Smithers et al. 1998). The following groups have been found to be at greatest risk:
Poor nutrition invariably involves a deficiency of more than one micronutrient, complicating the clinical picture. The major individual deficiencies prevalent in these groups are:
Iron deficiency remains the most prevalent of the nutritional deficiencies in the UK. Women of childbearing age, due to menstrual losses and childbearing, show the highest incidences of anaemia and iron depletion (33% having a serum ferritin concentration less than 25 microgram/l, Gregory et al. 1990). Adolescent girls show similar deficiencies (COMA 1991). Poor dietary practices in younger children are also associated with significant iron deficiency (Gregory et al. 1995), a worrying statistic as iron deficiency at this age adversely effects normal growth, behaviour and cognitive development (Lozoff 2000). Infants brought up on non-fortified cows milk are at greatest risk (Pizarro 1991).
Other major groups affected are vegetarians and Asian groups due to their consumption of a high-phytate diet containing low levels of bioavailable haem and non-haem iron (Hallberg 2000).
Malaise, loss of work and possible obstetric complications are some of the complications of iron deficiency.
Suboptimal levels of folic acid in the community become clinically significant amongst the institutionalised elderly (Smithers et al. 1998) and amongst alcoholics (Gregory et al. 1990). They are of particular concern due to the increased metabolic demands of pregnancy where folate deficiency is associated with neural tube defects. Prophylaxis here with folate supplementation has significantly reduced the incidence of this disorder (up to 85% reduction in incidence; Wald 1991, Berry 1999). An association with raised homocysteine levels and cardiovascular disease has also been suggested as a reason for folate supplementation (Selhub 1999).
Vitamin D deficiency remains a problem at the extremes of life, being associated with rickets and osteomalacia respectively. Intake is dependant on sun exposure and dietary intake which, in general, may be fortified. Nonetheless, children are at risk, especially if kept indoors for religious reasons and if consuming a special diet (e.g. the chappati diets of certain Indian communities; Preece 1973). Poor nutrition and lack of sun exposure increases the rate of vitamin D deficiency of old people in institutions (Chapuy 1994).
Vitamin B deficiency
Thiamin and riboflavin deficiencies have been identified in the elderly and more so in the institutionalised. Associations have been made with Alzheimer’s (Pepersack 1999) and supplementation with thiamine has been reported to be of some benefit (Mimori 1996). Thiamin deficiency is an important cause of neurological dysfunction in alcoholics (Cook 1998).
B12 deficiency is also more prevalent in the elderly institutionalised patient and is associated with dementia and cognitive dysfunction (Carmel 1995). In the community vegans are at risk of developing B12 deficiency, leading to pernicious anaemia and subacute degeneration of the cord, unless their diet is supplemented.
The US RNI for vitamin C is currently 90 mg/day, indicating that groups such as the elderly and the poor are now clinically deficient (Gregory et al. 1990, O’Neill 1991). Vitamin C, along with vitamin E, is an important antioxidant and has both cardioprotective and possibly anti-cancer effects (Nyyssonen 1997, Hornig 1988).
Marginal zinc status is prevalent in the community, particularly in the young and the elderly (Smithers et al. 1998, Briefel et al. 2000). Zinc is involved in normal immune function, growth and development. It has been linked to normal cognitive function in children and adults (Pollitt 1993, Penland 1991).
In summary, micronutrient deficiencies in the UK are still prevalent but affect only certain groups such as the very young and the elderly. Groups such as vegetarians and women of childbearing age may suffer from deficiencies such as iron and folate deficiency which require specific attention. For groups such as the elderly and alcoholics multiple deficiencies are likely to be present and will require considerable medical and nutritional counselling.
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