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Jun 19, Present Knowledge in Nutrition, 10th Edition provides comprehensive coverage of all aspects of human nutrition, including micronutrients.
Table of contents
Hagger , Luca Mallia , Fabio Lucidi. Integration of status consumption and theory of planned behavior: a conceptual framework Syed Naveed Altaf , Selvan Purumal , Zolkifli Hussin. Randomized controlled trial of a messaging intervention to increase fruit and vegetable intake in adolescents: Affective versus instrumental messages. The development of a functional food breakfast and its effects on gluco-regulation, cognitive performance, mood and satiety in adolescents Sarah Corner Kennedy.
References Publications referenced by this paper. The theory of planned behavior. Icek Ajzen. Predicting breakfast consumption: an application of the theory of planned behaviour and the investigation of past behaviour and executive function. Cara L. Wong , Barbara A Mullan. Breakfast habits, nutritional status, body weight, and academic performance in children and adolescents. Gail C.
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Efficacy of the Theory of Planned Behaviour: a meta-analytic review. Christopher J Armitage , Mark Conner. Predicting breakfast consumption: A comparison of the theory of planned behaviour and the health action process approach Barbara A Mullan , C. James Wong , Emily J. Kothe , Carolyn MacCann. Randomised controlled trial of a brief theorybased intervention promoting breakfast. Kothe , R. After administration of ascorbic acid, his pain improved rapidly, and he again began to walk.
After discharge from the hospital, he took mg of ascorbic acid twice daily, 2. Complete resolution of his pain occurred within 1 week, and his skin lesions faded simultaneously. Follow-up serum ascorbic acid level at 6 weeks was With behavioral modification, his dietary intake improved, and he remained well.
Ascorbic acid is a potent reducing agent and a cofactor for numerous enzymes that affects a variety of body functions. Humans cannot synthesize ascorbic acid and are dependent on intestinal absorption of this essential nutrient through an active sodium-dependent transporter protein. Absorbed ascorbic acid is transported to tissues in water-soluble form. The most common signs and symptoms of scurvy are manifestations of decreased production and increased fragility of collagen, because of faulty hydroxylation of proline and lysine residues critical in procollagen triple helix formation.
Infants may present with irritability and "frog-legged" pseudoparalysis, with external rotation and flexion of their lower extremities from the bone pain. Severe scurvy manifests as skeletal muscle degeneration, cardiac hypertrophy, diminished bone marrow function, and adrenal atrophy. Dermatologic findings appear early in the disease and may be helpful clues to the diagnosis. These include petechiae, ecchymoses, corkscrew or swan-neck hairs, follicular hyperkeratosis, and perifollicular hemorrhage.
Perifollicular hemorrhage occurs secondary to plugging of hair follicles with keratin and associated proliferation and bleeding of fragile blood vessels. This is a distal shower of petechiae with a sharp proximal line of demarcation, occurring immediately after release of venous occlusion of the extremity.
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Our patient developed petechiae distal to tourniquet placement. The etiology of anemia is believed to be multifactorial, including blood loss, concurrent vitamin deficiencies especially folate , and decreased iron absorption. The most common radiographic finding in scurvy is bony demineralization. There is preservation of the zones of provisional calcification at the ends of the metaphyses the white lines of Frankel. The lucent line adjacent to this is the scurvy zone, an area through which fractures may occur.
The classic Pelkan spurs at the periphery of the zone of calcification are the result of healing of these fractures. Another classic finding is the fine white line Wimberger ring outlining the epiphyses. If subperiosteal bleeding occurs, extensive periosteal new bone is seen along the shafts of the long bones. Because he did not demonstrate other classic radiographic findings of scurvy, the differential diagnosis of his symptoms included leukemia, since lucent metaphyseal bands occur in this condition also.
The diagnosis of scurvy is largely made on clinical grounds, 8 and may be supported by serum ascorbate levels of less than The serum values reflect metabolic turnover, while buffy-coat values represent tissue stores. Serum ascorbate levels are specific but not sensitive. They may be normal, even in states of severe depletion.
A better indicator of body stores is the measure of urinary excretion after parenteral ascorbic acid challenge.
Eighty percent of a given parenteral dose should be excreted within 5 hours if body stores are adequate. The strongest indicator of disease is the resolution of manifestations after the administration of ascorbic acid. For mild disease, mg daily, and for severe disease, to mg daily, may be administered for 1 week, with reduced doses until full recovery.
Oral and constitutional symptoms will usually resolve in 2 to 3 days, 23 with ecchymoses, bone abnormalities, and anemia usually resolving within 2 weeks. Because foods are increasingly supplemented with ascorbic acid, concern for scurvy has diminished in the developed world.
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However, individuals who remain at risk for scurvy include the elderly, those who infrequently prepare balanced meals, 22 psychiatric patients, 24 the homeless, food faddists, 20 alcoholics, 21 and dyspeptics who avoid acid-containing foods. The development of scurvy in an otherwise healthy child is remarkable, contributing to the initial confusion at our patient's presentation. While his mother described his diet as "normal for his age" during the admission history, the child exhibited severe dietary restriction, which seemed to be behavioral in nature. Despite repeated attempts by his mother to modify his diet, he had steadfastly refused to alter dietary intake.
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Eating behavior severe enough to result in malnutrition and scurvy should alert the practitioner to possible underlying psychiatric disorders in the patient or in the family. Psychiatric disorders to consider include mood disorders, obsessive-compulsive disorder, eating disorders, or thought disorders.
We thank Alexander R. Lawton III, MD, for his astute observations in making the diagnosis in this patient, and helpful comments during the preparation of this article. Corresponding author: Donna S. All Rights Reserved. Figure 1. View Large Download.
Interdental papillae with an ecchymotic and spongy appearance arrow. Edinburgh, Scotland Edinburgh University Press;. Vitamin C. Present Knowledge in Nutrition. Am J Clin Nutr. Am J Pathol. Nelson Textbook of Pediatrics. Textbook of Pediatric Rheumatology. Arch Phys Med Rehabil. Scurvy resembling cutaneous vasculitis. J Am Acad Dermatol. Ann N Y Acad Sci. Practice of Pediatrics. R I Med. Arch Dermatol.
Int J Dermatol. Hosp Pract Off Ed. Child and Adolescent Psychiatry.