List specific micronutrient deficiencies, their risk factors, and clinical signs.
Describe the epidemiology, pathophysiology, and clinical presentation of vitamin A, iron, and zinc deficiencies.
Describe the general management for micronutrient deficiency prevention and treatment in acute emergency settings.
Different dietary insufficiencies may lead to specific micronutrient deficiencies. Some of these have typical clinical manifestations. Specific dietary risk factors for important micronutrient deficiencies and possible solutions are outlined in Table 2. Table 3 summarizes the classic physical findings associated with significant micronutrient deficiencies.
Case 2.
You are providing pediatric care to a population that has been displaced after a flood. A mother comes to the health care unit with her 4-month old son, who was born after 35 weeks of gestation and is exclusively breastfed. Physical findings are normal. The weight and height are at the 50th percentile (age corrected for gestational age).
What are your recommendations regarding iron intake?
TABLE 2. Micronutrient deficiencies: risk factors and possible solutions
Niacin (pellagra)
Dietary risk factor
Maize-based diet
Possible solutions
Foods rich in proteins and whole grain cereals
Thiamin (beri-beri)
Dietary risk factor
Polished rice/or other cereal/cassava/manioc-based diet
Dark orange fruits and vegetables, yellow corn, fortified cereal, animal products, dark green leafy vegetables, amaranthus, baobab, mango leaves, vitamin A supplements
Vitamin C (scurvy)
Dietary risk factor
Diet with not enough fresh fruits and extremely low fat intake
Possible solutions
Fresh raw fruits/vegetables, liver, fresh animal milk
Iron (ferropenic anemia)
Dietary risk factor
Diet lacking animal products
Possible solutions
Animal products (liver, meat); dried fruits; consumption of vitamin C with meals; iron/folate supplements or fortified cereal blends. From ages 6-24 months on, nearly all iron intake is provided by supplementary foods.
Zinc
Dietary risk factor
Diet lacking animal products
Possible solutions
Animal products (liver, meat); fortified cereal, peanuts, Gombo (Okra), sesame and pumpkin seeds, avocado, all legumes: niebe, lentils, peas, Moringa leaves powder. Children 6-24 months on, millet, sorgho. From ages 6-24 months on, nearly all zinc intake is provided by supplementary foods.
Riboflavin
Dietary risk factor
Diet lacking animal products
Possible solutions
Animal products (liver, eggs, fish), milk, leafy green vegetables. From ages 6-24 months on, nearly all riboflavin intake is provided by supplementary foods.
Vitamin D (rickets)
Dietary risk factor
Lack of exposure to sunlight
Possible solutions
Apart from a supplement diet vitamin D is negligible
Calcium
Dietary risk factor
Lack of milk, dark-green leaves, or fish with bones
Possible solutions
Milk, fish with bones (e.g. sardines), fish flour, shell fish, egg shell powder, beans and green peas, dark green leaves, calcium carbonate (used in making tortillas)
TABLE 3. Physical findings commonly associated with micronutrient deficiencies
