During a community health survey in a slum area of Delhi, multiple children aged 2–5 years are found to have follicular hyperkeratosis, perifollicular hemorrhages, and poor wound healing. Dietary assessment reveals minimal intake of fresh fruits and vegetables. What is the most common cause of vitamin C deficiency in this population?

## Most Common Cause of Vitamin C Deficiency in Vulnerable Populations **Key Point:** Inadequate dietary intake of fresh fruits and vegetables is the most common cause of vitamin C (ascorbic acid) deficiency worldwide, particularly in low-income populations with limited access to fresh produce. ### Epidemiological Context in India Vitamin C deficiency is prevalent in: - Low-income urban slums with poor nutrition - Rural areas with seasonal food scarcity - Populations consuming predominantly processed or cooked foods - Children with inadequate complementary feeding ### Why Dietary Deficiency Dominates 1. **Vitamin C is heat-labile:** Cooking destroys 50–90% of vitamin C content 2. **Limited shelf life:** Fresh fruits/vegetables spoil quickly in hot climates 3. **Economic barriers:** Fresh produce is expensive in low-income settings 4. **Dietary patterns:** Reliance on staple grains (rice, wheat) with minimal fresh foods ### Clinical Presentation in This Case The children's findings are classic for scurvy (vitamin C deficiency): - Follicular hyperkeratosis (perifollicular hemorrhages around hair follicles) - Poor wound healing (defective collagen synthesis) - Age group 2–5 years (high-risk group for nutritional deficiencies) - Dietary history: minimal fresh fruits and vegetables ### Comparison of Vitamin C Deficiency Causes | Cause | Prevalence | Mechanism | Associated Features | |-------|-----------|-----------|---------------------| | **Dietary inadequacy** | **Most common globally** | Low intake of fresh produce | Gradual onset, reversible | | Malabsorption (celiac) | Uncommon | Intestinal mucosal damage | Associated GI symptoms, steatorrhea | | Chronic diarrhea | Uncommon | Increased losses, reduced absorption | Ongoing diarrheal disease evident | | Renal tubular dysfunction | Rare | Urinary wasting of ascorbate | Associated renal disease, electrolyte abnormalities | **Mnemonic:** SCURVY signs = **S**wollen gums, **C**orkscrew hairs, **U**lceration, **R**ash (follicular), **V**alor (poor wound healing), **Y**ellow (ecchymoses) **High-Yield:** In resource-limited settings, nutritional vitamin C deficiency vastly outnumbers pathological causes. Always assess dietary intake first before ordering investigations. **Clinical Pearl:** Vitamin C deficiency is preventable through dietary counseling and low-cost interventions (citrus fruits, leafy greens, fortified foods). In India, fortification of staple foods is an emerging public health strategy.