Relationship between biochemical and clinical indices of B-vitamin deficiency. A study in rural school boys

Abstract

I . A study amongst schoolboys in villages around Hyderabad, India, showed that almost all the boys had riboflavin deficiency, 61 % had pyridoxine deficiency, and 9'4% had thiamin deficiency as judged by enzymic tests.2. The prevalence of angular stomatitis was 41.3 yo and that of glossitis was 18.2 %. Biochemical deficiency of riboflavin and pyridoxine was marginally higher in children with angular stomatitis with or without associated glossitis, than in children without oral lesions.3. Treatment with B-complex vitamins (containing 4 mg riboflavin and 10 mg pyridoxine) daily for I month produced significant reduction in the prevalence of glossitis but had no effect on angular stomatitis. The latter responded to topical application of gentian violet. 4.Small but significant changes in erythrocyte enzymes occurred over the period of I month even without vitamin supplements.5 . Results suggest that while glossitis is a relatively early manifestation of riboflavin or pyridoxine deficiency or both, angular stomatitis has a more complex aetiology perhaps associated with infection.Lesions of the mouth such as angular stomatitis and glossitis have been shown in experimentally-induced riboflavin deficiency as well as pyridoxine deficiency. Recent reports from the National Institute of Nutrition, Hyderabad, show that in adults this condition responds to treatment with either riboflavin or pyridoxine (Krishnaswamy, 1971 ; Iyengar, 1973). While glossitis seems to be more common amongst the adults of our community, angular stomatitis is more common amongst the children.A recent survey of rural schoolchildren living near Hyderabad, revealed a higher incidence of angular stomatitis amongst boys than amongst girls. The condition failed to respond to treatment with either riboflavin alone or with B-complex vitamins over a period of 3 weeks and 4 weeks respectively (K. V. R. Sarma, M. Damodaran and A. Tiar, unpublished results).The present study was carried out to investigate this observation further, by applying biochemical tests for assessing vitamin status, and examining the response to topical application of gentian violet. EXPERIMENTALThe subjects, 407 boys aged 5-1 3 years old and attending four rural schools near Hyderabad, were examined for clinical signs of vitamin deficiency such as angular stomatitis, glossitis, cheilosis, Bitot's spots, phrynoderma and angular scars. Of these, 168 boys had active angular stomatitis with or without glossitis (group A) whereas 134 boys were completely free of all lesions of the mouth including healed scars (group B). Boys in group A were further divided randomly into three subgroups (groups AI, A2 and A3) and those in group B into two subgroups (groups BI and B2).These boys were treated daily with either two tablets of B-complex vitamins (containing (mg/tablet): thiamin 2, riboflavin 2, pyridoxine 5, calcium pantothenate 2, niacin 20) (groups Ar and BI) or with placebo tablet containing IOO mg lactose (groups A2 and B2) or by topical application of a solution of gentian violet (10 g/l...

Urinary Riboflavin Excretion and Erythrocyte Glutathione Reductase Activity in Preschool Children Suffering from Upper Respiratory Infections and Measles

“…These data may explain the much higher prevalence of biochemical riboflavin defi ciency compared to that of the other B com plex vitamins such as thiamine, pyridoxine and folic acid observed in our earlier studies [1][2][3][4][5]. The perplexing lack of clear-cut corre lation between biochemical and clinical le sions of riboflavin deficiency reported by us [2][3][4] and other workers [17,18] may also be explained by the artefactual changes in the riboflavin levels of blood or urine under above-mentioned conditions.…”

“…Thus when rural school children were supplemented daily with B complex vitamins containing 4 mg ribo flavin for 1 month, or 1.5 mg riboflavin for 1 year, only 50% showed normal riboflavin status as judged by the values for erythrocyte glutathione reductase (EGR) activity (EC 1.6.4.2), and its in vitro stimulation with FAD [3,4). The remaining 50% had im proved but not normalized.…”

“…Our recent studies reveal a high incidence of biochemical riboflavin deficiency among low-income-group women and children in India [1][2][3][4], While the diets of these people are generally deficient in riboflavin, factors other than dietary deficiency also seem to 1 Some of the data included were mentioned at the X lllth International Congress of Nutrition, Brighton. UK, held on 18-23 August, 1985, but not included in the proceedings.…”

Multiple micronutrient fortification of salt

“…This may be another limitation of the study. Angular stomatitis may be due to infections when it responds to topical applications of antibiotics or gentian violet, as in earlier studies (Bamji et al, 1979) or due to micronutrient deficiencies (Blanck et al, 2002). Since in our study angular stomatitis disappeared when fortified salt was used, it may be assumed that the cause of angular stomatitis in our study might have been micronutrient deficiencies and not infections.…”

Effect of Respiratory Infection on Tissue Riboflavin and Flavin Enzymes in Mice

“…Studies on women and children in devel oping countries have revealed a very high incidence of biochemical riboflavin defi ciency as judged by the activation of eryhtrocyte glutathione reductase (EGR) with its co enzyme flavin adenine dinucleotide (FAD, EGR activation coefficient, AC) [1][2][3][4][5]. While the diets of these people are generally deficient in riboflavin, supplementation with riboflavin does not always normalize biochemical deficiency suggesting involve ment of non-dietary factors as well, in the causation of riboflavin deficiency.…”