Famine and Bone Metabolism

Abstract

Throughout history, populations have been exposed to periods of severe food shortage, famine, and starvation. Famine continues to be a major world health issue today with an estimated 794.6 million people (10.9% of the world’s population) undernourished in the 2012–2014 period. Historical episodes of famine have sometimes allowed the effects on subsequent health to be studied in detail. For instance, during WWII, the studies of starved children in the Warsaw Ghetto documented bone softening, osteoporosis, and osteomalacia. Histologically the bone marrow was replaced with connective tissue and few myelocytes or chondrocytes were visible. Infants born to women who experienced famine during pregnancy may have increased risk for certain health conditions and there is evidence that musculoskeletal conditions may originate in the intrauterine period. Fetal programming is likely to increase the risk of osteoporosis when the environment during pregnancy is lacking in essential minerals and vitamins. The interplay between the three most important components of bone metabolic health, calcium, vitamin D, and vitamin K, often occur together in communities affected by hunger. Lack of adequate nutrition and vitamin D may lead to Rickets in children. Vitamin K deficiency can lead to intrauterine epiphyseal ossification and adolescent osteoporosis. Folic acid deficiency during pregnancy is also a key factor in neural tube anomaly development. Lathyrism due to famine-related dietary restriction to predominantly one food type, the lathyrus legume species, can lead to osteolathyrism. Symptoms include bone tissue hemorrhage, collagen disease causing bone softening, osteoporosis, and frequent fractures. Famine osteopathy is a conglomerate of metabolic aberrations resulting from nutritional deprivation. Developed countries that welcome immigrants and refugees from famine hit regions should make provision for screening and early detection of metabolic deficiencies such as osteoporosis.

“Never has a generation fallen from such

intellectual heights as ours, to such a depth.”

Stefan Zweig,

The World of Yesterday, 1942

All Metabolic Bone Disorders Resulting from Malnutrition Are Preventable and All Osteopathies, Except Lathyrism, Are Curable

Daily Requirements (Nat Inst Health USA)

Life stage group	Calcium recommended dietary allowance (mg/day)	Vitamin D recommended dietary allowance (IU/day)
0-6 months	a	b
6–12 months	a	b
1–3 years old	700	600
4–8 years old	1,000	600
9–13 years old	1,300	600
14–18 years old	1,300	600
19–30 years old	1,000	600
31–50 years old	1,000	600
51–70 years old	1,000	600
51–70 year old females	1,200	600
71+ years old	1,200	800

1. ^aFor infants, Adequate Intake is 200 mg/day for 0 to 6 months of age and 260 mg/day for 6 to 12 months of age
2. ^bFor infants, Adequate Intake is 400 IU/day for 0 to 6 months of age and 400 IU/day for 6 to 12 months of age

The British Nutrition Requirements

Reference nutrient intakes for vitamins (μg/day)
Age	Vitamin B12	Folate	Vitamin D
0–3 months	0.3	50	8.5–10c
4–6 months	0.3	50	8.5–10c
7–9 months	0.4	50	8.5–10c
10–12 months	0.4	50	8.5–10c
1–3 years	0.5	70	10
4–6 years	0.8	100	10
7–10 years	1.0	150	10
11–14 years	1.2	200	10
15–18 years	1.5	200	10
19–50 years	1.5	200	10
50+ years	1.5	200	10
11–14 years	1.2	200	10
15–18 years	1.5	200	10
19–50 years	1.5	200	10
50+ years	1.5	200	10

1. Sources: British Nutrition Foundation 2016, Nutrition Requirements, Reference Nutrient Intakes for Vitamins. https://www.nutrition.org.uk/attachments/article/261/Nutrition%20Requirements_Revised%20Oct%202016.pdf. Accessed 16 August 2017
2. Institute of Medicine of the National Academies, November 2010, Dietary Reference Intakes for Calcium and Vitamin D. http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D/Vitamin%20D%20and%20Calcium%202010%20Report%20Brief.pdf. Accessed 16 August 2017
3. ^cSafe intake