Scurvy in the tropics: Evidence for increasing non‐adult micronutrient deficiency with the transition to agriculture in northern Vietnam

Abstract

Objective Scurvy in non‐adults was assessed at the Pre‐Neolithic site of Con Co Ngua and the Neolithic site of Man Bac in northern Vietnam to investigate nutritional stress during the agricultural transition in Mainland Southeast Asia (MSEA). Materials One hundred and four human skeletons under the age of 20 years old were assessed. Methods Lesions were recorded macroscopically and radiographically. Differential diagnosis using prior established paleopathological diagnostic criteria for scurvy was conducted. Results There was no clear evidence for scurvy at Con Co Ngua and a high burden of scurvy was present at Man Bac (>79% diagnosed with probable scurvy). Scurvy levels were high across all non‐adult ages at Man Bac indicating significant burden throughout childhood and adolescence. Conclusions No scurvy at Con Co Ngua is consistent with widely available food sources at the peak of the Holocene thermal maximum. High levels of scurvy at Man Bac corresponds with decreased dietary diversity, high pathogen load, and increased population stress with the transition to agriculture around the time of the 4.2 ka desertification event. Significance This is the first systematic population‐level non‐adult investigation of specific nutritional disease in MSEA and demonstrates an increase in nutritional stress during the Neolithic transition in northern Vietnam. Limitations Subperiosteal new bone deposits can be due to normal growth in infants and young children, therefore, identification of scurvy in children under the age of 4 years needs to be considered critically. Suggestions for Further Research Further work in diagnosing specific nutritional disease in other non‐adult cohorts throughout MSEA is required.

Hypomineralization disorder in tropical Southeast Asia during the agricultural revolution: Analysis of morbidity and mortality

“…Con Co Ngua, a pre-Neolithic forager site dated approximately 2.5-3.5 thousand years before Man Bac, has also been heavily investigated for the above specific infectious and nutritional diseases. However, although the non-adult preservation was relatively poor compared with Man Bac, no evidence of hypomineralization disorder in the Con Co Ngua non-adults or adults was identified, as was also the case with scurvy (Vlok, 2020;Vlok, Oxenham, et al 2023). As such, we can conclude that the contexts of the agricultural revolution in northern Vietnam generated a unique set of circumstances where infectious and nutritional diseases proliferated in the population and had a significant impact on both morbidity and mortality.…”

“…These skeletal elements include bones of the crania, long bones, and ribs. All these individuals also presented with the minimum skeletal preservation required to be assessed for scurvy (crania and long bones) (Vlok, Oxenham, et al, 2023), which provides a valuable cross-analysis for scurvy and hypomineralization disorder co-occurrence at the site.…”

“…As is the case for the development of scurvy at Man Bac (Vlok, Oxenham, et al, 2023), the supplementation of domesticated rice may have contributed considerably to the development of hypomineralization disorder in Man Bac non-adults. Rice (Oryza sativa japonica) has approximately 32 mg/100 g of calcium with levels less than 300 mg/ day causing calcium deficiency and increasing a child's risk of developing hypomineralization disorder independent of their vitamin D levels (Munns et al, 2016;Pettifor et al, 1981;US Department of Agriculture, 2019).…”

“…The aim of this paper is to explore diagnostic approaches and assess epidemiological patterns of hypomineralization disorder in the Neolithic assemblage of Man Bac, northern Vietnam. Prior paleopathological research at the site (dated to 4‐3500BP) identified a uniquely heavy burden of scurvy (almost 80%) prolific throughout the non‐adult assemblage ( n = 44) (Vlok, Oxenham, et al, 2023). However, some pathological features that were identified in the differential diagnosis were not consistent with scurvy, but rather more consistent with hypomineralization disorder.…”

“…Although features consistent with hypomineralization disorder were identified in Vlok, Oxenham, et al (2023), the focus of that particular paper was on the diagnosis of scurvy. The research by Vlok, Oxenham, et al (2023) attributed the presence of scurvy in the non‐adults at Man Bac to a combination of climate change, the initiation of rice agriculture, an intense infectious disease burden, and rapid population growth.…”