Who is at risk for scurvy in the US? Uncovering modern-day risk factors

January 7, 2026 •

4 min read

Though often considered a disease of the past, recent studies have shown a troubling rise in pediatric scurvy cases in the US, tripling between 2016 and 2020. While severe vitamin C deficiency is uncommon, it is important to understand who is at risk for scurvy and the modern factors contributing to this disease.

Quick Summary

Scurvy is caused by severe vitamin C deficiency and, though rare, affects high-risk groups in the US, including the elderly, children with restrictive diets, and individuals with alcoholism.

Key Points

Scurvy is not extinct: While considered a historical disease, scurvy continues to appear in the US, particularly among vulnerable populations.
Children with restrictive diets are at risk: The pediatric scurvy rate has been rising, especially in children with neurodevelopmental disorders like autism who have sensory-based selective eating habits.
The elderly are susceptible: Seniors with limited income, social isolation, poor dental health, or those on restrictive diets are a key at-risk group.
Chronic conditions increase risk: Individuals undergoing dialysis, those with malabsorption issues post-bariatric surgery, and people with inflammatory bowel disease are at a higher risk of vitamin C deficiency.
Substance abuse and mental health are factors: Alcoholism, drug abuse, and certain mental illnesses like anorexia can severely impact dietary intake, leading to scurvy.
Prevention is straightforward: Early recognition and simple vitamin C supplementation are highly effective in treating and preventing scurvy, with symptoms improving rapidly.

Scurvy in a modern context

Scurvy, a disease resulting from severe vitamin C deficiency, was historically associated with sailors on long voyages who lacked fresh produce. However, modern scurvy is not a relic of the past. Although rates are low in the general population, specific groups in the US remain highly vulnerable due to various dietary, medical, and socioeconomic factors. The body’s vitamin C stores become depleted over several months of inadequate intake, leading to symptoms like fatigue, bleeding gums, easy bruising, and poor wound healing. Early recognition is crucial for effective treatment with vitamin C supplementation.

High-risk populations for scurvy in the US

Children with restrictive diets and neurodevelopmental conditions

Childhood scurvy cases have seen a notable increase, often linked to extreme food selectivity. This is particularly common in children with autism spectrum disorder (ASD), where sensory sensitivities can lead to very narrow diets, often excluding fruits and vegetables. Other neurodevelopmental conditions like cerebral palsy can also cause feeding difficulties, putting these children at risk.

Selective Eating: Children with ASD or Avoidant/Restrictive Food Intake Disorder (ARFID) may consume a diet of only a few preferred items, such as processed foods, eliminating vitamin C-rich options.
Developmental Delays: Conditions affecting motor skills can impact a child's ability to eat a wide variety of foods, or may be associated with other feeding issues.
Inadequate Weaning: Infants exclusively fed cow's milk or boiled milk are at risk, as pasteurization destroys vitamin C and these products are not nutritionally complete for infants. Most commercial formulas are fortified, but improper feeding practices can still lead to issues.

The elderly and socially isolated individuals

Older adults face several challenges that increase their risk of poor nutrition and subsequent vitamin C deficiency. Social isolation, reduced appetite, and limited financial resources can all contribute to diets lacking in fresh fruits and vegetables. This pattern is sometimes referred to as the "tea and toast" diet.

Individuals with alcohol use disorder

Chronic alcohol abuse is a significant risk factor for scurvy. This is due to a combination of inadequate dietary intake, impaired nutrient absorption in the gut, and increased metabolic stress. Malnourished alcoholics may present with various signs of nutrient deficiencies, and scurvy can easily be overlooked.

Patients with malabsorption and chronic diseases

Several medical conditions and procedures can interfere with the body's ability to absorb or utilize vitamin C, or increase its requirements.

Bariatric Surgery: Weight-loss surgeries like gastric bypass or sleeve gastrectomy can significantly alter the gut's anatomy, leading to impaired vitamin C absorption and a higher risk of deficiency.
Dialysis Patients: Individuals with end-stage renal disease on chronic hemodialysis or peritoneal dialysis are at heightened risk because vitamin C is a water-soluble vitamin that is filtered out during the dialysis process.
Inflammatory Bowel Disease: Conditions like Crohn's disease and celiac disease can cause poor nutrient absorption due to inflammation in the small intestine, where vitamin C is typically absorbed.
Iron Overload Disorders: Certain genetic blood disorders like thalassemia can lead to iron overload, which can increase vitamin C consumption.

Other vulnerable groups

Beyond these primary categories, other groups face elevated risk:

Smokers: Smoking increases the body's oxidative stress, which accelerates the breakdown of vitamin C. As a result, smokers require a higher daily intake of vitamin C than non-smokers to maintain adequate levels.
Individuals with Mental Illness: Psychiatric conditions such as schizophrenia, depression, or anorexia nervosa can be associated with extremely poor dietary habits and disinterest in self-care, increasing malnutrition risk.
Low Socioeconomic Status: Limited access to or affordability of fresh fruits and vegetables is a major driver of malnutrition, impacting economically disadvantaged individuals and families.
Homeless Individuals: This population often has unreliable access to fresh food and adequate nutrition, placing them at significant risk.

Comparison of Historical vs. Modern Scurvy Risk Factors


Feature	Historical Scurvy (e.g., sailors)	Modern Scurvy (US)
Primary Cause	Prolonged lack of access to fresh produce during long sea voyages.	Chronic inadequate intake due to a range of dietary, medical, and social issues.
Dietary Pattern	Monotonous, non-perishable diet of staples like dried meat and hardtack.	Restrictive diets, high intake of processed foods, low fruit/vegetable consumption.
Affected Population	Adult male sailors.	Children, the elderly, individuals with certain chronic illnesses, and those with substance abuse issues.
Contributing Factors	Limited knowledge of nutrition, environmental constraints.	Underlying health conditions (ASD, dialysis), socioeconomic barriers, behavioral issues.
Prevalence	High mortality rates during voyages.	Rare but with pockets of rising incidence in specific at-risk groups.

Conclusion: Vigilance and targeted support are key

While scurvy is not a widespread public health crisis in the United States, its persistence among certain vulnerable groups highlights ongoing nutritional disparities. The increasing incidence in the pediatric population, particularly among those with conditions like autism, underscores the need for greater awareness among healthcare providers and caregivers. For adults, factors like alcohol use, bariatric surgery, and dialysis require diligent monitoring and appropriate vitamin C supplementation. By recognizing the specific risk factors that can lead to severe vitamin C deficiency, targeted nutritional education and intervention can effectively prevent and treat this otherwise easily manageable condition.

For more detailed nutritional information, consult the NIH's Vitamin C Fact Sheet.

Frequently Asked Questions

Yes, although scurvy is rare in the general population, cases still occur, especially within specific high-risk groups due to nutritional, medical, and social factors.

Common issues include highly restrictive diets, selective eating (often seen in children with autism), social isolation leading to poor eating habits in the elderly, and diets lacking fresh fruits and vegetables.

Patients on dialysis are at increased risk because the dialysis process filters out water-soluble vitamins like vitamin C. Their dietary restrictions can also limit their intake of vitamin C-rich foods.

Yes, bariatric surgery alters the digestive tract, which can impair the body's ability to absorb vitamin C. This, combined with a post-surgery restrictive diet, increases the risk of deficiency.

Chronic alcohol abuse leads to poor dietary intake and can damage the gastrointestinal tract, impairing the absorption of vitamin C and other essential nutrients.

Pregnant and breastfeeding women have an increased requirement for vitamin C. If their diet is poor during these times, they may be at risk for a deficiency.

A 'tea and toast' diet is a very limited diet consisting mainly of tea and bread. It is dangerous because it is severely lacking in essential nutrients, particularly vitamin C, and is often seen in socially isolated or elderly individuals.