Clinical prevalence of micronutrient deficiency in school-age children: An observational study

INTRODUCTION

Micro-nutrient deficiencies among school-age children (5–14 years) represent a silent yet significant public health concern in low- and middle-income countries, including India. These deficiencies often manifest without overt clinical symptoms but can profoundly affect growth, immunity cognitive function.^[1-3] Key nutrients such as iron, Vitamin A, zinc, Vitamin D and Vitamin B12 are critical for a child’s growth and cognitive development. Inadequate intake or absorption of these micronutrients can lead to various clinical problems, including anaemia, stunted growth, poor academic performance and long-term developmental delay.

In India, dietary patterns are frequently dominated by calorie-rich but nutrient-poor meals, exacerbated by socioeconomic disparities, limited access to fortified foods and poor dietary diversity.^[4,5] This has led to the persistence of ‘hidden hunger’ - a form of undernutrition where children meet caloric needs but fall short on essential micronutrients.^[6,7] Despite national programmes focusing on early childhood nutrition, school-age children are often left out of routine nutritional surveillance and intervention strategies.^[8,9]

In addition, cultural feeding practices, reduced outdoor activity and sedentary lifestyles further contribute to micronutrient inadequacies in this group.^[10,11] There is a paucity of data from clinical settings assessing micronutrient status among school-going children, particularly through physical examination and observed clinical symptoms. This study addresses that gap by evaluating the clinical prevalence of key micronutrient deficiencies in children attending a tertiary care hospital. Findings from this analysis are expected to guide local nutrition policies and school-based interventions.^[12,13]

MATERIAL AND METHODS

This cross-sectional observational study was conducted at a single tertiary care centre over 12 months. The study was reviewed and approved by the Institutional Ethics Committee on 22 August 2024 with registered number TMCHRC/Surg/2024/IEC Protocol-02/11. A total of 125 school-age children, between 5 and 14 years, were selected through simple random sampling from those presenting to the outpatient department. After obtaining informed consent from their parents or guardians, data were collected using a pre-validated case record pro forma.

Clinical evaluation focused on identifying signs and symptoms suggestive of micronutrient deficiencies, including but not limited to pallor, glossitis, angular stomatitis, skin changes and signs of rickets. Anthropometric measurements, including weight, height and body mass index (BMI), were recorded for each participant. Growth parameters were assessed in relation to standardised percentile charts.

The data were analysed descriptively, with calculations of mean, median and percentile distributions for anthropometric and clinical findings. Correlations between suspected micronutrient deficiencies and growth measurements were evaluated using appropriate statistical methods.

This was a purely observational study with no interventions or administration of investigational drugs.

RESULTS

The results are based on data collected from 125 school-going children. Tables 1-4 summarise anthropometric measurements, dietary patterns and clinically observed signs of micronutrient deficiency.

DISCUSSION

This study highlights a considerable burden of clinically observed micronutrient deficiencies in school-age children. Iron deficiency can severely compromise cognitive and physical performance, particularly in a learning environment.^[1] Contrary to expectations, BMI and dietary classification (vegetarian vs. non-vegetarian) did not show a statistically significant association with deficiency status. This supports the idea that ‘hidden hunger’ can affect children across nutritional and dietary profiles, and anthropometric measurements alone are insufficient for diagnosis.^[6,10] Notably, over half of the participants were underweight, and iron deficiency, indicated by the presence of pica, was the most prevalent, consistent with findings from national nutrition surveys.^[7,9,11]

The high prevalence of zinc and Vitamin B12 deficiency also aligns with prior studies linking these nutrients to immune competence, appetite regulation and neural development.^[12] These findings are in line with earlier rural and urban surveys in India, reinforcing the need for holistic public health approaches to childhood nutrition.^[13,14] Interestingly, Vitamin B12 deficiency was present even among non-vegetarian children, pointing to possible issues with food quality, bioavailability or meal frequency.^[15] Regular basis deworming and iron fortification of the food will have significant impact on improving the iron status of these children.^[16,17]

Vitamin A and D deficiencies remain problematic despite national fortification and supplementation programmes. Reduced sunlight exposure, especially in urban populations and a lack of nutrient-rich foods may explain the persistent levels of Vitamin D insufficiency.^[18,19] The widespread incidence of dental caries (39.2%) reflects not just oral hygiene deficits but also dietary quality issues and possible calcium or Vitamin D deficiency.^[20] Effective interventions must include school-level screening,nutrition counseling and targeted supplementation, particularly in under-resourced settings.

Contrary to expectations, BMI and dietary classification (vegetarian vs. non-vegetarian) did not show a statistically significant association with deficiency status. This supports the idea that ‘hidden hunger’ can affect children across nutritional and dietary profiles, and anthropometric measurements alone are insufficient for diagnosis.^[6,11]

These findings are in line with earlier rural and urban surveys in India, reinforcing the need for holistic public health approaches to childhood nutrition.^[13,14,16] Effective interventions must include school-level screening, nutrition counseling and targeted supplementation, particularly in under-resourced settings.^[5,9]

CONCLUSION

The findings of this study underscore a significant burden of micronutrient deficiencies among school-going children, particularly iron, zinc, Vitamin A, Vitamin D and Vitamin B12. These deficiencies were observed across BMI categories and diet types, highlighting the pervasive nature of hidden hunger.

Routine clinical screening in schools, fortified mid-day meals and parent-focused nutrition education are essential to improve the academic performance and overall health of these children. The screening programmes can identify children at risk for health issues and facilitate timely intervention. Healthy eating habits and regular physical activities through school programmes can significantly decrease the risk of chronic diseases in later life. Public health programmes should prioritise school-age children as a critical target group to prevent long-term developmental consequences and improve educational performance.