Riboflavin Deficiency in Baltistan (1997;
revised Nov. 2008)
H.A. Zappe, S. Nuss, K. Becker, R.H. Schirmer, N. Frey-Rahman
Riboflavin (vitamin B2) is an essential
component of the coenzymes flavin mononucleotide (FMN) and flavin
adenine dinucleotide (FAD) which transfer electrons. If there
is not sufficient riboflavin in the diet, erythrocytes cannot
synthesize enough FAD, the prosthetic group of glutathione reductase
and other flavoenzymes. The so-called erythrocyte glutathione
reductase activation coefficient (EGRAC) test is based on this
fact.
The EGRAC test measures the enzyme activity of glutathione
reductase in haemolysate with and without addition of FAD. The
ratio of these two activities is a measure for riboflavin deficiency.
Not more than 10 µl of blood from the finger tip is needed.
The field version of the test takes about 30 min, and it includes
the rapid determination of haemoglobin.
Riboflavin deficiency mostly manifests
itself at the edge of the mucosa. Frequently, there are painful
fissures at the angles of the mouth (perlèche, angular
stomatitis), fissures of the lips (cheilosis), an inflammation
of the periglottis (glossitis) and a seborrhoic dermatitis of
the nasolabial area, the eyelids and the scrotum. Besides, a riboflavin
deficiency entails serious risks in fetal development.
Riboflavin is found mainly in food
of high nutritional value such as meat, offals, milk, eggs and
germs of cereals. Therefore, riboflavin deficiency is always associated
with malnutrition or hypo-alimentation. Thus, the EGRAC-test is
considered to be a reliable indicator for objectifying a state
of malnutrition or concealed hypo-alimentation. Riboflavin is
photosensitive and disintegrates when food is dried or stored
in open daylight.
In Baltistan, a mountain area around the headwaters of the River
Indus in the north of Pakistan, we determined the EGRA-coefficient
in 66 women aged 15 to 50. We found an average value of 1.65 (which
means that the concentration of free FAD in erythrocytes was 3
to 4 times lower compared to that of European populations). This
may be caused by a considerable riboflavin deficiency as livestock
breeding is hardly possible in this mountain area and people therefore
rarely eat meat. Moreover, cereals are traditionally dried in
the open air and are thus exposed to sunlight. Our hypothesis
is supported by the fact that the above-mentioned skin diseases
occur frequently in Baltistan.
We are planning to confirm our diagnosis by the administration
of defined doses of riboflavin and, to try to alter people's traditional
diet using an educational program on nutrition. In addition, WHO
has announced to support an epidemiological field study which
is designed to assess people's dietary health and population situation
in the hardly accessible region of Baltistan.
Becker K, Krebs B, Schirmer RH (1991). Protein-chemical standardization
of the EGRAC test.
International Journal of Vitamin and Nutrition Research 61, 180-187