Nutrient Deficiencies in Skeletal Remains

Presented by Corinne M. Bashaw

12 December 2013

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Nutrient deficiencies can be detected in skeletal remains and provide great insight about dietary changes in humans over time for biological anthropologists. A great example of this would be examining cribra orbitalia in human skulls. Cribra orbitalia is usually indicative of anemia caused by a deficiency in specific nutrients. Marks of Cribra Orbitalia are left in the eye socket of the skull due to increase in bone marrow caused by large amounts of erythrocytes (Walker, et.al., 111). Many environmental factors influence these deficiencies and can be detected in skeletal remains including bones and teeth (Larsen, Clark S., 345). When viewing trends over certain geographical locations and learning about resources available (flora, fauna, water sources, environmental factors) of such individuals it can aid in understanding of such causes for these depletions and lack of nutrients and help promote awareness and activate plans to prevent these deficiencies that can be detrimental to human health. First, I will specifically discuss deficiencies that cause anemia and lead to the presence of cribra orbitalia. Then, I will explain the histology and implications of such pathological processes caused by nutrient deficiencies and describe how this study is beneficial as it relates to other biological and anthropological studies. First, there are many nutritional deficiencies that lead to anemia. Nutrient deficiencies can be caused by numerous factors. Lack of resources, specific cultural practices, society type, and malabsorption are all probable causes. (Walker, et.al 117). Food procurement and diet varies among geographical locations depending upon the prevalence of specific resources and tools. Some cultures practice restricting certain foods from their diet and others evoke overindulgence of certain foods based on value and meaning given (Walker, et.al., 117). Lack of sanitation and clean drinking water sources also contribute to such nutrient deficiencies. Malabsorbption of certain nutrients needed by the body, like vitamin b12, iron, and folic acid, aid in the destruction

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or overproduction of erythrocytes that cause anemia to occur (Walker, et. al., 110). Sufficient evidence in other studies suggests that iron-deficiency-anemia may not be type of anemia that causes cribra orbitalia. However, megaloblastic and hemolytic anemia both are more likely to be associated as a probable cause (Walker, et.al., 111). Walker (p. 110) explains anemia as the insufficient amount of blood cells or hemoglobin. There are various types of anemia that are from a result of different nutrient deficiencies. These types can be due to genetic abnormalities or induced because nutritional needs are not met (Walker, et.al., 111). The latter is consistent in skeletal remains found within various geographical locations that have these lesions in the eye orbitals. Prolonged effects of anemia on the human skull include lytic lesions which are located in the cranial vault; specifically, in the orbital areas. It is often described as a creating a pitted surface on the inner orbitals (Hunt, et.al., 2005). The increase of erythrocyte production as the body tries to compensate for lack of iron leads to inflammation. This rapid overproduction causes inflammation of the periosteum and dipole (Walker, et.al., 112). Eventually, the inflammation causes the bone marrow to expand and creates cortical bone erosion. These lesions remain permanent in the skeletal remains. Traumatic injuries that create subperiosteal hematomas, Rickets, Scurvy, and hemangiomas also cause cribra orbitalia. Antemortem conditions such as anemia are present in many skeletal remains and provide the population with insight on how detrimental nutrient deficiencies can be to the human skeletal system (Walker, et.al., 116). Taking a further look, examining bone histology provides more insight. Marrow hypertrophy, the cause of the presence of Cribra Orbitalia, creates porosity in the bone. Specifically, this is seen in the eye orbitals because of the subperiosteal inflammation (Walker, et.al., 110). Bone is made up of several layers. Many of these layers can be affected by dietary

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intake when specific needs for nutrients are not met by the body. The increase of stress, whether it be due to environmental or cultural conditions, alongside the increase of nutrient deficiencies is associated with a decreased bone growth rate and associated with increase early mortality rates (Larsen, Clark S., 357). The trabecular bone is the sponge-like inside layer of the bone. It is referred to as the dipole when examining the cranium and consists of fatty tissues (Byer,53). As seen in anemia, the dipole becomes irritated due to swelling. The cortex, or outer bone, contains collagen fibers. In persons with anemia, the cortical bone located in the orbital roof becomes eroded over time (Hunt, et.al., 2005). The outermost covering layer of the bone is called the periosteum. The periosteum is essential because it creates bone and is involved in repairing sections damaged bone (Byer, 53). As the bone grows the collagen fibers are filled with mineral crystals help create organization in the bone. Inflammation in the periosteum leads to these small holes when the new bone is created. Located inside the cortex are osteons with a Haversian canal where the blood vessels enter (Byer,53). Osteoblasts are bone destroying cells; whereas, osteoclasts are bone forming cells. Both are essential in the growth and repair of bone over time. In human skeletons, subject to genetic pathological variation, the osteoblasts and osteoclasts work together to repair and lengthen bone growth over time, usually until the age of twenty-five. After the age of twenty-five the bone stops growing and only repairing, and changes to the surface of the bone occurs (Byer, 53). This is easily observed when looking at a collection of specific bone surfaces, such as the plates of the skull at different ages. The progression and fusion over time is noted as the age increases like one would expect to see. This growth and repairing of bone generally occurs at a uniform rate; however, in those that suffered from nutrient deficiencies, further research in the lab indicated that this rate is non-uniform at the microscopic level. On the microscopic level, it

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becomes easier to observe, specific nutritional stressors because of the observation of the repair rate of the osteoblasts and osteoclasts (Larsen, Clark S., 354). Nutrient deficiencies can be observed in various ways among skeletal remains because they detrimentally affect bone growth and development. Bones are made up of calcium, phosphate, carbonate and citrate (Larsen, C.S. 1987, 354). These microscopic structures can be further observed in a lab and expose environmental stressors that are present as nutrient deficiencies are revealed. This is because nutrient deficiencies cause a displacement in the rate of bone growth, Larsen, Clark S., 348). When a study of pre-adult skeletal remains was observed by Larsen the decreased mass of the cortical bone proved to be related to lack of nutrients. This lack of nutrients caused an overall decrease in the statures among the observed skeletal remains. Another indicator of deficiencies that cause Cribra Orbitalia is the decreased sexual dimorphism in the skeletal remains. Females usually require a greater intake of essential nutrients and this is because their bodies need it to reproduce successfully. Therefore, the nutrient capacity for females is greater. Because of this, it is suggested that males tend to be greater impacted than females by nutrient deficiencies (Larsen, Clark S., 350). Likewise, it is important to consider such factors that can skew results of any research; specifically when observing nutrient deficiencies. There are discrepancies when such histological aspects are researched in search of certain nutrient deficiencies. This is because over time bones are subject to the environmental conditions which can alter them (Clark, Larsen S. 341). One such example of a common error in data is being able to observe sexual dimorphism in skeletal remains while collecting data. Due to such nutrient deficiencies and their effects upon bone, male and female skeletons can often be misinterpreted for the opposite sex (Clark, Larsen S. 352). Bones are also not protected from the surrounding environment (Clark, Larsen S. 341). The

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condition of bones and the preservation of them are all dependent upon aspects of the burial and location of the bone. In all, taking a closer look at the makeup of bone provides a better understanding of how these nutritional deficiencies affect the body and eventually lead to pitting in the eye orbitals. Porotic Hyperostosis, which is pitting on the surrounding skull, is also an indicator of anemia, an underlying symptom of nutrient deficiency. Porotic Hyperostosis and Cribra Orbitalia often coincide in the skeletal remains in which they are found (Walker, et.al., 2009). Irondeficiency anemia is most commonly associated with Porotic Hyperostosis and due to this it is often implied that it would be the same cause of Cribra Orbitalia. However, evidence suggests otherwise as this hypothesis cannot explain the overproduction of bone marrow (Walker, et.al., 112). Walkers study (2009) provides another hypothesis, that another nutrient deficiency is responsiblelack of vitamin B twelve. Continuing to study such nutrient deficiencies would be beneficial as it increase the current resources available. As new hypotheses are challenged and researched by others, the increase in accuracy of the data to study cases such as cribra orbitalia. The iron-deficiency-anemia hypothesis has recently been proposed as incorrect. This is because in order for bone marrow to exhibit hypertrophy there usually requires increases in erythrocytes in the blood. However, iron-deficiency anemia creates a decrease in these red blood cells which would be unlikely for the cause of the inflamed bone marrow that creates such pitting in the skull (Walker, et al., 113). Because iron-deficiency anemia can be caused by many coinciding factors, it is often seen in children and young adults. It would be thought that they would appear to be the most resilient to such conditions; however, they are the greatest impacted by nutrient deficiencies. Children are most impacted because of the many changes in the skeletal system that takes place as it grows and develops. This growth and development cannot occur

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without necessary nutrient intake (Walker, et. al., 119). The most likely specific cause of cribra orbitalia among such populations as the Pueblo peoples is linked to the deficiency of vitamin b. Mothers nursing their young are unable to provide them with this essential nutrient because they lack the proper nutrients needed. Over time this creates the pitting in the eye orbitals of the skull (Walker, et. al., 119). An example to observe such occurrences of cribra orbitalia as well as porotic hyperostosis would be the Puebloean peoples as Walker depicts in his studies. He states that the Puebloean peoples had a diet that highly consists of corn maize. However, maize does not supply most of the nutritional needs of the human body and lacks the most essential amino acid contents (Larsen, Clark, S., 360). Alongside this, the increases of hunting depleted other food sources available and lead to famine-like conditions. The consequences of this were noted in many skeletal remains as evidence of dental caries, cribra orbitalia, Scurvy, and porotic hyperostosis were present (Walker, et al., 116). This study is relevant as the origin for these conditions was a direct result of the Puebloean diet. Although the calories taken in by the peoples were sufficient, the nutrient needs were not successfully met (Walker, et al., 116). In comparison, another study of the Pueblo Indians by Larson yielded similar results. In such subsistence economies and early agricultural societies, the mass production of a specific crop proved to negatively impact health as one specific food obviously cannot sustain all nutritional needs (Larsen, Clark, S., 457). A more recent study in the Southeastern states of America revealed that when certain crops such as maize were taken with meats (specifically, fish and beef) the effects of iron deficiencies were decreasingly noted (Larsen, Clark S. 357). Such studies as this can link nutrient deficiencies to specific geographical locations when a closer look at food sources and food procurement is taken.

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Dietary restrictions due to cultural practices and lack of nutritional needs being met are the most probable causes of anemic symptoms that cause cribra orbitalia. However, they are not the only causes. Unsanitary conditions also contribute to such cases as the increase of infectious diseases also cause nutrients to become depleted. More specifically, the Pueblo people had high rates of chronic diarrhea (Walker, et. al., 118). The lack of clean drinking water increased the spread of various diseases as fecal matter was not properly contained due to lack of resources (McNeill, William H., 275). It is proposed that the increase of infectious diseases also increased the chances for cribra orbitalia being noted in skeletal remains (Larsen, Clark S., 361). Over time it becomes increasingly important to understand such implications as humans evolve in constant attempt to adapt to changes in their surrounding environment. Likewise, not only is it important to study the evolutionary aspects of humans, but the microscopic evolution of infectious organisms as well. (McNeill, William H., 27). Unsanitary living conditions in different geographical regions often leads to the spread of diseases and illnesses that compromise the bodys ability to absorb needed nutrients and this can lead to an increasing prevalence of cribra orbitalia in human skeletal remains. It is important to note that many combined factors such as: food availability, cultural practices, living conditions, and climate can all contribute to nutrient deficiencies. Lack of nutritional needs can be caused by various factors. Overexploitation of hunting animals specific to the geographical region, limited food supplies, limited access to clean drinking water or water filtration systems, cultural practices (such as abstaining from eating certain foods) and can enhance the detrimental effects of nutrient deficiencies that cause anemia and lead to cribra orbitalia. This was such the case of the Puebloean peoples. (Larson, Clark S., 357). These outside limitations can cause the body to either insufficiently absorb the nutrients needed and get

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rid of them, such as diarrhea as an effect of unsanitary living conditions, or not obtain any of the nutrients at all (dietary restrictions). This overall, decreases the health of individuals (Walker, et al., 116). The body must compromise in other areas, such as the bone growth and reconstruction process, to try and make up for lack of these essentials. Permanent remnants of these nutrient deficiencies are etched into the bone as cribra orbitalia and porotic hyperostosis. In summation, examining cribra orbitalia in eye orbitals of the skull provides a very beneficial example of one of the many nutrient deficiencies that can be observed in skeletal remains. Anemia causes cribra orbitalia when vitamins, such as vitamin B twelve, needed by the body are unavailable and the tissue layers of the bone become inflamed. This inflammation of the bone tissues creates pitting specifically in the orbitals of the eyes (Walker, et.al., 110). It was once thought that iron-deficiency anemia was the most probable cause for this condition to be observed, but now further evidence suggests that this is not so. This is applicable to ecological anthropology as one study how various environmental conditions, cultural practices, and availability of resources coincide and create profound indicators of diet and nutrient intake across geographical locations. Lack of vitamin B twelve, unsanitary conditions, dietary restrictions, overhunting, and other climate conditions all are linked to anemia caused by nutrient deficiencies and leads to cribra orbitalia or porotic hyperostosis (Walker, et al., 119). Skeletal remains provide an abundance of data that can be collected as one studies the past of mankind. This knowledge can be used to better educate future generations about the importance of making sure nutritional needs are met in dietary regimens.

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Works Cited Byers, Stephen. N. 2008. Introduction to forensic anthropology. Boston. Pearson Education Inc.

Hunt, David, R., Mann, Robert,W. 2005.Photographic regional atlas of bone disease: a guide to pathological and normal variations in the human skeleton. Charles C. Thomas Publishing.

Larsen, Clark, S. 1987. Bioarchaeological interpretations of substinence economy and behavior from human skeletal remains. Advances in Archaeological Methods and Theory. 10:339-445

McNeill, William H. Plauges and peoples.New York. Anchor Books. 1976.

Walker, Phillip L. Andrushko, Valerie A., Bathhurst, Rhonda R., Gjerdrum, Thor., Richman, Rebecca. 2009. The causes of porotic hyperostosis and cribra orbitalia: a reappraisal of the iron-deficiency-anemia hypothesis. American Journal of Physical Anthropology.