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

Melandri Vlok* (Corresponding Author), Marc Oxenham, Kate Domett, Hiep Hoang Trinh, Tran Thi Minh, Nguyen Thi Mai Huong, Hirofumi Matsumura, Nghia Truong Huu, Nguyen Lan Cuong, Anna Willis, Hallie Buckley

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


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: 104 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 4.2ka desertification event.
Significance: This is the first systemic 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.
Original languageEnglish
Pages (from-to)715-732
Number of pages18
JournalAmerican Journal of Biological Anthropology
Issue number4
Early online date28 Jan 2023
Publication statusPublished - Apr 2023

Bibliographical note

We would like to thank Dr Ngo Anh Son, Dr Bui Van Khanh, and Ms Nellissa Ling for their assistance with the radiographs, and Dr Anne Marie Snoddy for discussions on the diagnosis of scurvy and comments on the manuscript. We would also like to thank Dr Clare McFadden for assistance on an earlier version of the manuscript. This work was supported by Australian Research Council (DP110101097, FT120100299); National Geographic Early Career Grant (EC-54332R-18); Royal Society of New Zealand Skinner Fund Grant; and a University of Otago Doctoral Scholarship. Open access publishing facilitated by The University of Sydney, as part of the Wiley - The University of Sydney agreement via the Council of Australian University Librarians.

Data Availability Statement

Data is provided in the supplementary material.


  • health
  • agriculture
  • nutritional disease
  • MSEA
  • diet
  • Neolithic


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