The Indian Journal of Pediatrics

, Volume 70, Issue 2, pp 139–143 | Cite as

Low plasma zinc and iron in pica

  • Sunit Singhi
  • R. Ravishanker
  • Pratibha Singhi
  • R. Nath
Original Article


Objective : To determine role of trace elements in causation of pica with specific reference to zinc and iron we studied plasma levels of iron (Fe), Zinc (Zn), calcium (Ca) and magnesium (Mg) and blood lead (Pb) levels by atomic absorption spectrophotometer in 31 children with pica (Pica Group) and 60 controls matched for age, sex and nutrition (Control Group) in an observational case and control study in the settings of outpatient clinic of a tertiary care, teaching hospital.Methods : Data from each group were further stratified by hemoglobin level <9 and >9 g/dl into two subgroups pica-1 and pica-2, and control-1 and control-2 respectively, to control for confounding effect of iron deficiency anemia.Results : The plasma Fe level (mean ±SD) in children with pica (42.7 ±9.2) mg/dl) was about 20% lower than that in controls (51.5 ±10.0 mg/dl, p<0.001). Plasma Zn levels in the pica group (60 ±4.4 mg/dl) was about 45% lower than those in controls (110.2±8.5 mg/dl, p<0.001). Correlation of Zn and Fe levels with pica-related variables such as age at onset, duration and frequency and number of inedible objects ingested was not significant.Conclusion : These findings suggest that hypozincemia with low iron levels may be the possible cause of pica and contradict the contention that low levels of plasma Zn and Fe could be an effect of pica.

Key words

Iron Iron-deficiency Pica Zinc Lead 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Scot C, Datton R. Vegetative disorders. In Behrman RE, Kliegman RM, Jenson HB, eds.Nelson Textbook of Pediatrics, 16th edn. Philadelphia: WB Saunder 2000; 72.Google Scholar
  2. 2.
    Cooper M. Pica Springfield, Charles C Thomas, 1957.Google Scholar
  3. 3.
    Barltrop D. Prevalence of pica.Am J Dis CM 1966; 112:116–123.Google Scholar
  4. 4.
    Millican FK, Layman EM, Lowrie RS, Takashashi L, Dublin CC. Prevalence of ingestion and mouthing of non-edible substances by children.Clin Proc Child Hosp Wash 1962; 18: 207–214.Google Scholar
  5. 5.
    Geissler PB, Mwaniki DL, Thiong’o F, Friis H. Geophagy among school children in western Kenya.Trop Med Int Health 1997; 7:624–630.CrossRefGoogle Scholar
  6. 6.
    Glickman TL, Chaudry IV, Constantino J, Clark FB, Cypess RH, Winslow L. Pica patterns, toxocariasis and elevated blood lead levels in children.Am J Trop Med Hyg 1981; 30: 77–80.PubMedGoogle Scholar
  7. 7.
    Crosby WH Pica: compulsion caused by iron deficiency.Br J Haematol 1976; 34:341–342.PubMedGoogle Scholar
  8. 8.
    McGehee FT Jr, Buchanan GR. Trichoghagia and trichobezoar: etiologic role of iron deficiency.J Pediatr 1980; 97: 946–948.PubMedCrossRefGoogle Scholar
  9. 9.
    Phillips MR, Zaheer S, Drugas GT. Gastric trichobezoar: case report and literature review.Mayo Clin Proc 1998; 7: 653–656.Google Scholar
  10. 10.
    Gonzaelez JJ, Owens W, Ungaro PC, Werk EE, Hurtz PH. Clay ingestion: a rare cause of hypokalemia.Ann Intern Med 1982; 97:65–66.Google Scholar
  11. 11.
    Menge H, Lang A, Cuntze H. Pica in Germany-amylophagia as the etiology of iron deficiency anemia.Z Gastroenterol 1998; 8: 635–640.Google Scholar
  12. 12.
    Jacobziner H. Lead poisoning in childhood: epidemiology, manifestation and prevention.Clin Pediatr 1966; 5:277–286.Google Scholar
  13. 13.
    Federman DG, Kirsner RS, Federman GS. Pica: are you hungry for the facts ?Conn Med 1997; 4:207–209.Google Scholar
  14. 14.
    Lanzkowsky P. Investigation into the aetiology and treatment of pica.Arch Dis Child 1959; 34:140–148.PubMedGoogle Scholar
  15. 15.
    Munoz JA, Marcos J, Risueno CE, de Cos C, Lopez R, Capote FJet al. Iron deficiency and pical.Sangre (Barc) 1988; 43:31–34.Google Scholar
  16. 16.
    Prasad AS, Miale A, Farid Z, Sansted H, Schuler AR. Zinc metabolism in patients with the syndrome of iron deficiency anemia, hepatosplenomegaly, dwarfism and hypogonadism.J Lab Clin Med 1963; 61: 537–549.PubMedGoogle Scholar
  17. 17.
    Hambidge MK, Silverman A. Pica with rapid improvement after dietary zinc supplementation.Am J Clin Nutr 1971; 24: 1021–1022.Google Scholar
  18. 18.
    Singhi S, Singhi P, Adwani CB. Role of psychosocial stress in the etiology of pica.Clin Pediatr 1981; 20: 783–785.CrossRefGoogle Scholar
  19. 19.
    Bithoney WG, Synder J, Michalek J, Newberger EH. Childhood ingestions as a symptom of family distress.Am J Dis Child 1985; 139:456–459.PubMedGoogle Scholar
  20. 20.
    Kumar S, Rao KSJ. Plasma and erythrocytic zinc levels in protein caloric malnutrition.Nutr Metabol 1973; 15:364–371.Google Scholar
  21. 21.
    Nath R. Proceedings of integrated programme on heavy metals. Training camp-cum-workshop on analysis and quality control of heavy metals in biological samples. Chandigarh, PGMER 1986; 18–20.Google Scholar
  22. 22.
    Gutelius MF, Millican FK, Layman EM, Cohen GJ, Dubin CC. Nutritional studies of children with pica: I. Controlled study evaluating nutritional status II. Treatment of pica with iron given intramusculary.Pediatrics 1962; 29:1012–1023.PubMedGoogle Scholar
  23. 23.
    Halstead JA. Geophagia in man: Its nature and nutritional effects.Am J Clin Nutr 1968; 21:1384–1393.Google Scholar
  24. 24.
    Okcuoglu CA, Arcasoy A, Minnich V, Tarcon Y, Clin S, Yorukoglu Oet al. Pica in Turkey I. The incidence and association with anemia.Am J Clin Nutr 1966; 19:125–131.PubMedGoogle Scholar
  25. 25.
    Minnich V, Okcuoglu CA, Tarcon Y, Arcasoy A, Clin S, Yorukoglu Oet al. Pica in Turkey II. Effect of clay on iron absorption.Am J Clin Nutr 1968; 21: 78–86.PubMedGoogle Scholar
  26. 26.
    Johnson NE, Stephens Dl. Geomelophagia. Unusual pica in iron deficiency anemia.Am J Med 1982; 73:931–932.PubMedCrossRefGoogle Scholar
  27. 27.
    Shapiro MD, Linas SL. Sodium chloride pica secondary to iron deficiency anemia.Am J Kidney Dis 1985 ; 5:67–68.PubMedGoogle Scholar
  28. 28.
    Bhalla JN, Khanna PK, Srivastava JR, Sur BK, Bhalla M. Serum zinc levels in pica.Indian Pediatr 1983; 19: 615–618.Google Scholar
  29. 29.
    Chen XC, Yin TA, He HS, Ma QY, Han Zm, Li LX. Low levels of zinc in hair and blood, pica, anorexia and poor growth in Chinese pre-school children.Am J Cli Nutr 1985; 45:694–700.Google Scholar
  30. 30.
    Sipahi T, Akar Net al. Plasma zinc levels in patients with irondeficiency anemia.J Trop Pediatr 2001; 2:122–123.Google Scholar
  31. 31.
    Thomas FB, Falko JM, Zuckerman K. Inhibition of intestinal iron absorption by laundry starch.Gastoenterology 1976; 71: 1028–1032.Google Scholar
  32. 32.
    Arcasoy A, Cavadar AO, Babacan E. Decreased iron and zinc absorption in Turkish children wih iron deficiency and geophagia.Acta Haematol 1978; 60: 76–84.PubMedCrossRefGoogle Scholar
  33. 33.
    Danford DE, Huber AM. Pica among mentally retarded adults.Am J Ment Defic 1982; 87:141–146.PubMedGoogle Scholar
  34. 34.
    Kendall NR, Telfer SB. Induction of zinc deficiency in sheep and its correction with a soluble glass bolus containing zinc.Vet Rec 2000; 22: 634–637.Google Scholar
  35. 35.
    Singhi P, Singhi S. Pica type of non-food articles eaten by Ajmer children and their significance.Indian J Pediatr 1982; 49: 681–684.PubMedGoogle Scholar
  36. 36.
    Kumar A, Dey PK, Singla PN, Ambasht RS, Upadhyay SK. Blood lead levels in children with neurological disorders.J Trop Paediatr 1998; 44:320–322.CrossRefGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2003

Authors and Affiliations

  • Sunit Singhi
    • 1
  • R. Ravishanker
    • 1
  • Pratibha Singhi
    • 1
  • R. Nath
    • 2
  1. 1.Department of PediatricsPostgraduate Institute of Medical Education and ResearchChandigarhIndia
  2. 2.Department of BiochemistryPostgraduate Institute of Medical Education and ResearchChandigarhIndia

Personalised recommendations