The Re-Emergence of Scurvy: A Systematic Review and Meta-Analysis of its Prevalence and Risk Factors in High-Income Countries

Background Traditionally associated with maritime voyages and nutritional deprivation, scurvy - a condition resulting from severe vitamin C deficiency - has recently re-emerged in high-income countries (HICs). This trend raises critical concerns about hidden malnutrition and the effectiveness of current dietary surveillance systems in developed nations. This systematic review and meta-analysis aimed to evaluate the contemporary prevalence, risk factors, and clinical characteristics of scurvy in HICs. Methods We conducted a comprehensive systematic review in accordance with PRISMA 2020 guidelines. PubMed, Embase, and Web of Science were systematically searched for studies published between January 2012 and March 2025. Eligible studies reported scurvy cases or prevalence in countries classified as high-income by the World Bank. Risk of bias was assessed using validated tools appropriate to each study design. When possible, a meta-analysis was performed using random-effects models. Results A total of 27 studies were included, comprising case reports, case series, and three observational studies conducted across 15 HICs. A meta-analysis of two large-scale studies (n = 365,512 children) yielded a pooled prevalence of 3%, albeit with substantial heterogeneity. Key risk factors included food insecurity, autism spectrum disorders, restrictive diets, and mental health conditions. Clinical manifestations ranged from classical features (e.g., petechiae, gingival bleeding) to atypical symptoms such as fatigue and psychiatric disturbances. Conclusions Scurvy remains a relevant and underrecognized condition in high-income settings, disproportionately affecting socially and medically vulnerable populations. Improved nutritional screening, heightened clinical suspicion, and public health strategies targeting at-risk groups are urgently needed to prevent its persistence and misdiagnosis.