Selenium Deficiency

Reference from the joint report of FAO/WHO expert consultation of Human Vitamins and Minerals verbatim.

Non-endemic deficiencies of selenium

10. Brennan, M.F. & Horwitz, G.D. 1984. Total parenteral nutrition in surgical patients. Advances in Surgery, 17: 1-7.

11. van RiJ., A.M., Thompson, D., McKenzie, J.M. & Robinson, M.F. 1979. Selenium deficiency in total parenteral nutrition. Am. J. Clin. Nutr., 32: 2076-2085. 

Biochemical evidence of selenium depletion (e.g., a decline in blood GSHPx activity) is not uncommon in subjects maintained on parenteral or enteral feeding for long periods. Blood selenium values declining to one-tenth of normal values have been reported when the selenium content of such preparations has not been maintained by fortification (10, 11).

12. Rossipal, E. & Tiran, B. 1995. Selenium and glutathione peroxidase levels in healthy infants and children in Austria and the influence of nutrition regimens on these levels. Nutrition, 11 (5 suppl): 573-575.

13. Lombeck, I., Kasperek, K., Bonnermann, B. et al. 1975. Selenium content of human milk, cows milk and cows milk infant formulas. Eur. J. Pediatr., 139-145.

14. Okada, A., Takagi, Y., Nezu, R., Sando, K. & Shenkin, A. 1995. Trace element metabolism in parenteral and enteral nutrition. Nutrition, 11; 106-113.

Low selenium contents of some commercial formulas for infants resulting in a fall in daily selenium intake to approximately 0.5 μg/day have been shown to strongly exacerbate the fall in serum selenium and GSHPx activity normally experienced from 2 to 8 months of age even in human-milk-fed infants typically receiving threefold higher selenium intakes (12, 13). The importance of maintaining trace element levels in such preparations was reviewed elsewhere (14).

15. Collip, P.J. & Chen, S.Y. 1981. Cardiomyopathy and selenium deficiency in a two year old girl. N. Engl. J. Med., 304: 1304-1305.

Clinical manifestations of deficiency arising from such situations are uncommon and poorly defined. They include muscular weakness and myalgia with, in several instances, the development of congestive heart failure. In at least one instance such pathologic signs have developed as a consequence of a generally inadequate diet providing selenium at less than 10 μg/day. The 2-year-old subject recovered rapidly after selenium administration (15).

16. Lombeck, I., Ebert, K.H., Kasparek, K. et al. 1984. Selenium intake of infants and young children, healthy children and dietetically treated patients with phenylketonnria. Eur. J. Pediatr., 143: 91-102.

With this last exception, virtually all of the above reports describe observations with subjects under close medical supervision. This may well be relevant to the scarcity of consistent pathologic findings (16).

Keshan disease

3. Ge, K. & Yang, G. 1993. The epidemiology of selenium deficiency in the etiological study of endemic diseases in China. Am. J. Clin. Nutr., Supplement 57: 259S-263S.

Keshan disease was first described in Chinese medical literature more than 100 years ago, but not until 40 years after its widespread occurrence in 1935 was it discovered that selenium deficiency was an important factor in its aetiology (3). 

Endemic in children aged 2–10 years and in women of childbearing age, this disease has a geographic distribution covering localities from northeast to southwest China. Typical manifestations are fatigue after even mild exercise, cardiac arrhythmia and palpitations, loss of appetite, cardiac insufficiency, cardiomegaly, and congestive heart failure.

3. Ge, K. & Yang, G. 1993. The epidemiology of selenium deficiency in the etiological study of endemic diseases in China. Am. J. Clin. Nutr., Supplement 57: 259S-263S.

8. Reilly, C. 1996. Selenium in food and health. London, Blackie Academic and Professional.

Pathologic changes include a multifocal myocardial necrosis and fibrosis. The coronary arteries are essentially unaffected. Ultrastructural studies show that membranous organelles, such as mitochondria orsarcolemma, are affected earliest. The disease has a marked seasonal fluctuation in incidence (3) and may appear after only 3 months exposure to conditions in localities known to be associated with a high risk of myocarditis (3, 8). 

Once the disease is established, selenium is of little or no therapeutic value. Prophylaxis consisting of oral administration of selenium 3 months before the periods of highest anticipated risk is highly effective. Although geographic similarities in the distribution of Keshan disease and the selenium and vitamin E–responsive white muscle disease in animals first prompted successful investigation of the relevance of a low selenium status, evidence has grown steadily that the disease is multifactorial in origin.

17. Levander, O.A. & Beck, M.A. 1997. Interacting nutritional and infectious ecologies of Keshan Disease. Biol. Trace Elem. Res., 56: 5-21.

3. Ge, K. & Yang, G. 1993. The epidemiology of selenium deficiency in the etiological study of endemic diseases in China. Am. J. Clin. Nutr., Supplement 57: 259S-263S.

18. Yang, G-Q., Zhu, L-Z., Liu, S-J., Gu, L-Z., Qian, P-C., Huang, J-H. & Lu, M-D. 1984. Human selenium requirements in China. In: Selenium in Biology and Medicine. Combs, G.R., Spallholz, J.E., Levander, O.A., Oldfield, J.E. eds. p.589-607. New York, AVI Van Nostrand.

The strongest suspicions have fallen on the development of a viral myocarditis probably attributable to enhancement of the virulence of a coxsackievirus during its passage through selenium-deficient host tissues (17). Although other nutritionalvariables such as a marginal vitamin E status may also be involved, the finding of extremely low selenium contents in staple crops of affected areas and convincing demonstrations of the prophylactic effectiveness of selenium administration leave no doubt that selenium deficiency is the primary factor (3, 18).

19. Johnson, C.C., Ge, X., Green, K.A. & Liu, X. 1996. Studies of selenium distribution in soil, grain, drinking water and human hair samples from the Keshan Disease belt of Zhangjiakou district, Henei Province, China. Technical Report WC/96/52. Nottingham, UK, Overseas Geology Series, British Geological Survey.

Recent studies indicate that geochemical variables have an important influence on the distribution of Keshan disease. Acid soils high in organic matter and iron oxide content appear to be responsible for fixing selenium in forms which are poorly absorbed by staple crops which, in the instance of cereal grains, typically have a selenium content of less than 0.01 μg/g (19). A similar geochemical background is believed to be associated with reports of selenium-responsive disorders resembling.

8. Reilly, C. 1996. Selenium in food and health. London, Blackie Academic and Professional.

Keshan disease in the Transbaikalia region of south Siberia. Dietary intakes of selenium are inadequate to maintain blood GSHPx activity; biochemical indicators of tissue peroxidative damage are elevated until selenium therapy is initiated (8).

Kaschin-beck disease

8. Reilly, C. 1996. Selenium in food and health. London, Blackie Academic and Professional.

20. Li, J-Y., Ren, S-X., Cheng, D-Z., Wan, H-J., Liang, S-T., Zhang, F-J. & Gao, F-M. 1984. Distribution of selenium in the microenvironment related to Kaschin-Beck disease. In: Selenium in Biology and Medicine. Combs, G.F., Spallholz, J.E., Levander, O.E., Oldfield, J.E. eds. p.911-925. New York, AVI Van Nostrand.

A selenium-responsive bone and joint disease (osteoarthropathy) has been detected in children aged 5–13 years in China and less extensively in south-east Siberia. The disease is characterised by joint necrosis – epiphyseal degeneration of the arm and leg joints resulting in structural shortening of the fingers and long bones with consequent growth retardation andstunting (3, 20). 

Although not identical to Keshan disease, Kaschin-Beck disease also occurs in areas where the availability of soil selenium for crop growth is low. The selenium contents of hair and of whole blood are abnormally low and the blood content of GSHPx is reduced. Although it is ameliorated by selenium therapy, other factors such as the frequent presence of mycotoxins in cereal grains grown in the area may be involved. A spontaneous decrease in incidence from 1970 (44 percent) to 1980 (14 percent) to 1986 (1 percent) has been attributed to general improvements in the nutritional status of Chinese rural communities (20).