The starchy items were raw cassava, raw sweet potato, uncooked rice, and ambaradedin-ambazaha (genus Hedychium, a wild root vegetable which is consumed raw). In comparison with pregnant women without pica, women who routinely ate uncooked rice had mean hemoglobin concentrations that were 0.6 g/dL lower ( P 5 years of age in 16 villages in the Makira Protected Area of Madagascar, the prevalence of geophagia was 53%, of consumption of raw starchy items was 85%, and of other unusual substances was 19%. Of those 897, 86% had pica for uncooked rice alone and 4% had pica for both uncooked rice and earth. In 2,367 pregnant women on Pemba Island, Zanzibar, Tanzania, 897 had pica. Pica for uncooked basmati rice was more intense during pregnancy in Patient 1. None of 79 control subjects reported ryzophagia. In 79 European and non-European patients (92% women) with iron deficiency in France, 4% had pica for uncooked rice. In 16 adolescent girls with anemia or iron deficiency on Réunion Island (La Réunion), 81% had pica for uncooked rice. These observations are consistent with previous reports of ryzophagia in men and nonpregnant women. The present women had iron deficiency complicated by microcytic anemia, fatigue, hair and nail symptoms, and pica for uncooked milled basmati rice. Other manifestations (except tooth damage) resolved after completion of iron dextran therapy. Pica resolved after the first infusion of 500 mg of iron. She was intolerant of oral iron supplements and thus was treated with intravenous iron (1000 mg total). Iron deficiency and microcytic anemia ( Table 1) were attributed to menorrhagia and multiparity. Physical examination revealed moderate pallor and chipped and abraded teeth due to eating her pica substances. She often developed abdominal pain after eating large amounts of uncooked basmati rice. She reported having pica for uncooked milled basmati rice (the most popular rice in Karachi and her usual rice in the USA), drying cement, and dirt. A 44-year-old woman, a native of Karachi, Pakistan, presented with fatigue, dizziness, cold intolerance, hair loss, and decreased growth and thinning of nails. Hb: hemoglobin RBC: red blood cells MCV: mean corpuscular volume RDW: red blood cell distribution width WBC: white blood cells TS: transferrin saturation. Other manifestations (except tooth damage) resolved after completion of iron dextran therapy.ġIron deficiency was defined as both TS <10% and SF <20 µg/L. She was intolerant of oral iron supplements and thus was treated with intravenous iron (1500 mg Fe, total). Her iron deficiency and microcytic anemia ( Table 1) were attributed to menorrhagia and multiparity. Physical examination revealed moderate pallor and several teeth chipped by eating uncooked rice. She reported that her mother, grandmother, and other women in Mumbai also craved uncooked basmati rice. She often developed abdominal pain after eating large quantities of uncooked rice. This manifestation had occurred for many years and was more intense during pregnancy. She reported pica for uncooked milled basmati rice, the predominant local rice in Mumbai and her usual rice in the USA. A 39-year-old woman, a native of Mumbai, India, presented with severe fatigue and hair loss. We discuss particular aspects of basmati ryzophagia in the context of the two present women and review ryzophagia in adults of European and non-European ancestry and its relationships to iron deficiency, pregnancy, race/ethnicity, local traditions, geographic origin, and other conditions. We report the evaluation and treatment of two women with iron deficiency, one from India and the other from Pakistan, who developed pica for uncooked basmati rice. Although pica for uncooked rice (ryzophagia) has been reported in nonpregnant adolescents and adults with iron deficiency and in pregnancy, other aspects of ryzophagia are undescribed. Pica items in adults with iron deficiency are diverse, typically contain little or no absorbable iron, and vary according to personal choice, race/ethnicity, culture, item availability and convenience, and geographic location. In adults, pica for items not part of one's habitual diet or preferences is a common but incompletely understood accompaniment of iron deficiency and pregnancy. Pica is the compulsive, repetitive eating of nonfood substances or large amounts of specific foods or condiments daily for more than one month.
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