Clinical nutrition — Which group is most often affected by copper deficiency due to low body stores and high requirements?

Introduction / Context:
Copper is a trace mineral required for iron mobilization (via ceruloplasmin), antioxidant defense (Cu/Zn superoxide dismutase), connective tissue formation (lysyl oxidase), and neurodevelopment. Certain populations are at special risk for deficiency because of limited stores and elevated needs. This question asks you to identify the group most typically affected.

Given Data / Assumptions:

• Body copper stores accumulate late in gestation.
• Rapid growth increases micronutrient requirements.
• Dietary sources and parenteral nutrition formulations vary in copper content.

Concept / Approach:
Preterm infants are born before third-trimester mineral accretion, leaving them with low hepatic copper reserves. Rapid postnatal growth and potential feeding challenges further elevate risk. Without adequate copper (enterally or via carefully formulated parenteral nutrition), infants can develop anemia refractory to iron, neutropenia, skeletal abnormalities, hypopigmentation, and impaired neurodevelopment.

Step-by-Step Solution:

Verification / Alternative check:
Neonatal nutrition guidelines include copper in human milk fortifiers and parenteral solutions, reflecting evidence-based prevention of deficiency in high-risk preterm populations.

Why Other Options Are Wrong:

• Elderly women: may have various deficiencies, but copper deficiency is less characteristic than in preterms.
• Alcoholics: can develop multiple deficiencies; copper deficiency is not the signature issue compared with thiamine, folate, or magnesium.
• Active toddlers with limited diet: possible risk, but not as consistently vulnerable as preterm infants.
• Adults on short-term multivitamins: unlikely to be copper deficient.

Common Pitfalls:
Attributing microcytic anemia solely to iron deficiency in preterms; copper deficiency can cause similar hematologic findings by impairing iron mobilization.

Final Answer:
Preterm infants.