Phosphorus In Children Research Articles

VITAMIN D, CALCIUM, AND PHOSPHORUS STATUS IN CHILDREN WITH SPINA BIFIDA

Introduction. Children with spina bifida (SB) are at the highest risk of developing vitamin and mineral deficiencies, including vitamin D, due to a sedentary lifestyle, prolonged indoor stays, and dietary peculiarities. The aim of our study was to determine the dietary intakes of vitamin D, calcium, and phosphorus in children with spina bifida and the concentration of these nutrients in the serum of children with SB. Materials and Methods. The study included 20 children aged 2 to 17 years with congenital neural tube defect (spina bifida). The control group consisted of 67 healthy children aged 6 to 17 years. To determine the dietary intakes of vitamin D, calcium and phosphorus, children or their parents were surveyed using a questionnaire containing questions about the amount of consumption of certain food products over the week. The total amount of vitamin D, calcium, and phosphorus in the weekly diet were calculated, as well as their average daily intakes with food and overall. The concentration of 25-OH vitamin D, calcium, and phosphorus in the blood serum was determined using an enzyme immunoassay. Results. Among the examined children with SB, girls predominated (70.0%). Physical development delay and undernutrition were identified in 3 (15.0%), overweight - in 6 (30.0%) children. Most children with SB exhibited clinical manifestations of mineral metabolism disorders: body proportion disturbances (55.0%), posture disorders (40.0%), scoliosis and/or chest deformity (50.0%), caries (40.0%). Despite the presence of dairy, meat, and fish products in the weekly diet of all children with SB, their quantity was insufficient to meet the daily needs for vitamin D, calcium, and phosphorus. Inadequate intake of vitamin D from food occurred in 70.0% of children, calcium deficiency in 90.0%, phosphorus deficiency in 80.0%, with the alimentary provision of calcium and phosphorus in children with SB being significantly lower than in healthy children (p=0.0027 and p=0.0047, respectively). Optimal levels of vitamin D in the blood serum were observed in only 10.0% of children with SB, which was twice less than in healthy children, while its deficiency was observed 1.5 times more often in children with SB than in healthy children. Half of the patients with SB had reduced calcium levels, and 70.0% had reduced phosphorus levels. Conclusions. The study results demonstrate a wide prevalence of vitamin D deficiency and insufficiency (in 90.0%), calcium and phosphorus deficiency in children with SB, indicating the need for additional intake of these nutrients alongside dietary and lifestyle corrections. Further research on a larger cohort of patients with supplementation regimens is necessary to reduce the risk of complications and improve the quality of life for children with SB.

Calcium homeostasis and certain aspects of its disturbances in juvenile idiopathic arthritis

Background. In the pathogenesis of juvenile idiopathic arthritis (JIA), the main role is played by immunopathological changes in the body with a loss of tolerance to the elements of own tissues; herewith, disorders of calcium and bone metabolism are very important. Such changes occur as a result of autoimmune inflammation, pharmacotherapy, and the influence of a number of other factors that negatively affect calcium homeostasis in the body. Purpose: to study the features of calcium homeostasis and certain aspects of its disorders with an assessment of the structural and functional state of bone tissue, taking into account clinical subtypes and disease activity. Material and methods. Sixty-two children with JIA aged 3.5 to 16 years were examined, of them 11 had systemic and 51 had oligo- and polyarthritis. There were determined serum concentrations of a total calcium using the Lachema test kit (Czech Republic), protein-bound and ultrafiltered fractions, content of inorganic phosphorus (with the generally accepted spectrophotometric method using the Cobas 6000 analyzer and test systems by Roche Diagnostics, Switzerland), the activity of total alkaline phosphatase and its isoenzymes (bone and intestinal) using the Lachema test system (Czech Republic). Ultrasonic osteometry of the calcaneal (trabecular) bone was performed on the Achilles device (Lunar, USA). Results. A significant decrease was found in the average concentration of total calcium, protein-bound calcium in systemic JIA and in high disease activity. The concentration of the ultrafiltered calcium fraction decreased only with high disease activity. The average concentration of inorganic phosphorus in children with oligo- and polyarthritis was within the normal range, while in systemic JIA it decreased. A significant decrease in the serum content of inorganic phosphorus, as well as in the activity of total alkaline phosphatase and its bone isoenzyme was detected in patients with high activity of systemic JIA. In patients with JIA (oligo-, polyarthritis) characterized by a slowly progressive rheumatic process, only the indicator of broadband ultrasound attenuation significantly changed during the first year of the disease, while the speed of ultrasound propagation and the index of bone tissue strength were not changed. In patients with a longer duration of the disease, all densitometric indicators decreased significantly. In the group of patients with systemic JIA and a rapidly progressive course, high activity of the disease that required a glucocorticoid therapy, a significant loss of bone mass was noted by the end of the first year of the disease. Conclusions. In JIA, there are changes in the concentration of total calcium and its protein-bound and ultrafiltered fractions in the blood serum, which indicate the tension of calcium-phosphorus metabolism and possible calcium deficiency in the body already at the early stages of the pathological process. A decrease in the activity of the alkaline phosphatase and its bone isoenzyme is associated with a violation of the structural and functional changes in the bone system of patients with JIA, which progresses with the duration of the disease. Patients with JIA require timely diagnosis and monitoring of calcium-phosphorus metabolism disorders with an assessment of the structural and functional state of the bone system for purposeful correction of comprehensive therapy due to the use of drugs in order to increase bone tissue regeneration, reduce the progression of osteopenia and osteoporosis, and preserve the health of the growing organism.

Relation between Serum level of calcium, phosphorus, and vitamin D and early childhood caries.

Objective: Early Childhood Caries (ECC) considers a multifactorial disease. Vitamin D, calcium, and phosphorus have a crucial role in mineralized tissue formation and mineralization. The purpose of this study was to evaluate the association between the serum level of vitamin D, calcium, and phosphorus, and ECC in healthy preschool children. Subject and methods: A 36 preschool children with age from 1 to 6 years old were selected for this clinical study. Enrolled children were randomly divided into two equal groups (n=18); group I; children with ECC, group II; children with caries-free. Clinical examination was carried out to assess decay, missing, filled teeth (dmft) caries index using World Health Organization (WHO) criteria. 25-hydroxyvitamin D “25(OH)D”, calcium, and phosphorus in serum had been measured for all enrolled children. Data were analyzed using paired t-test, and chi-square test at a p Results: The results of this study showed a significant decrease in serum level of vitamin D, calcium, and phosphorus in children with ECC when compared to children with caries-free. However, the result of the dmft index revealed that the filled tooth due to caries showed a higher mean followed by decay and missing teeth. Conclusion: There is a relation between the deficiency in serum level of vitamin D, calcium, and phosphorus and the incidence of ECC.

MO054EFFICACY OF ORAL PHOSPHATE SUPPLEMENTATION IN CHILDREN WITH HEREDITARY HYPOPHOSPHATEMIC RICKETS WITH HYPERCALCIURIA

Abstract Background and Aims Hereditary hypophosphatemic rickets with hypercalciuria (HHRH; MIM #241530) is an autosomal recessive renal phosphate-wasting disorder caused by mutations in the SLC34A3/NPT2c gene. HHRH characterized by increased urinary phosphate excretion leading to hypophosphatemic rickets, short stature and elevated serum 1,25(OH)2D levels which result in hypercalciuria leads to nephrocalcinosis/urolithiasis due to enhanced intestinal calcium absorption and reduced PTH-dependent calcium reabsorption in the distal renal tubules. Treatment of HHRH involves administration of oral phosphate supplements alone to normalize of serum phosphate, alkaline phosphatase activity (ALP), PTH levels, urine calcium excretion for prevention of renal calcifications and progression of rickets. Currently there is no consensus on the optimal dose of oral phosphate in patients with HHRH. The aim of the study was to evaluate the efficacy of oral phosphate supplements in Russian cohort of children with HHRH. Method 9 children (7M/2F) with homozygous (n=6) and compound heterozygous (n=3) SLC34A3 mutations from unrelated families were examined. Treatment with oral phosphate supplements was started at the median age of patients 12.0 (IQR: 9.0; 13.0) years. The median dosage of oral phosphate supplements was 14.1 (IQR: 13.8; 14.8) mg/kg/day based on elemental phosphorus. The duration of follow-up was 36.0 (IQR: 16; 49) months. Blood electrolytes levels, ALP, PTH and 24-hour-urine excretion of calcium were evaluated in all children. ALP Z-scores were calculated using age- and sex-specific mean/standard deviation (SD) lab reference data. Bone mineral density with Z-score were measured in lumbar spine and whole body for all patients using a dual energy X-ray absorptiometry device. Molecular genetic analysis was performed in all children using by next generation sequencing. Results The median SD score of height at the first and last follow-up was -1.35 (IQR: -1.8; -0.87) and -1.51 (IQR: -2.0; -0.66) (p=0.6), respectively, short stature had 33.3% (3/9) of patients at first and 44.4% (4/9) at last follow-up (p=0.7). Treatment with low doses of oral phosphate supplements did not led to normalization of serum phosphorus:1.05 (IQR: 0.97; 1.39) vs. 0.93 (IQR: 0.81; 1.27) mmol/l (p=0.13), PTH: 8.3 (IQR: 5.8; 13.8) vs. 12.9 (IQR: 12.0; 16.0) pg/ml (p=0.34), Z-score in lumbar spine: -1.2 (IQR: -2.7; -0.1) vs. -1.8 (IQR: -2.8; -1.1) (p=0.48) and Z-score in total body: -2.1 (IQR -2.6; -1.5) vs. -2.4 (IQR: -3.0; -2.0) (p=0.37). Hypercalciuria had 88.8% (8/9) of children (0.15 (IQR: 0.12; 0.19) mmol/kg/day) at first follow-up and 44.4% (4/9) (0.09 (IQR: 0.08; 0.16) mmol/kg/day) in last examination (p=0.13). ALP blood levels were elevated in all patients (9/9) at first and most recent visit, but ALP Z-score were significant lower at last follow-up: 3.9 (IQR: 1.2; 5.1) vs. 0.57 (IQR: -0.36; 2.1) (p=0.04). There were significant correlations between doses of oral phosphate supplements and ALP Z-score (r=-0.68; p=0.04) and total body Z-score (r=0.78; p=0.03). There was no significant correlations between ALP Z-score and total body Z-score (r=-0.3) or lumbar spine Z-score (r=-0.1). Conclusion The present study demonstrated that treatment of HHRH with low doses (<20 mg/kg/day) of oral phosphorus supplements led to decreasing of ALP Z-score in 7/9 (77.8%) and hypercalciuria in 5/9 (55.6%) of patients. However, that therapy didn’t improve significantly height and severity of rickets, as well didn’t led to normalization of serum phosphorus in children with HHRH. It is therefore conceivable that higher daily doses of phosphate supplements are needed to normalize all clinical and radiological features of disease. Lack of association between ALP Z-score and bone mineral density severity on radiographs limits the value of serum ALP as the indicator of rickets activity.

ASSESSMENT OF THE RELATIONSHIP OF SERUM AND SALIVARY PARAMETERS IN CHILDREN UNDERGOING HEMODIALYSIS

INTRODUCTION: Various metabolic changes were elaborated in patients with chronic kidney disease which often require biochemical analysis of blood regularly. Saliva analysis has many advantages as an alternative to blood analysis. OBJECTIVE: Evaluate levels of some parameters in saliva and serum including: urea, creatinine, calcium and phosphorus in children undergoing hemodialysis and to determine the correlation between saliva and serum regarding these parameters in order to evaluate salivary diagnostic potential. MATERIALS AND METHODS: A cross sectional analytical study was conducted on children undergoing hemodialysis in Alexandria University Children’s Hospital (AUCH). A total of 20 patients were included in the present study of whom, 10 were boys (50%) and 10 were girls (50%) with a mean age 8.85 ± 2.74. Serum and salivary samples were collected from the participants for analysis. Serum tests including Urea, creatinine (Cr), calcium (Ca), phosphorus (P) and salivary tests including Urea, Cr, Ca and P were recorded in all subjects. RESULTS: There was significant a positive correlation (P <0.0001) between serum and salivary urea (r = 0.79), as well as between serum and salivary creatinine (r = 0.68). Besides, levels of phosphorus were significantly higher in saliva than in serum. However, levels of creatinine and calcium showed significantly lower levels in saliva compared to serum. CONCLUSION: Outcomes of this study found that analysis of salivary creatinine and urea in patients with chronic kidney disease mirrored their levels in serum. Consequently, salivary creatinine and urea levels could be used non-invasively to measure serum urea and creatinine levels respectively in patients with chronic kidney disease which may be helpful in monitoring of these patients.

How Antiepileptics May Change the Serum Level of Vitamin D, Calcium, and Phosphorus in Children with Epilepsy.

Studies have shown vitamin (Vit) D deficiency and bone disease in long-term use of antiepileptics, especially in young individuals. This study aimed to determine the relationship between antiepileptic drugs and the level of Vit D, calcium (Ca), and phosphorus (P) in children with epilepsy at the Shohada Hospital from 2016 to 2017. In this case-control study, 60 consecutive children with epilepsy at the Shohada Hospital from 2016 to 2017 under treatment with anticonvulsions for more than six months were enrolled as the case group. The level of Vit D, Ca, and P was determined in the case group and compared with 60 children without seizure as the control group. The mean Ca and P were alike across the groups (P > 0.05). The mean Vit D3 level was 31.3 and 40 in the case and control groups, respectively, with significant difference (P=0.0001). The mean Ca and P were alike across the types of drug in the case group (P > 0.05); however, the mean Vit D3 level was lower in the case versus control group with significant difference (P=0.040). Totally, according to the obtained results, it may be concluded that treatment with antiepileptic drugs, especially stimulant type, is related to the lower Vit D3 level, but not to the Ca and P levels.

Salivary levels of calcium and phosphorus in children with and without early childhood caries: A pilot study

Background: The role of saliva in the maintenance of oral health is unequivocal, and its composition influences the dynamics of dental caries by modifying the phases of demineralization and remineralization. Rationale: Dental caries is a dynamic disease characterized by phases of demineralization and remineralization. Remineralization is facilitated by saliva. In children-free from caries, remineralization is dominant, and in caries-active children, demineralization is predominant. Hence, this study has been planned to evaluate the levels of calcium and phosphorus in the saliva which play a significant role in the remineralization process. Objectives: This pilot study was carried out to evaluate the salivary calcium and phosphorus levels of children aged 3–6 years and their possible association with early childhood caries. Materials and Methods: Eighteen children aged 3–6 years were divided into two groups of nine children each – Group I is the caries-free group and children affected with early childhood caries comprising the Group II. Four milliliters of unstimulated whole saliva was collected. The salivary levels of calcium and phosphorus were evaluated using an emission spectrometer – inductively coupled plasma optical emission spectrometer ICP-OES available at Sophisticated Analytical Instrument Facility, Indian Institute of Technology Madras. Descriptive statistics were done. Results: The salivary levels of calcium and phosphorus in children-free from caries were found to be higher than in saliva of children with early childhood caries. Conclusion: More research is needed to elucidate the role of these elements in the prevention of caries.

A Rare Cause of Poisoning in Childhood: Yellow Phosphorus

BackgroundYellow phosphorus poisoning is rare, but when it occurs, it may result in pathological changes in almost all organs of the body, especially the liver, heart, kidney, spleen, and brain, and it has a significant mortality rate. ObjectivesThis report presents two cases of poisoning by yellow phosphorus in children. Yellow phosphorus ingestion rarely has been reported among the pediatric population. Case ReportThis report presents two cases of yellow phosphorus poisoning in children. The patients were admitted with upper abdominal pain, vomiting, lethargy, and respiratory distress. Laboratory testing revealed hepatotoxicity and coagulation disorder. Yellow phosphorus poisoning was treated with conservative therapy in both patients, and one patient died. ConclusionYellow phosphorus poisoning is a rare clinical entity and should be considered a dangerous toxic ingestion in children.

Rickets Secondary to Phosphate Depletion

Two infants presented with growth failure and were found to have generalized osteomalacia (rickets) due to phosphate depletion from prolonged administration of an aluminum-containing antacid given for the symptoms of colic. One of the infants developed bilateral proptosis due to craniosynostosis related to the underlying metabolic bone disease. The chronic use of aluminum-containing antacids in infants has potential risk for the growing skeleton and is not innocuous. Therefore, antacid therapy should be used in low doses and very cautiously, with routine monitoring of serum calcium and phosphorus in children taking medications which reduce gastrointestinal phosphate absorption.

Retention of phosphorus in children during recuperation from dehydration caused by diarrhea

Retention of phosphorus in children during recuperation from dehydration caused by diarrhea

THE EFFECT OF A SUPPLEMENTARY PROTEIN FOOD CONTAINING FISH FLOUR (FROM OIL SARDINE) ON THE METABOLISM OF NITROGEN, CALCIUM AND PHOSPHORUS IN CHILDREN.

1. The metabolism of nitrogen, calcium and phosphorus was studied in seven pairs of boys aged 9 to 10 years, similar in height and weight and fed on a diet based on rice or the same, supplemented daily with 40 gm. of protein-food based on 2∶1∶1 blend of groundnut flour, Bengal gram flour and fish flour (from oil sardine) adequately fortfied with certain vitamins. 2. All the experimental subjects in the two groups maintained a positive nitrogen balance. The mean daily nitrogen intake on the rice diet and rice-protein food diet was 7.51 and 10.42 gm. respectively. The apparent digestibility coefficients of the proteins in the above diets were 73.5 and 81.9 respectively. The mean daily nitrogen retention on the rice-protein food diet (2.68 gm.) was significantly higher (P<0.001) than that on the control rice diet (1.36 gm.). 3. The mean daily intake of calcium on the rice and rice-protein food diets was 348 and 731 mg. respectively. All the subjects were in positive calcium balance. The mean daily retention of calcium in the subjects receiving the protein food supplement (249 mg.) was significantly higher (P<0.001) than that (123 mg.) observed in subjects receiving the control rice diet. 4. The mean daily intake of phosphorus on the rice diet and rice-protein food diet was 932 mg. and 1275 mg. respectively. All the subjects maintained positive phosphorus balance. The mean daily retention of phosphorous on the rice-protein food diet (417 mg.) was significantly higher (P<0.001) than that (195 mg.) observed on the control rice diet.

The metabolism of nitrogen, calcium and phosphorus in children on a poor Indian diet based on maize (Zea Mays).

1. The metabolism of nitrogen, calcium and phosphorus was studied in eight boys aged 9 to 10 years on a poor maize diet. The composition of the diet was similar to that consumed by the poorer classes of people in certain parts of the country. 2. All the experimental subjects maintained a positive nitrogen balance, the average daily intake and retention being 8.66 and 0.99 gm. respectively. The loss of nitrogen in the faeces was very high (3.98 gm.) and the apparent digestibility of the proteins was only 54.0 per cent. 3. The average daily intake and retention of calcium were 0.382 gm. and 0.067 gm. respectively. All the subjects maintained a positive calcium balance. 4. The average daily intake and retention of phosphorus were 1.389 and 0.340 gm. respectively. All the subjects maintained a positive phosphorus balance.

The metabolism of nitrogen, calcium and phosphorus in undernourished children. 6. The effect of partial or complete replacement of rice in por vegetarian diets by kaffir corn (Sorghum vulgare).

in different parts of India. Over considerable parts of the Deccan plateau and Cental India it is eaten as a staple food by millions of people. It is also grown to a considerable extent in other countries, especially in Africa, China, the U.S.A. and Latin America. The grain is usually ground to flour and cooked and eaten as dumplings or unleavened bread. The poorer classes generally prefer kaffir corn to softer grains like rice because of its cheapness and sustaining qualities. Diets containing kafh corn and other cereals have been compared in growth experiments on albino rats (Sur, Swaminathan & Subrahmanyan, 1955 ; Subrahmanyan, Kuppuswamy, Ramarao, Swaminathan & Bhatia, 1954). These studies have shown that the general nutritive value of a poor vegetarian diet containing kaffir corn is higher than that of rice, but slightly less than that of similar diets containing ragi (Eleusine coracana) or wheat. Our metabolic studies carried out on children in India have so far been confined to diets containing rice and ragi (Murthy, Reddy, Swaminathan & Subrahmanyan, 1955 ; Joseph, Narayanarao, Ganapathy, Swaminathan & Subrahmanyan, 1958; Joseph, Kurien, Swaminathan & Subrahmanyan, 1959). We have not previously reported any metabolic studies in children on kaffir-corn diets. Because of the acute shortage of rice in the country, the use of kaffir corn and other millets as partial substitutes for rice needs to be studied. The present paper describes the results of investigations on the effects of partial or complete replacement of rice in a poor Indian diet by kaffir corn on the metabolism of nitrogen, calcium and phosphorus in children.

The excretion of inorganic phosphorus in children after the administration of glucose.

Acta Medica ScandinavicaVolume 141, Issue 1 p. 1-5 The Excretion of Inorganic Phosphorus in Children after the Administration of Glucose A. C. M. LIPS M.D., A. C. M. LIPS M.D. Nijmegen. The NetherlandsSearch for more papers by this author A. C. M. LIPS M.D., A. C. M. LIPS M.D. Nijmegen. The NetherlandsSearch for more papers by this author First published: January/December 1951 https://doi.org/10.1111/j.0954-6820.1951.tb14188.xCitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume141, Issue1January/December 1951Pages 1-5 RelatedInformation

STUDIES ON BLOOD PHOSPHORUS

Studies on blood phosphorus in children usually refer to the inorganic phosphorus of the serum or plasma. The change in blood phosphorus content in both rickets and tetany, for instance, refers to inorganic phosphorus compounds. Recent experiments, however, tend to prove that the organic phosphorus compounds of the blood play an important part in many pathologic conditions in childhood. The following papers deal with only one group of the organic blood phosphates, namely, the esters, which are mainly contained in the red cells. These intracellular phosphate esters are closely related to sugar metabolism and help to maintain the base-binding power and osmotic pressure of the red cell. Pronounced changes in the concentration of inorganic and organic phosphorus compounds have been found in many clinical conditions associated with electrolyte imbalance. Thus the inorganic blood phosphorus seems to possess other functions besides its role as the structural substance needed for bone formation.