Prevention Of Nutritional Rickets Research Articles

Semptomatik Hipokalsemi ve Nütrisyonel Rikets Nedenli Hastane Başvuruları: Göçmen Suriye’li Süt Çocuklarının Predominansı

Amac: Nutrisyonel rikets, buyume cagindaki cocuklarda D vitamini ve kalsiyum eksikligine bagli olarak gelisen epifizyal kikirdagin defektif mineralizasyonudur. Nutrisyonel riketsin onlenmesi icin D vitamini profilaksisi ulkemizde sut cocuklugu doneminde rutin olarak uygulanmaktadir. Ancak halen semptomatik hipokalsemi ve D vitamini eksikligi nedeniyle hastane basvurularinin olmasi dikkat cekicidir. Calismamizda bu olgularin ozelliklerinin ortaya konulmasi amaclanmistir. Gerec ve Yontem: Ocak 2018-Mayis 2018 tarihleri arasinda nutrisyonel rikets tanisi ile yatirilarak izlenmis olan 28 hastanin (9 kiz, 19 erkek) verisi retrospektif olarak incelendi. Olgularin basvuru anindaki antropometrik ve laboratuvar ozellikleri kaydedildi. Bulgular: Olgularin ortanca basvuru yasi 8,8 (1-35) ay idi. Olgularin %67,9’u Suriye gocmeni idi. Hastalarin %57,1’i hic D vitamini profilaksisi almamis, %42,9’u ise duzensiz almisti. Basvuru yakinmasi olgularin %50’sinde konvulsiyon gecirme, %28,6’sinda rikets bulgulari iken %21,4’unde ise ates, enfeksiyon vb. nedenlerden dolayi hastaneye basvuran hastalarda rastlantisal olarak hipokalsemi tespit edilmis olmasi idi. Ilk basvuruda ortanca kalsiyum 6,6 mg/dL; iyonize kalsiyum 0,85 mmol/L; fosfor 3,5 mg/dL; alkalen fosfataz 787 U/L; parathormon 241 pg/mL ve 25-hidroksi vitamin D 3,4 ng/mL saptanmisti. Olgularin %60,7’sinde hipofosfatemi, %3,6’sinda hiperfosfatemi mevcuttu. Tum olgular hastanede yatirilarak tedavi edilmis ve D vitamini eksikligine bagli nutrisyonel rikets tanisi almisti. Sonuc: Ulkemizde D vitamini profilaksisine ragmen halen nutrisyonel rikets gorulebilmekte ve kis-ilkbahar aylarinda hipokalsemik konvulsiyon nedeniyle hastane basvurularina yol acabilmektedir. Ozellikle gocmen Suriyeli sut cocuklarinda D vitamini destek programina uyumun artirilmasi nutrisyonel riketsin onlenmesi acisindan onemlidir.

Global Consensus Recommendations on Prevention and Management of Nutritional Rickets.

Vitamin D and calcium deficiencies are common worldwide, causing nutritional rickets and osteomalacia, which have a major impact on health, growth, and development of infants, children, and adolescents; the consequences can be lethal or can last into adulthood. The goals of this evidence-based consensus document are to provide health care professionals with guidance for prevention, diagnosis, and management of nutritional rickets and to provide policy makers with a framework to work toward its eradication. A systematic literature search examining the definition, diagnosis, treatment, and prevention of nutritional rickets in children was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system that describe the strength of the recommendation and the quality of supporting evidence. Thirty-three nominated experts in pediatric endocrinology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required.

Consensus Recommendations for Prevention of Nutritional Rickets: Food Fortification and Micronutrient Supplements for Global Health

1 Department of Endocrinology & Diabetes, Birmingham Children’s Hospital; and Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom 2 Department of Health Economics, Institute of Applied Health Research, University of Birmingham, United Kingdom 3 Vitamin D Research Group, School of Food and Nutritional Sciences, University College Cork, Ireland 4 Professor Emeritus: Braun School of Public Health and Community Medicine, Hebrew University-Hadassah, 91220 Jerusalem, Israel. Head of School of Health Professions, Ashkelon College, Ashkelon, Israel

Prevention of nutritional rickets in Nigerian children with dietary calcium supplementation

Nutritional rickets in Nigerian children usually results from dietary calcium insufficiency. Typical dietary calcium intakes in African children are about 200mg daily (approximately 20–28% of US RDAs for age). We sought to determine if rickets could be prevented with supplemental calcium or with an indigenous food rich in calcium. We enrolled Nigerian children aged 12 to 18months from three urban communities. Two communities were assigned calcium, either as calcium carbonate (400mg) or ground fish (529±109mg) daily, while children in all three communities received vitamin A (2500IU) daily as placebo. Serum markers of mineral homeostasis and forearm bone density (pDEXA) were measured and radiographs were obtained at enrollment and after 18months of supplementation. The overall prevalence of radiographic rickets at baseline was 1.2% and of vitamin D deficiency [serum 25(OH)D<12ng/ml] 5.4%. Of 647 children enrolled, 390 completed the 18-month follow-up. Rickets developed in 1, 1, and 2 children assigned to the calcium tablet, ground fish, and control groups, respectively (approximate incidence 6.4/1000 children/year between 1 and 3years of age). Children who developed rickets in the calcium-supplemented groups had less than 50% adherence. Compared with the group that received no calcium supplementation, the groups that received calcium had a greater increase in areal bone density of the distal and proximal 1/3 radius and ulna over time (P<0.04). We conclude that calcium supplementation increased areal bone density at the radius and ulna, but a larger sample size would be required to determine its effect on the incidence of rickets.

Theobald palm and his remarkable observation: how the sunshine vitamin came to be recognized.

The seminal discovery that sunlight was important in the prevention of nutritional rickets was made in 1890 by Theobald A. Palm, a medical missionary who contrasted the prevalence of rickets in northern European urban areas with similar areas in Japan and other tropical countries. He surmised that exposure to sunlight prevented rickets. Over the next 40 years his observation led to an understanding of ultraviolet irradiation and its role in vitamin D synthesis. This opened a new era of appreciation for the curative powers of the sun and “the sunshine vitamin”. While Palm’s observations were in some ways obscure, they had a potent effect on the development of photobiology.

Nutritional Rickets: Still a Problem for the Pediatric Population

Rickets is a mineralization disorder of the growing bone. Nutritional rickets is still prevalent in many parts of the developing world and is re-emerging in developed countries. Although vitamin D deficiency plays a central role in the pathogenesis of this disease, calcium deficiency and genetic factors may also cause or contribute to the development of rickets. This review will focus on the classical form of nutritional rickets, in other words, vitamin D-deficiency rickets. The epidemiology, ethiopathogenesis, risk factors, clinical picture, diagnosis, treatment and prevention of nutritional rickets are reviewed.

Nutritional rickets: nature or nurture?

Rickets is a mineralization disorder of the growing bone. Nutritional rickets is still prevalent in many parts of the world. Although vitamin D deficiency plays a central role in the pathogenesis of this disease, calcium deficiency and genetic factors may also cause or contribute to the development of rickets. This review will focus on the classical form of nutritional rickets: vitamin D deficiency rickets. Epidemiology, ethiopathogenesis, risk factors, the current clinical picture, diagnosis, treatment and prevention of nutritional rickets will be reviewed.