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Published in: International Journal of Pediatric Endocrinology 1/2010

Open Access 01-12-2010 | Clinical Study

Nutritional Rickets among Children in a Sun Rich Country

Authors: Abdulbari Bener, Georg F. Hoffmann

Published in: International Journal of Pediatric Endocrinology | Issue 1/2010

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Abstract

Objective. This study describes the magnitude and characteristics of nutritional rickets and associated risk factors among children in Qatar. Subjects. A consecutive sample of 730 healthy subjects who visited the primay health care clinics were approached and 540 (73.9%) subjects gave consent. Mehods. Nutritional rickets diagnosis was based on clinical radiologic and biochemical parameters and normalization of alkaline phosphatase level after 6 weeks course of daily vitamin D therapy. Results. The study revealed that 23.9% of the studied children had nutritional rickets. The mean https://static-content.springer.com/image/art%3A10.1155%2F2010%2F410502/MediaObjects/13633_2010_Article_418_IEq1_HTML.gif SD age of those with rickets (3.76 years https://static-content.springer.com/image/art%3A10.1155%2F2010%2F410502/MediaObjects/13633_2010_Article_418_IEq2_HTML.gif 1.51) was slightly higher than those without rickets (3.57 years https://static-content.springer.com/image/art%3A10.1155%2F2010%2F410502/MediaObjects/13633_2010_Article_418_IEq3_HTML.gif 1.45). Family history of vitamin D deficiency (44.2%; P = .001) and diabetes mellitus (53.5%; P = .002) were significantly higher in rachitic children than in nonrachitic children. The children with rickets spent a significantly shorter average duration (26.86 minutes https://static-content.springer.com/image/art%3A10.1155%2F2010%2F410502/MediaObjects/13633_2010_Article_418_IEq4_HTML.gif 19.94) under the sun than those without rickets (30.59 minutes https://static-content.springer.com/image/art%3A10.1155%2F2010%2F410502/MediaObjects/13633_2010_Article_418_IEq5_HTML.gif 15.72; https://static-content.springer.com/image/art%3A10.1155%2F2010%2F410502/MediaObjects/13633_2010_Article_418_IEq6_HTML.gif ). A significantly larger proportion of rachitic children was afflicted with vitamin D deficiency (75.2% versus 62.2%; https://static-content.springer.com/image/art%3A10.1155%2F2010%2F410502/MediaObjects/13633_2010_Article_418_IEq7_HTML.gif ), secondary hypothyroidism (100% versus 7.5%; P = .009) and muscular weakness (56.6% versus 26.3%; https://static-content.springer.com/image/art%3A10.1155%2F2010%2F410502/MediaObjects/13633_2010_Article_418_IEq8_HTML.gif ). Conclusion. The most important risk factors were low vitamin D and calcium intakes, lack of exposure to sunlight, prolonged breast feeding without supplementation of vitamin D.
Literature
1.
go back to reference Lerch C, Meissner T: Interventions for the prevention of nutritional rickets in term born children. Cochrane Database of Systematic Reviews. 2007, CD006164-4 Lerch C, Meissner T: Interventions for the prevention of nutritional rickets in term born children. Cochrane Database of Systematic Reviews. 2007, CD006164-4
2.
go back to reference Welch TR, Bergstrom WH, Tsang RC: Vitamin D-deficient rickets: the reemergence of a once-conquered disease. Journal of Pediatrics. 2000, 137 (2): 143-145. 10.1067/mpd.2000.109008.CrossRefPubMed Welch TR, Bergstrom WH, Tsang RC: Vitamin D-deficient rickets: the reemergence of a once-conquered disease. Journal of Pediatrics. 2000, 137 (2): 143-145. 10.1067/mpd.2000.109008.CrossRefPubMed
3.
go back to reference Wagner CL, Greer FR: Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. American Academy of Pediatrics Section on Breastfeeding; American Academy of Pediatrics Committee on Nutrition. Pediatrics. 2008, 122 (5): 1142-1152. 10.1542/peds.2008-1862.CrossRefPubMed Wagner CL, Greer FR: Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. American Academy of Pediatrics Section on Breastfeeding; American Academy of Pediatrics Committee on Nutrition. Pediatrics. 2008, 122 (5): 1142-1152. 10.1542/peds.2008-1862.CrossRefPubMed
4.
go back to reference David L: Common vitamin D-deficiency rickets. Rickets. Edited by: Glorieux FH. 1991, Raven Press, New York, NY, USA, 107-122. David L: Common vitamin D-deficiency rickets. Rickets. Edited by: Glorieux FH. 1991, Raven Press, New York, NY, USA, 107-122.
5.
go back to reference Kreiter SR, Schwartz RP, Kirkman HN, Charlton PA, Calikoglu AS, Davenport ML: Nutritional rickets in African American breast-fed infants. Journal of Pediatrics. 2000, 137 (2): 153-157. 10.1067/mpd.2000.109009.CrossRefPubMed Kreiter SR, Schwartz RP, Kirkman HN, Charlton PA, Calikoglu AS, Davenport ML: Nutritional rickets in African American breast-fed infants. Journal of Pediatrics. 2000, 137 (2): 153-157. 10.1067/mpd.2000.109009.CrossRefPubMed
6.
go back to reference DeLucia MC, Mitnick ME, Carpenter TO: Nutritional rickets with normal circulating 25-hydroxyvitamin D: a call for reexamining the role of dietary calcium intake in North American infants. Journal of Clinical Endocrinology and Metabolism. 2003, 88 (8): 3539-3545. 10.1210/jc.2002-021935.CrossRefPubMed DeLucia MC, Mitnick ME, Carpenter TO: Nutritional rickets with normal circulating 25-hydroxyvitamin D: a call for reexamining the role of dietary calcium intake in North American infants. Journal of Clinical Endocrinology and Metabolism. 2003, 88 (8): 3539-3545. 10.1210/jc.2002-021935.CrossRefPubMed
7.
go back to reference Bener A, Alsaied A, Al-Ali M, Hassan AS, Basha B, Al-Kubaisi A, Abraham A, Mian M, Guiter G, Tewfik I: Impact of lifestyle and dietary habits on hypovitaminosis D in type 1 diabetes mellitus and healthy children from Qatar, a sun-rich country. Annals of Nutrition and Metabolism. 2009, 53 (3-4): 215-222. 10.1159/000184439.CrossRef Bener A, Alsaied A, Al-Ali M, Hassan AS, Basha B, Al-Kubaisi A, Abraham A, Mian M, Guiter G, Tewfik I: Impact of lifestyle and dietary habits on hypovitaminosis D in type 1 diabetes mellitus and healthy children from Qatar, a sun-rich country. Annals of Nutrition and Metabolism. 2009, 53 (3-4): 215-222. 10.1159/000184439.CrossRef
9.
go back to reference Ward LM, Gaboury I, Ladhani M, Zlotkin S: Vitamin D-deficiency rickets among children in Canada. Canadian Medical Association Journal. 2007, 177 (2): 161-166. 10.1503/cmaj.061377.PubMedCentralCrossRefPubMed Ward LM, Gaboury I, Ladhani M, Zlotkin S: Vitamin D-deficiency rickets among children in Canada. Canadian Medical Association Journal. 2007, 177 (2): 161-166. 10.1503/cmaj.061377.PubMedCentralCrossRefPubMed
10.
go back to reference Pettifor JM: Nutritional rickets: deficiency of vitamin D, calcium, or both?. The American Journal of Clinical Nutrition. 2004, 80 (6): 1725S-1729S.PubMed Pettifor JM: Nutritional rickets: deficiency of vitamin D, calcium, or both?. The American Journal of Clinical Nutrition. 2004, 80 (6): 1725S-1729S.PubMed
11.
go back to reference Thacher TD, Fischer PR, Pettifor JM, Lawson JO, Isichei CO, Reading JC, Chan GM: A comparison of calcium, vitamin D, or both for nutritional rickets in Nigerian children. The New England Journal of Medicine. 1999, 341 (8): 563-568. 10.1056/NEJM199908193410803.CrossRefPubMed Thacher TD, Fischer PR, Pettifor JM, Lawson JO, Isichei CO, Reading JC, Chan GM: A comparison of calcium, vitamin D, or both for nutritional rickets in Nigerian children. The New England Journal of Medicine. 1999, 341 (8): 563-568. 10.1056/NEJM199908193410803.CrossRefPubMed
12.
go back to reference Thacher TD, Fischer PR, Pettifor JM, Lawson JO, Isichei CO, Chan GM: Case-control study of factors associated with nutritional rickets in Nigerian children. Journal of Pediatrics. 2000, 137 (3): 367-373. 10.1067/mpd.2000.107527.CrossRefPubMed Thacher TD, Fischer PR, Pettifor JM, Lawson JO, Isichei CO, Chan GM: Case-control study of factors associated with nutritional rickets in Nigerian children. Journal of Pediatrics. 2000, 137 (3): 367-373. 10.1067/mpd.2000.107527.CrossRefPubMed
13.
go back to reference Prentice A: Vitamin D deficiency: a global perspective. Nutrition Reviews. 2008, 66 (2): S153-S164. 10.1111/j.1753-4887.2008.00100.x.CrossRefPubMed Prentice A: Vitamin D deficiency: a global perspective. Nutrition Reviews. 2008, 66 (2): S153-S164. 10.1111/j.1753-4887.2008.00100.x.CrossRefPubMed
14.
go back to reference Fischer PR, Rahman A, Cimma JP, Kyaw-Myint TO, Kabir ARML, Talukder K, Hassan N, Manaster BJ, Staab DB, Duxbury JM, Welch RM, Meisner CA, Haque S, Combs GF: Nutritional rickets without vitamin D deficiency in Bangladesh. Journal of Tropical Pediatrics. 1999, 45 (5): 291-293. 10.1093/tropej/45.5.291.CrossRefPubMed Fischer PR, Rahman A, Cimma JP, Kyaw-Myint TO, Kabir ARML, Talukder K, Hassan N, Manaster BJ, Staab DB, Duxbury JM, Welch RM, Meisner CA, Haque S, Combs GF: Nutritional rickets without vitamin D deficiency in Bangladesh. Journal of Tropical Pediatrics. 1999, 45 (5): 291-293. 10.1093/tropej/45.5.291.CrossRefPubMed
15.
go back to reference Beck-Nielsen SS, Brock-Jacobsen B, Gram J, Brixen K, Jensen TK: Incidence and prevalence of nutritional and hereditary rickets in southern Denmark. European Journal of Endocrinology. 2009, 160 (3): 491-497. 10.1530/EJE-08-0818.CrossRefPubMed Beck-Nielsen SS, Brock-Jacobsen B, Gram J, Brixen K, Jensen TK: Incidence and prevalence of nutritional and hereditary rickets in southern Denmark. European Journal of Endocrinology. 2009, 160 (3): 491-497. 10.1530/EJE-08-0818.CrossRefPubMed
16.
go back to reference Robinson PD, Högler W, Craig ME, Verge CF, Walker JL, Piper AC, Woodhead HJ, Cowell CT, Ambler GR: The re-emerging burden of rickets: a decade of experience from Sydney. Archives of Disease in Childhood. 2006, 91 (7): 564-568. 10.1136/adc.2004.069575.PubMedCentralCrossRefPubMed Robinson PD, Högler W, Craig ME, Verge CF, Walker JL, Piper AC, Woodhead HJ, Cowell CT, Ambler GR: The re-emerging burden of rickets: a decade of experience from Sydney. Archives of Disease in Childhood. 2006, 91 (7): 564-568. 10.1136/adc.2004.069575.PubMedCentralCrossRefPubMed
17.
go back to reference McGillivray G, Skull SA, Davie G, Kofoed SE, Frydenberg A, Rice J, Cooke R, Carapetis JR: High prevalence of asymptomatic vitamin D and iron deficiency in East African immigrant children and adolescents living in a temperate climate. Archives of Disease in Childhood. 2007, 92 (12): 1088-1093. 10.1136/adc.2006.112813.PubMedCentralCrossRefPubMed McGillivray G, Skull SA, Davie G, Kofoed SE, Frydenberg A, Rice J, Cooke R, Carapetis JR: High prevalence of asymptomatic vitamin D and iron deficiency in East African immigrant children and adolescents living in a temperate climate. Archives of Disease in Childhood. 2007, 92 (12): 1088-1093. 10.1136/adc.2006.112813.PubMedCentralCrossRefPubMed
18.
go back to reference Bahijri SM: Serum 25-hydroxy cholecalciferol in infants and preschool children in the Western region of Saudi Arabia. Etiological factors. Saudi Medical Journal. 2001, 22 (11): 973-979.PubMed Bahijri SM: Serum 25-hydroxy cholecalciferol in infants and preschool children in the Western region of Saudi Arabia. Etiological factors. Saudi Medical Journal. 2001, 22 (11): 973-979.PubMed
19.
go back to reference Bener A, Kamal AA: Growth patterns of Qatari school children and adolescent aged 6-18 years. Journal of Health, Population and Nutrition. 2005, 23 (3): 250-258. Bener A, Kamal AA: Growth patterns of Qatari school children and adolescent aged 6-18 years. Journal of Health, Population and Nutrition. 2005, 23 (3): 250-258.
20.
go back to reference Baroncelli GI, Bereket A, El Kholy M, Audì L, Cesur Y, Ozkan B, Rashad M, Fernández-Cancio M, Weisman Y, Saggese G, Hochberg Z: Rickets in the Middle East: role of environment and genetic predisposition. Journal of Clinical Endocrinology and Metabolism. 2008, 93 (5): 1743-1750. 10.1210/jc.2007-1413.CrossRefPubMed Baroncelli GI, Bereket A, El Kholy M, Audì L, Cesur Y, Ozkan B, Rashad M, Fernández-Cancio M, Weisman Y, Saggese G, Hochberg Z: Rickets in the Middle East: role of environment and genetic predisposition. Journal of Clinical Endocrinology and Metabolism. 2008, 93 (5): 1743-1750. 10.1210/jc.2007-1413.CrossRefPubMed
21.
go back to reference Hatun S, Ozkan B, Orbak Z, Doneray H, Cizmecioglu F, Toprak D, Calikoglu AS: Vitamin D deficiency in early infancy. Journal of Nutrition. 2005, 135 (2): 279-282.PubMed Hatun S, Ozkan B, Orbak Z, Doneray H, Cizmecioglu F, Toprak D, Calikoglu AS: Vitamin D deficiency in early infancy. Journal of Nutrition. 2005, 135 (2): 279-282.PubMed
22.
go back to reference Das G, Crocombe S, McGrath M, Berry JL, Mughal MZ: Hypovitaminosis D among healthy adolescent girls attending an inner city school. Archives of Disease in Childhood. 2006, 91 (7): 569-572. 10.1136/adc.2005.077974.PubMedCentralCrossRefPubMed Das G, Crocombe S, McGrath M, Berry JL, Mughal MZ: Hypovitaminosis D among healthy adolescent girls attending an inner city school. Archives of Disease in Childhood. 2006, 91 (7): 569-572. 10.1136/adc.2005.077974.PubMedCentralCrossRefPubMed
23.
go back to reference Bener A, Al-Ali M, Hoffmann GF: High prevalence of vitamin D deficiency in young children in a highly sunny humid country: a global health problem. Minerva Pediatrica. 2009, 61 (1): 15-22.PubMed Bener A, Al-Ali M, Hoffmann GF: High prevalence of vitamin D deficiency in young children in a highly sunny humid country: a global health problem. Minerva Pediatrica. 2009, 61 (1): 15-22.PubMed
24.
go back to reference Holick MF, Chen TC: Vitamin D deficiency: a worldwide problem with health consequences. American Journal of Clinical Nutrition. 2008, 87 (4): Holick MF, Chen TC: Vitamin D deficiency: a worldwide problem with health consequences. American Journal of Clinical Nutrition. 2008, 87 (4):
25.
go back to reference Al-Mustafa ZH, Al-Madan M, Al-Majid HJ, Al-Muslem S, Al-Ateeq S, Al-Ali AK: Vitamin D deficiency and rickets in the Eastern Province of Saudi Arabia. Annals of Tropical Paediatrics. 2007, 27 (1): 63-67. 10.1179/146532807X170529.CrossRefPubMed Al-Mustafa ZH, Al-Madan M, Al-Majid HJ, Al-Muslem S, Al-Ateeq S, Al-Ali AK: Vitamin D deficiency and rickets in the Eastern Province of Saudi Arabia. Annals of Tropical Paediatrics. 2007, 27 (1): 63-67. 10.1179/146532807X170529.CrossRefPubMed
26.
go back to reference Dahifar H, Faraji A, Ghorbani A, Yassobi S: Impact of dietary and lifestyle on vitamin D in healthy student girls aged 11-15 years. Journal of Medical Investigation. 2006, 53 (3-4): 204-208. 10.2152/jmi.53.204.CrossRefPubMed Dahifar H, Faraji A, Ghorbani A, Yassobi S: Impact of dietary and lifestyle on vitamin D in healthy student girls aged 11-15 years. Journal of Medical Investigation. 2006, 53 (3-4): 204-208. 10.2152/jmi.53.204.CrossRefPubMed
Metadata
Title
Nutritional Rickets among Children in a Sun Rich Country
Authors
Abdulbari Bener
Georg F. Hoffmann
Publication date
01-12-2010
Publisher
BioMed Central
Published in
International Journal of Pediatric Endocrinology / Issue 1/2010
Electronic ISSN: 1687-9856
DOI
https://doi.org/10.1155/2010/410502

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