CONTEXT: Nutritional rickets is usually attributed to vitamin D deficiency. Studies from some tropical countries have postulated low dietary intake of calcium as the cause of nutritional rickets. Both vitamin D and dietary calcium deficiency are highly prevalent in India. Information on their relative contribution in the development of rickets in Indian children is limited. OBJECTIVE: The aim was to study the role of calcium and vitamin D deficiency in causation of nutritional rickets in young Indian children. DESIGN AND METHODS: In a case-control study, 67 children with nutritional rickets and 68 age- and sex-matched healthy controls were compared for demographic factors, nutritional status, sun exposure (UV score), dietary calcium and phytate intake (for subjects not breast-fed at presentation), and biochemical parameters [serum calcium, inorganic phosphate, alkaline phosphatase, 25-hydroxyvitamin D (25OHD), and PTH]. RESULTS: Mean intake of calcium (204±129 vs. 453±234 mg/d; P<0.001) and proportion of calcium from dairy sources (41.7 vs. 88.6%; P<0.001) were significantly lower in cases vs. controls. The dietary intake of phytate was also significantly higher in cases (P=0.01). Median serum 25OHD level (interquartile range) in both cases and controls was in the range of deficiency [13.7 (10; 17.9) and 19.4 (12.3; 24.6) ng/ml, respectively]. There was no significant difference in the serum 25OHD level (P=0.08) or sun exposure as measured by UV score (P=0.39) among the cases and controls. In cases with rickets, significant negative correlations were seen between dietary calcium intake and radiological score (r=-0.28; P=0.03) and PTH (r=-0.26; P=0.02). No correlation was found between serum 25OHD level and radiological score or biochemical parameters of rickets. CONCLUSIONS: Rickets develops when low dietary calcium intake coexists with a low or borderline vitamin D nutrition status.
CONTEXT: Nutritional rickets is usually attributed to vitamin D deficiency. Studies from some tropical countries have postulated low dietary intake of calcium as the cause of nutritional rickets. Both vitamin D and dietary calcium deficiency are highly prevalent in India. Information on their relative contribution in the development of rickets in Indian children is limited. OBJECTIVE: The aim was to study the role of calcium and vitamin D deficiency in causation of nutritional rickets in young Indian children. DESIGN AND METHODS: In a case-control study, 67 children with nutritional rickets and 68 age- and sex-matched healthy controls were compared for demographic factors, nutritional status, sun exposure (UV score), dietary calcium and phytate intake (for subjects not breast-fed at presentation), and biochemical parameters [serum calcium, inorganic phosphate, alkaline phosphatase, 25-hydroxyvitamin D (25OHD), and PTH]. RESULTS: Mean intake of calcium (204±129 vs. 453±234 mg/d; P<0.001) and proportion of calcium from dairy sources (41.7 vs. 88.6%; P<0.001) were significantly lower in cases vs. controls. The dietary intake of phytate was also significantly higher in cases (P=0.01). Median serum 25OHD level (interquartile range) in both cases and controls was in the range of deficiency [13.7 (10; 17.9) and 19.4 (12.3; 24.6) ng/ml, respectively]. There was no significant difference in the serum 25OHD level (P=0.08) or sun exposure as measured by UV score (P=0.39) among the cases and controls. In cases with rickets, significant negative correlations were seen between dietary calcium intake and radiological score (r=-0.28; P=0.03) and PTH (r=-0.26; P=0.02). No correlation was found between serum 25OHD level and radiological score or biochemical parameters of rickets. CONCLUSIONS: Rickets develops when low dietary calcium intake coexists with a low or borderline vitamin D nutrition status.
Authors: Giuseppe Saggese; Francesco Vierucci; Annemieke M Boot; Justyna Czech-Kowalska; Giovanna Weber; Carlos A Camargo; Eric Mallet; Margherita Fanos; Nick J Shaw; Michael F Holick Journal: Eur J Pediatr Date: 2015-04-02 Impact factor: 3.183
Authors: Roger Bouillon; Claudio Marcocci; Geert Carmeliet; Daniel Bikle; John H White; Bess Dawson-Hughes; Paul Lips; Craig F Munns; Marise Lazaretti-Castro; Andrea Giustina; John Bilezikian Journal: Endocr Rev Date: 2019-08-01 Impact factor: 19.871
Authors: Craig F Munns; Nick Shaw; Mairead Kiely; Bonny L Specker; Tom D Thacher; Keiichi Ozono; Toshimi Michigami; Dov Tiosano; M Zulf Mughal; Outi Mäkitie; Lorna Ramos-Abad; Leanne Ward; Linda A DiMeglio; Navoda Atapattu; Hamilton Cassinelli; Christian Braegger; John M Pettifor; Anju Seth; Hafsatu Wasagu Idris; Vijayalakshmi Bhatia; Junfen Fu; Gail Goldberg; Lars Sävendahl; Rajesh Khadgawat; Pawel Pludowski; Jane Maddock; Elina Hyppönen; Abiola Oduwole; Emma Frew; Magda Aguiar; Ted Tulchinsky; Gary Butler; Wolfgang Högler Journal: J Clin Endocrinol Metab Date: 2016-01-08 Impact factor: 5.958
Authors: Daniel E Roth; Steven A Abrams; John Aloia; Gilles Bergeron; Megan W Bourassa; Kenneth H Brown; Mona S Calvo; Kevin D Cashman; Gerald Combs; Luz María De-Regil; Maria Elena Jefferds; Kerry S Jones; Hallie Kapner; Adrian R Martineau; Lynnette M Neufeld; Rosemary L Schleicher; Tom D Thacher; Susan J Whiting Journal: Ann N Y Acad Sci Date: 2018-09-18 Impact factor: 5.691