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.

Background: 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. Evidence: 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 describes the strength of the recommendation and the quality of supporting evidence. Process: 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. Results: 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. Conclusion: 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. nology, 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. Results: 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. Conclusion: 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. Key WordsRickets · Nutrition · Vitamin D · Calcium · Consensus recommendations Abstract Background: Vitamin D and ca...

Background: Current guidelines use differing definitions of vitamin D deficiency based on serum 25-hydroxyvitamin D (25OHD) levels, which complicates clinical decision making on vitamin D doses used for the prevention and treatment. This study examined the natural relationship between serum 25OHD, parathyroid hormone (PTH), calcium, phosphate, and alkaline phosphatase. Methods: Two-hundred and fourteen children routinely admitted without conditions affecting the natural relationship among metabolites, including 17 with radiologically confirmed vitamin D deficiency rickets, were studied. The frequency of abnormal bone metabolites was examined for different 25OHD thresholds. results: The best fitting intersection point where PTH levels increased was a 25OHD level of 34 nmol/l (R 2 = 0.454; 95% confidence interval: 27-41 nmol/l). Seventy-three and 86% of the children demonstrated some biochemical abnormality below 25OHD levels of 41 and 27 nmol/l, respectively. All patients with rickets had 25OHD levels < 34 nmol/l. The vast majority of children with abnormal bone metabolites had 25OHD levels < 34 nmol/l and PTH levels > 50 ng/l. conclusion: Vitamin D deficiency, based on PTH elevation, was best defined by a 25OHD level of < 34 nmol/l. Because deficient calcium supply often coexists with vitamin D deficiency and both can independently cause nutritional rickets, a threshold for the skeletal effects of vitamin D should not be based purely on 25OHD levels. Vitamin D deficiency and its potential health implications are currently the subject of significant interest and controversy (1-6). However, what defines vitamin D deficiency is still under debate, in particular, in children, where studies are limited. The serum level of 25-hydroxyvitamin D (25OHD) is currently considered to be the most appropriate marker of the vitamin D status of an individual. Until recently, the conventional definition of vitamin D deficiency was a serum 25OHD level of < 25 nmol/l (<10 ng/ml) (7-9) as this level was associated with rickets or osteomalacia. However, the Pediatric Endocrine Society advocated a 25OHD level of < 37.5 nmol/l (<15 ng/ml) to define deficiency and < 50 nmol/l (20 ng/ml) to define insufficiency (10). More recently, the Institute of Medicine defined vitamin D sufficiency as a 25OHD level > 50 nmol/l (20 ng/ml) (11), whereas the Endocrine Society defined deficiency as a 25OHD level < 50 nmol/l (20 ng/ml), and insufficiency as a 25OHD level of 52.5-72.5 nmol/l (21-29 ng/ml), for both adults and children (12).These cutoff values were often based on adult studies in relation to fracture risk, intestinal calcium absorption, or bone mineral density (1,2,13-16). In addition, metabolic evidence supporting these chosen cutoff levels comes from the observations in adults that serum levels of parathyroid hormone (PTH) increase when serum 25OHD level decreases below a variably defined range of 37.5-75 nmol/l (15-30 ng/ml) (14,(16)(17)(18)(19)(20)(21). Active vitamin D (calcitriol) facilitates absorption of calcium and phosphorous fro...

Background As in many other Asian countries, Sri Lanka is in the phase of a rapid demographic, nutritional and epidemiological transition. As a result dietary habits and lifestyle are changing. These have led to new health problems in the region. Childhood overweight and obesity are examples of such problems.Objective To provide information on the nutritional status of 8-12 years old schoolchildren in an urban area of Sri Lanka.Subjects and methods Seven schools situated in the city of Colombo were randomly selected. They showed a fair representation of children of all social levels. Fifty students from each grade (years 4, 5, 6, 7) of each school were randomly selected. Their height was measured using a stadiometer to the closest 0.1cm and weight measured using an electronic weighing scale (Seca®, France) to the closest 100 g. Calibration was checked with a standard weight at each 25 measurements. Information regarding behaviour, feeding practices and socioeconomic factors were obtained by a questionnaire filled by the parent or the guardian. To define obesity and overweight, sex and age specific body mass index (BMI) criteria recommended by the International Obesity Task Force (IOTF) were used. The age and sex specific BMI 5th percentile from revised NCHS (2000) growth charts were used to define thinness. Weight and height Z score of less than -2 from the median of height for age and weight for age derived using the ANTHRO software (CDC, USA) were used to define stunting and underweight respectively. Data were analysed using EpiInfo 2000 (CDC, USA) computer package.Results Anthropometric data of 1 224 children (48% boys), and feeding practices and behaviour pattern data of 1 102 children (44% boys) were analysed. Obesity prevalence among boys (4.3%) was higher than in girls (3.1%). The prevalence of thinness was 24.7% in boys and 23.1% in girls. 5.1% of boys and 5.2% of girls were stunted. 7.0% of boys and 6.8% of girls were underweight. 66% of obese children and 43.5% of overweight children belonged to high-income category (monthly family income more than Rs. 20 000). Apart from family income, behaviour patterns did not significantly influence the nutritional status.Conclusions Although the data are not representative of the entire country, nutritional transition is evident in the city of Colombo. Obesity and overweight in older children are some emerging nutritional problems that may be the consequence of emerging patterns of the lifestyle and diet in response to social and cultural changes.

Background: Septo-optic dysplasia (SOD) is a disorder with postulated environmental and genetic aetiology. This study delineates clinical features and potential perinatal environmental factors along with epidemiology in SOD children. Methods: Assessment of patients with SOD triad features in the UK West Midlands region. Results: Of 227 patients identified between 1998 and 2009 with 1 or more feature of the triad, 55 had midline defects, 149 had optic nerve hypoplasia and 132 had hypopituitarism. Eighty-eight children (52% males; incidence 8.3/100,000 live births) had SOD defined as 2 out of 3 features and 21 (24%) had all 3. Sixty-one percent had anterior pituitary deficiency and 21.5% had diabetes insipidus. Median maternal/paternal ages in SOD were 21 and 23.5 years, compared to UK means of 29.3 and 32.4 years (p < 0.001). First trimester bleeding was markedly increased at 12/48 (25%) compared to 0.07% in the UK (p < 0.001). Ethnicity showed a non-significant higher prevalence in Afro-Caribbean and mixed race groups, and significantly lower prevalence (p = 0.004) in South Asian groups compared to West Midland and Birmingham city data: 8% versus 2.5 and 6.7%, 9% versus 1.8 and 3.2% and 3% versus 8.4 and 21%, respectively. Conclusions: SOD is associated with younger maternal and paternal age, primigravida births and ethnic differences. Increased first trimester bleeding may indicate that SOD is a vascular disruption sequence.