Case Report: Children with Severe Nutritional Rickets in the Naga Region in Northwest Myanmar, on the border with India

Aung, Hein; Soe, Kyaw; Smithuis, Frank F; Lamb, Thomas; Aung, Moe Wint; Smithuis, Frank

doi:10.4269/ajtmh.20-1431

Cited by 5 publications

(3 citation statements)

References 12 publications

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“…Its elevation was associated with the degree of Fanconi syndrome (e.g., hypophosphatemia, low bicarbonate levels). Both hypophosphatemia and acidosis are main causes of rickets resulting in impaired apoptosis of hypertrophic chondrocytes and consecutive widening of the growth plates in long bones and costal arches, and in severe cases of for example nutritional rickets, resulting in pectus carinatum, and thus increased chest depth [ 31 , 32 ]. Despite those implications of Fanconi syndrome for ribcage development, our results suggest further factors to be at play.…”

Section: Discussionmentioning

confidence: 99%

Chest configuration in children and adolescents with infantile nephropathic cystinosis compared with other chronic kidney disease entities and its clinical determinants

Müller,

Kluck,

Jagodzinski

et al. 2023

Pediatr Nephrol

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Background Infantile nephropathic cystinosis (INC) is a systemic lysosomal storage disease causing intracellular cystine accumulation, resulting in renal Fanconi syndrome, progressive kidney disease (CKD), rickets, malnutrition, and myopathy. An INC-specific disproportionately diminished trunk length compared to leg length poses questions regarding the functionality of the trunk. Methods Thus, we prospectively investigated thoracic dimensions and proportions, as well as their clinical determinants in 44 pediatric patients with INC with CKD stages 1–5 and 97 age-matched patients with CKD of other etiology between the ages of 2–17 years. A total of 92 and 221 annual measurements of patients with INC and CKD, respectively, were performed, and associations between anthropometric and clinical parameters were assessed using linear mixed-effects models. Results Patients with INC exhibited altered chest dimensions that were distinct from CKD controls, characterized by markedly increased chest depth to height and chest depth to chest width ratio z-scores (> 1.0), while those of patients with CKD were only mildly affected (z-score within ± 1.0). Ratio z-scores differed significantly between both patient groups from 2–6 years of age onward. The degree of chest disproportion in INC patients was significantly associated with both the degree of CKD and tubular dysfunction (e.g., low serum phosphate and bicarbonate) across three different age groups (2–6, 7–12, and 13–17 years). Conclusion Our data show an INC-specific alteration in thoracic shape from early childhood onward, which is distinct from CKD of other etiologies, suggesting early childhood subclinical changes of the musculoskeletal unit of the thoracic cage, which are associated with kidney function. Graphical abstract

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Section: Discussionmentioning

confidence: 99%

Chest configuration in children and adolescents with infantile nephropathic cystinosis compared with other chronic kidney disease entities and its clinical determinants

Müller,

Kluck,

Jagodzinski

et al. 2023

Pediatr Nephrol

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“…As for the AGE, the results of the present study are compatible with most of the previous research conducted with adults, wherein AGE did not significantly determine the levels of adherence to MD [ 27 ]. Moreover, previous studies have verified that malnutrition can impact HE and even cause rickets [ 86 , 87 ]. However, we understand that this only occurs when there is a severe nutritional deficit involving a significant deficiency of vitamin D, calcium, and phosphorus [ 87 ].…”

Section: Discussionmentioning

confidence: 99%

Association between Adherence to the Mediterranean Diet and Anthropometric and Health Variables in College-Aged Males

2022

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The present study aimed to verify the association between adherence to the Mediterranean diet (MD) and anthropometric and health variables. Four-hundred-and-ninety-five college-aged males aged 18–25 participated in this cross-sectional research. The KIMED (Mediterranean Diet Quality Index for children and adolescents) was used to assess the adherence to MD. The following variables were also assessed: body mass (BM), height (HE), body mass index (BMI), body fat percentage (%FAT), lean mass (LEAN), abdominal girth (AG), waist-to-hip ratio (WHR), oxygen saturation (SPO2), systolic blood pressure (SBP), diastolic blood pressure (DBP), double product (DP), and fasting blood glucose (GLU). The results showed that adherence to MD presented a strong negative correlation with most of the anthropometric parameters (BM: r = −0.571; BMI: r = −0.614; %FAT: r = −0.558; and AG: r = −0.564), a moderate or weak correlation with most of the health variables (GLU: r = −0.407; SBP: r = −0.238; DBP: r = −0.217, and DP: r = −0.265) and LEAN (r = −0.497), and a very weak correlation with WHR (r = −0.090). Many anthropometric parameters (BM, BMI, %FAT, LEAN, AG, WHR) present significant correlations with health variables (SBP, DBP, DP, and GLU). We conclude that greater adherence to Mediterranean diet is associated with healthier values of the selected anthropometric and health parameters. Since most of the anthropometric and health parameters present significant correlations among themselves, this finding could be useful in medical diagnosis, health monitoring, and risk detection. Based on the level of adherence to Mediterranean diet and the KIDMED found in the present study, and considering the prevalence of obesity in the Middle East, it is imperative to implement nutritional interventions with the target population of this research to prevent nutrition-related diseases and promote public health.

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“…While several recent case reports have been published [5][6][7][8][9] , most recently in 2023 in the United States, nutritional rickets in infants can be overlooked due to many nonspecific clinical manifestations 2 . Recent case reports have been seen from Morocco and remote regions of Myanmar, but to our knowledge, no recent case studies of nutritional rickets have been reported in the United States [5][6][7][8] .…”

Section: Introduction and Literature Reviewmentioning

confidence: 99%

Multiple Diagnoses of Nutritional Rickets in An Inner-City Pediatric Population: A Case Series

Jeffery,

Lima,

Khokhar

et al. 2024

J Orthopedics & Orthopedic Surg

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This case series details seven pediatric cases of nutritional rickets in an inner-city population of New Jersey. Eighty six percent of these patients were exclusively breast fed, and all self-identified as black or African American. Patients ranged in age from 8 months to 3 years at the time of initial diagnosis. All seven patients were male. Five patients were presented in an office setting, while two were found to have nutritional rickets in an emergency setting. Patients demonstrated classic pathognomonic findings of rickets, including three patients with rachitic rosary. The aim of this case series is to emphasize the importance of surveillance and high clinical suspicion for nutritional rickets, particularly in children with darker skin complexions and who were exclusively breast-fed during infancy. Rapid diagnosis and intervention may delay or negate the need for orthopedic surgical intervention.

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Case Report: Children with Severe Nutritional Rickets in the Naga Region in Northwest Myanmar, on the border with India

Cited by 5 publications

References 12 publications

Chest configuration in children and adolescents with infantile nephropathic cystinosis compared with other chronic kidney disease entities and its clinical determinants

Chest configuration in children and adolescents with infantile nephropathic cystinosis compared with other chronic kidney disease entities and its clinical determinants

Association between Adherence to the Mediterranean Diet and Anthropometric and Health Variables in College-Aged Males

Multiple Diagnoses of Nutritional Rickets in An Inner-City Pediatric Population: A Case Series

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