Nutritional rickets without vitamin D deficiency in Bangladesh

Fischer, Philip R.; Rahman, Ahmed Shafiqur; Cimma, J. P.; Kyaw-Myint, T. O.; Kabir, Arml; Talukder, K R; Hassan, Nazmul; Manaster, B.J.; Staab, David; Duxbury, J. M.; Welch, R. M.; Meisner, C. A.; Haque, Shahidul; Combs, Gerald F.

doi:10.1093/tropej/45.5.291

Cited by 113 publications

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“…It tends to be thought of in historic terms, without the recognition in many quarters that it continues to be a source of disability in the developing world. In recent years, rickets has been reported in some 21 countries (Bishop, 2001), including Tibet (Harris et al, 2001), Kuwait (Majid Molla et al, 2000), Ethiopia (Muhe et al, 1997), Yemen, (Banajeh et al, 1997), Mongolia (Fraser & Tserendolgor, 2001), the United Kingdom (Mughal et al, 1999), the United States (Eugster et al, 1996;Pugliese et al, 1998;Kreiter et al, 2000;Shah et al, 2000), South Africa (Pettifor et al, 1978), Nigeria (Okonofua et al, 1991;Oginni et al, 1996;Thacher et al, 1997Thacher et al, , 1999Thacher et al, , 2000a, and Bangladesh (Snedecor & Cochran, 1967;Anonymous, 1998;Fischer et al, 1999;Staab et al, 1999;Karim et al, 2001). While some of these reports describe sporadic occurrences of the disease in association with lifestyle and the lack of solar exposure sufficient to support adequate vitamin D biosynthesis, studies in South Africa (Pettifor et al, 1978) and Nigeria (Okonofua et al, 1991;Oginni et al, 1996;Thacher et al, 1997Thacher et al, , 1999Thacher et al, , 2000a have shown the disease to be caused by primary dietary deficiencies of calcium (Ca).…”

Section: Introductionmentioning

confidence: 99%

The Chakaria food system study: household-level, case–control study to identify risk factor for rickets in Bangladesh

Combs

Hassan

2005

Eur J Clin Nutr

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Objective: A comprehensive, multiround survey of local food systems in a rickets-endemic area of Bangladesh was conducted to identify household-level risk factors for rickets. Design: A household-level, case-control study was conducted in a rickets-endemic area, Chakaria, with planned comparisons between households with one or more rachitic child and neighboring households with no affected children. Setting: A rickets-endemic area of southeastern Bangladesh, Chakaria. Subjects and methods: An interview-based survey was conducted in six villages in Chakaria with 199 households with at least one child showing physical signs consistent with rickets and 281 households with no affected children. Results: Households with rachitic children in Chakaria had more children, more pregnant or lactating women, and fewer adults than unaffected households in that community. Affected households tended to rely on farming for their livelihood and tended to have less economic activity as indicated by less outstanding debt than their neighbors. Households with rickets were at significantly greater risk of pneumonia than were other households. Calcium undernutrition was severe and widespread in Chakaria due to a food system that offered very little of the element in accessible forms. Household diets were based on cereals and starchy vegetables. Rice and fish constituted the major source of calcium for most households, although dairy products, when used, were very important calcium sources, particularly for young children. In fact, the use of dairy products was the only household choice that led to substantial increases in the calcium intakes of children, and households that used dairy products tended to show increased calcium intakes for all of their members. Conclusions: The risk of a Chakarian household having a child with rickets appeared to be related to its economic status. Although this might be expected to be manifest as limitations in food access and/or use, rickets households failed to show a dietary pattern associated with rickets. Calcium undernutrition was prevalent and, thus, would appear to be a predisposing factor for rickets; however, calcium undernutrition was prevalent in Chakarian households with and without rickets. Therefore, it is probable that another precipitating factor(s) play a role(s) in the etiology of rickets in Chakaria.

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Section: Introductionmentioning

confidence: 99%

The Chakaria food system study: household-level, case–control study to identify risk factor for rickets in Bangladesh

Combs

Hassan

2005

Eur J Clin Nutr

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“…[3][4][5] These reports, which deviate from the earlier concept, have stimulated much interest. [6][7][8][9] More recently there have been reports of rickets apparently caused by calcium deficiency in Bangladesh 10 and also Colombia, 11 whereas the rickets associated with dietary calcium deficiency in India appears to be linked to fluoride toxicity. 12 Some evidence of healing of rickets with calcium has been reported from South Africa [13][14][15] and in Nigerian infants, 4 but this has remained controversial.…”

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confidence: 99%

Radiological and biochemical resolution of nutritional rickets with calcium * COMMENTARY

Oginni

Sharp²,

Badru³

et al. 2003

Archives of Disease in Childhood

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Aims: To determine the response to oral calcium in Nigerian children with rickets. Methods: In a teaching hospital in Western Nigeria, 26 children (13 boys, 13 girls, aged 2-5 years) with confirmed rickets received calcium lactate (2.7 g/day). Results: Within one month of treatment leg pain was relieved and the children were more active. The mean x ray score improved from 3.3 at baseline to 1.7 at three months and 0.9 at six months (arbitrary scoring system, 0-6). Twelve cases were healed radiologically after six months, 11 others improved considerably, two showed no significant improvement, and a non-compliant patient was worse. There was progressive reversal of biochemical features. Median plasma alkaline phosphatase fell from 519 (range 178-1078) to 283 (209-443) IU/l (p = 0.04) in four months, while mean 1,25-dihydroxyvitamin D fell from 473 (251-1057) to 281 (155-481) pmol/l (p = 0.04), and mean plasma calcium increased from 2.26 (1.63-2.54) to 2.37 (2.06-2.54) mmol/l (p = 0.13). Parathyroid hormone fell from 5.3 (0.4-21.5) to 1.7 (0.45-7.4) pmol/l. Type I collagen carboxy terminal cross linked telopeptide was very high at baseline (20 (7.2-103) to 14 (11-24) µg/l) (p = 0.03) and fell promptly to normal. Conclusion: Calcium supplementation alone effected healing of rickets in most of these Nigerian children and may provide sufficient treatment in this environment.

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“…A number of studies have indicated the importance of low dietary calcium intake in the pathogenesis of nutritional rickets in children particularly in those living in communities in developing countries, [18][19][20][21][22][23] where calcium intakes are characteristically low and hours of daily sunshine adequate. Furthermore, a single report from the USA suggests that low dietary calcium intake might be responsible for nutritional rickets in toddlers whose dairy intakes are limited.…”

Section: Dietary Calcium Deficiency Ricketsmentioning

confidence: 99%

Vitamin D/dietary calcium deficiency rickets and pseudo-vitamin D deficiency rickets

Glorieux

Pettifor

2014

BoneKEy Reports

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This review describes the pathogenesis, clinical presentation and biochemical perturbations found in privational (nutritional) rickets and pseudo-vitamin D deficiency rickets (PDDR), an autosomal recessive condition with loss of function mutations in CYP27B1. It may seem strange to combine a discussion on privational rickets and PDDR as a single topic, but privational rickets and PDDR present with similar clinical signs and symptoms and with similar perturbations in bone and mineral metabolism. Of interest is the characteristic lack of features of rickets at birth in infants with PDDR, a finding which has also been reported in infants born to vitamin D-deficient mothers. This highlights the independence of the fetus and neonate from the need for vitamin D to maintain calcium homeostasis during this period. The variable roles of vitamin D deficiency and dietary calcium deficiency in the pathogenesis of privational rickets are discussed and the associated alterations in vitamin D metabolism highlighted. Although PDDR is a rare autosomal recessive disorder, results of long-term follow-up are now available on the effect of treatment with calcitriol, and these are discussed. Areas of uncertainty, such as should affected mothers breastfeed their infants, are emphasized.

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Nutritional rickets without vitamin D deficiency in Bangladesh

Cited by 113 publications

References 0 publications

The Chakaria food system study: household-level, case–control study to identify risk factor for rickets in Bangladesh

The Chakaria food system study: household-level, case–control study to identify risk factor for rickets in Bangladesh

Radiological and biochemical resolution of nutritional rickets with calcium * COMMENTARY

Vitamin D/dietary calcium deficiency rickets and pseudo-vitamin D deficiency rickets

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