Protein-Calorie Nutritional Status of Infants with Deficiency Rickets in Riyadh

Abstract

Rickets among breast-fed infants is seen in Riyadh, Saudi Arabia. This study was carried out to elucidate the relationship between protein-calorie malnutrition (PCM) and rickets, since a positive correlation has been reported from other areas of the Middle East and India. Children with active rickets were assessed nutritionally, clinically and anthropometrically and were compared to nonrachitic children. The protein-calorie nutritional status of rachitic and nonrachitic children did not show a statistically significant difference. Only 31% of the rachitic children in this study were malnourished in contrast to more than 70% in three other reports. Malnutrition was more marked after the first year of life, especially among breastfed infants who received no nutritional supplement. Nutritional rickets in Riyadh usually occurs as an isolated disease entity related to environmental deprivation of sunlight among infants with no dietary vitamin D supplementation. The PCM that may occur in some of the rachitic children is merely coincidental.

Differences in vitamin D status and calcium metabolism in Saudi Arabian boys and girls aged 6 to 18 years: effects of age, gender, extent of veiling and physical activity with concomitant implications for bone health

“…These countries have experienced rapid economic and social changes during the past two decades, resulting in a marked improvement in lifestyle and health status (6)(7)(8)(9)(10)(11) . However, these rapid changes have led to the development of a paradoxical situation regarding nutrition, in that both a lack of and an excess of nutrition coexist.…”

“…However, these rapid changes have led to the development of a paradoxical situation regarding nutrition, in that both a lack of and an excess of nutrition coexist. Undernutrition has manifested as growth retardation/bone deformity among pre-school children and Fe-deficiency anaemia, while overnutrition has manifested as obesity, dental caries and non-communicable disease (5,(7)(8)(9)(10)(11) .…”

Vitamin D Deficiency Rickets in a Sunny Country: Pathogenesis, Clinical Picture and Management

“…6,24 Although cases of congenital rickets have been reported, 25,26 the youngest infant seen with clinical rickets in our series was two months old, and this presented with hypocalcemic convulsions associated with minimal bony changes. 24 The mothers of rachitic infants were found to be vita-min-D deficient, 27 and paired maternal and cord blood vitamin D status proved to be low. 28,29 In spite of this low 25-OHD, calcium levels in cord blood were maintained within normal limits and were even higher than the corresponding maternal levels.…”

“…24 This proves that breast-feeding can maintain an adequate nutritional status for the first six to nine months of life, 50 but it does not supply infants with enough vitamin D to meet the needs of bone growth. 51,52 It has been proven beyond doubt that there is no water-soluble vitamin D sulphate in breast milk.…”

“…Most of the rachitic infants were living in either flats or traditional mud houses. 6,24 The traditional mud house is high walled with small, high windows. Neither of these types of dwellings offer direct access to sunshine, in contrast to rural houses that have courtyards where mothers and their children can have privacy and still be exposed to sunlight.…”