A major health problem facing immigrant children: nutritional rickets.
immigrants
nutritional rickets
refugee
vitamin D deficiency
Journal
Journal of pediatric endocrinology & metabolism : JPEM
ISSN: 2191-0251
Titre abrégé: J Pediatr Endocrinol Metab
Pays: Germany
ID NLM: 9508900
Informations de publication
Date de publication:
23 Feb 2022
23 Feb 2022
Historique:
received:
21
06
2021
accepted:
22
09
2021
pubmed:
6
10
2021
medline:
31
3
2022
entrez:
5
10
2021
Statut:
epublish
Résumé
Nutritional rickets (NR) is still an important problem and one which increasing influxes of immigrants are further exacerbating. This study evaluated cases of mostly immigrant children followed up with diagnoses of NR in our pediatric endocrinology clinic. Details of 20 cases diagnosed with NR between 2017 and 2020 were retrieved from file records. Twenty (11 male) cases were included in the study. Three (15%) were Turkish nationals and the others (85%) were immigrants. Hypocalcemia and hypophosphatemia were detected in 17 and 13, respectively. Alkaline phosphatase (ALP) values were normal in two cases, while ALP and parathyroid hormone (PTH) values were elevated in all other cases, and PTH levels were very high (473.64 ± 197.05 pg/mL). 25-hydroxyvitamin D levels were below 20 ng/mL in all cases. Patients with NR received high-dose long-term vitamin D or stoss therapy. Six patients failed to attend long-term follow-up, while PTH and ALP levels and clinical findings improved at long-term follow-up in the other 14 cases. The elevated PTH levels suggest only the most severe cases of NR presented to our clinic. Clinically evident NR is therefore only the tip of the iceberg, and the true burden of subclinical rickets and osteomalacia remains unidentified. Public health policies should therefore focus on universal vitamin D supplementation and adequate dietary calcium provision, their integration into child surveillance programs, adequate advice and support to ensure normal nutrition, exposure to sunlight, and informing families of the increased risk not only for resident populations but also for refugee and immigrant children.
Identifiants
pubmed: 34610231
pii: jpem-2021-0420
doi: 10.1515/jpem-2021-0420
doi:
Substances chimiques
Calcium, Dietary
0
Parathyroid Hormone
0
Vitamin D
1406-16-2
Alkaline Phosphatase
EC 3.1.3.1
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
223-229Informations de copyright
© 2021 Walter de Gruyter GmbH, Berlin/Boston.
Références
Uday, S, Högler, W. Nutritional rickets and osteomalacia in the twenty-first century: revised concepts, public health, and prevention strategies. Curr Osteoporos Rep 2017;15:293–302. https://doi.org/10.1007/s11914-017-0383-y.
Pettifor, JM. Nutritional rickets: deficiency of vitamin D, calcium, or both? Am J Clin Nutr 2004;80:1725S–9S. https://doi.org/10.1093/ajcn/80.6.1725s.
Thacher, TD, Clarke, BL. Vitamin D insufficiency. Mayo Clin Proc 2011;86:50–60. https://doi.org/10.4065/mcp.2010.0567.
Tiosano, D, Hochberg, Z. Hypophosphatemia: the common denominator of all rickets. J Bone Miner Metabol 2009;27:392–401. https://doi.org/10.1007/s00774-009-0079-1.
Maiya, S, Sullivan, I, Allgrove, J, Yates, R, Malone, M, Brain, C, et al.. Hypocalcaemia and vitamin D deficiency: an important, but preventable, cause of life-threatening infant heart failure. Heart 2008;94:581–4. https://doi.org/10.1136/hrt.2007.119792.
Uday, S, Högler, W. Prevention of rickets and osteomalacia in the UK: political action overdue. Arch Dis Child 2018;103:901–6. https://doi.org/10.1136/archdischild-2018-314826.
Munns, CF, Shaw, N, Kiely, M, Specker, BL, Thacher, TD, Ozono, K, et al.. Global consensus recommendations on prevention and management of nutritional rickets. J Clin Endocrinol Metab 2016;101:394–415. https://doi.org/10.1210/jc.2015-2175.
Munns, CF, Shaw, N, Kiely, M, Specker, BL, Thacher, TD, Ozono, K, et al.. Global consensus recommendations on prevention and management of nutritional rickets. Horm Res Paediatr 2016;85:83–106. https://doi.org/10.1159/000443136.
Thacher, TD, Pludowski, P, Shaw, NJ, Mughal, MZ, Munns, CF, Högler, W. Nutritional rickets in immigrant and refugee children. Publ Health Rev 2016;37:3. https://doi.org/10.1186/s40985-016-0018-3.
Gültekin, A, Savaş, A, Özalp, İ. 0–3 yaş grubunda raşitizmin görülme sıklığı [Frequency of rickets in the 0–3 age group]. Çocuk Sağlığı ve Hastalıkları Dergisi 1985;28:119–25.
Ozkan, B, Büyükavcı, M, Aksoy, H, Tan, H, Akdağ, R. Incidence of rickets among 0–3 year old children in Erzurum. Çocuk Sagligi ve Hast Derg 1999;42:389–96.
Hatun, S, Bereket, A, Ozkan, B, Coşkun, T, Köse, R, Calıkoğlu, AS. Free vitamin D supplementation for every infant in Turkey. Arch Dis Child 2007;92:373–4. https://doi.org/10.1136/adc.2006.113829.
Ozkan, B, Doneray, H, Karacan, M, Vançelik, S, Yildirim, ZK, Ozkan, A, et al.. Prevalence of vitamin D deficiency rickets in the eastern part of Turkey. Eur J Pediatr 2009;168:95–100. https://doi.org/10.1007/s00431-008-0821-z.
Cesur, Y, Doğan, M, Ariyuca, S, Basaranoglu, M, Bektas, MS, Peker, E, et al.. Evaluation of children with nutritional rickets. J Pediatr Endocrinol Metab 2011;24:35–43. https://doi.org/10.1515/jpem.2011.108.
Thacher, TD, Fischer, PR, Tebben, PJ, Singh, RJ, Cha, SS, Maxson, JA, et al.. Increasing incidence of nutritional rickets: a population-based study in Olmsted County, Minnesota. Mayo Clin Proc 2013;88:176–83. https://doi.org/10.1016/j.mayocp.2012.10.018.
Neyzi, O, Bundak, R, Gökçay, G, Günöz, H, Furman, A, Darendeliler, F, et al.. Reference values for weight, height, head circumference, and body mass index in Turkish children. J Clin Res Pediatr Endocrinol 2015;7:280–93. https://doi.org/10.4274/jcrpe.2183.
Karacan Küçükali, G, Kurnaz, E, Savaş-Erdeve, Ş, Aycan, Z. Ülkemizde D vitamini profilaksisine rağmen devam eden bir problem: nutrisyonel Rikets [an on-going problem despite vitamin D prophylaxis in our country: nutritional rickets]. Türkiye Çocuk Hastalıkları Dergisi 2017;2:98–102.
Munns, CF, Simm, PJ, Rodda, CP, Garnett, SP, Zacharin, MR, Ward, LM, et al.. APSU vitamin D study group. Incidence of vitamin D deficiency rickets among Australian children: an Australian paediatric surveillance unit study. Med J Aust 2012;196:466–8. https://doi.org/10.5694/mja11.10662.
Beck-Nielsen, SS, Brock-Jacobsen, B, Gram, J, Brixen, K, Jensen, TK. Incidence and prevalence of nutritional and hereditary rickets in Southern Denmark. Eur J Endocrinol 2009;160:491–7. https://doi.org/10.1530/eje-08-0818.
Modgil, G, Williams, B, Oakley, G, Burren, CP. High prevalence of Somali population in children presenting with vitamin D deficiency in the UK. Arch Dis Child 2010;95:568–9. https://doi.org/10.1136/adc.2010.187435.
Callaghan, AL, Moy, RJ, Booth, IW, Debelle, G, Shaw, NJ. Incidence of symptomatic vitamin D deficiency. Arch Dis Child 2006;91:606–7. https://doi.org/10.1136/adc.2006.095075.
Banajeh, SM. Nutritional rickets and vitamin D deficiency-association with the outcomes of childhood very severe pneumonia: a prospective cohort study. Pediatr Pulmonol 2009;44:1207–15. https://doi.org/10.1002/ppul.21121.
Najada, AS, Habashneh, MS, Khader, M. The frequency of nutritional rickets among hospitalized infants and its relation to respiratory diseases. J Trop Pediatr 2004;50:364–8. https://doi.org/10.1093/tropej/50.6.364.
Bener, A, Hoffmann, GF. Nutritional rickets among children in a sun rich country. Int J Pediatr Endocrinol 2010;2010:410502. https://doi.org/10.1186/1687-9856-2010-410502.
Al-Atawi, MS, Al-Alwan, IA, Al-Mutair, AN, Tamim, HM, Al-Jurayyan, NA. Epidemiology of nutritional rickets in children. Saudi J Kidney Dis Transpl 2009;20:260–5.
Fida, NM. Assessment of nutritional rickets in Western Saudi Arabia. Saudi Med J 2003;24:337–40.
Robinson, PD, Högler, W, Craig, ME, Verge, CF, Walker, JL, Piper, AC, et al.. The re-emerging burden of rickets: a decade of experience from Sydney. Arch Dis Child 2006;91:564–8. https://doi.org/10.1136/adc.2004.069575.
Supporting Migrant Health Services in Turkey; SIHHAT project. Available from: http://www.sihhatproject.org/ [Accessed 14 Aug 2021].
Aguiar, M, Andronis, L, Pallan, M, Högler, W, Frew, E. Micronutrient deficiencies and health-related quality of life: the case of children with vitamin D deficiency. Publ Health Nutr 2020;23:1165–72. https://doi.org/10.1017/s1368980018003841.
Högler, W, Munns, CF. Rickets and osteomalacia: a call for action to protect immigrants and ethnic risk groups. Lancet Glob Health 2016;4:e229–30. https://doi.org/10.1016/s2214-109x(16)00061-9.
Uday, S, Naseem, S, Large, J, Denmeade, R, Goddard, P, Preece, MA, et al.. Failure of national antenatal vitamin D supplementation programme puts dark skinned infants at highest risk: a newborn bloodspot screening study. Clin Nutr 2021;40:3542–51. https://doi.org/10.1016/j.clnu.2020.12.008.
Uday, S, Kongjonaj, A, Aguiar, M, Tulchinsky, T, Högler, W. Variations in infant and childhood vitamin D supplementation programmes across Europe and factors influencing adherence. Endocr Connect 2017;6:667–75. https://doi.org/10.1530/ec-17-0193.