Raquitismo carencial en inmigrantes asiáticos

Possible Health Implications and Low Vitamin D Status during Childhood and Adolescence: An Updated Mini Review

Vitamin D deficiency is common in the developing countries and exists in both childhood and adult life. The great importance of Vitamin D is the moderation of calcium (Ca) and phosphorus (P) homeostasis as well as the absorption of Ca. While insufficiency of vitamin D is a significant contributing factor to risk of rickets in childhood, it is possible that a more marginal deficiency of vitamin D during life span contribute to osteoporosis as well as potentially to the development and various other chronic diseases such as cardiovascular disease, cancer and diabetes. This paper reviews the metabolism, epidemiology, and treatment of vitamin D and calcium insufficiency as well as its relation to various diseases during childhood and adolescence.

[Vitamin D deficiency in women of reproductive age]

OBJECTIVE

To determine the level of hypovitaminosis D in adult healthy women attended in primary care and their associated factors.

DESIGN

Cross-sectional, descriptive study.

SETTING

A neighbourhood of Barcelona, Spain, with a socially deprived population with a high percentage of immigrants, and urban factors which meant that they lived with hardly any sunlight.

PARTICIPANTS

Women between 15-50 years seen between February and March 2005.

MEASUREMENTS AND RESULTS

Primary: residence time (years), skin phototype, sun exposure, vitamin D deficiency pain type, calcium, vitamin D consumed, and measurement of serum 25-hydroxyvitamin D (25[OH]D) or calcidiol and parathyroid hormone (PTH) if (25[OH]D) was <10 ng/mL; 94 women were included. Mean age: 33 years (SD, 7.8); 62.8% immigrants (mean years of residence, 11.5). Mean (25[OH]D), 14.0 ng/mL (95% CI, 12.5-15.5). Skin phototype V-VI was associated with low levels of (25[OH]D) (P=.001). None of the women stated that they consumed the recommended amount of vitamin D and only 46% the recommended amount of calcium. Sun exposure of >4 hours/week: 37%. Sixteen percent had musculo-skeletal pain. No relationship was found between vitamin D levels and immigration. All the women had (25[OH]D) levels of <40 mg/mL, 47.9% had insufficient (25[OH]D), 10-20 ng/mL, and 37.2% were deficient: pound10 mg/mL. PTH was within the normal range.

CONCLUSIONS

All the women had low levels of vitamin D, more than a third of these, deficient. No relationship with immigration was found. A relationship was established between skin phototype V-VI and (25[OH]D) deficiency. None of the cases consumed the recommended amounts of vitamin D.

Vitamin D: a growing perspective

Vitamin D deficiency has been widely reported in all age groups in recent years. Rickets has never been eradicated in developed countries, and it most commonly affects children from recent immigrant groups. There is much evidence that current vitamin D guidelines for the neonatal period, 5-10 microg (200-400 IU)/day, prevent rickets at the typical calcium intakes in developed countries. The annual incidence of vitamin D-deficiency rickets in developed countries ranges between 2.9 and 7.5 cases per 100,000 children. The prevalence of vitamin D deficiency in mothers and their neonates is remarkable, and the results of one study suggest that third-trimester 25-hydroxyvitamin D (25(OH)D) is associated with fetal bone mineral accrual that may affect prepubertal bone mass accumulation. Beyond infancy, the evidence indicates that 5 microg (200 IU)/day of vitamin D has little effect on vitamin D status as measured by the serum 25(OH)D concentration. Two randomized clinical trials show that higher vitamin D intake improves one-year gain in bone density in adolescent girls. The functions of vitamin D extend beyond bone to include immune system regulation and anti-proliferative effects on cells. Early life vitamin D inadequacy is implicated in the risk of bone disease, autoimmune disease, and certain cancers later in life; however, long-term interventional studies do not exist to validate the widespread implementation of greater vitamin D consumption. Here we review the available data concerning vitamin D status and health effects of vitamin D in pregnancy through to and including adolescence.

[Foreign minors in the protection system of the Autonomous Community of Aragón (Spain)]

OBJECTIVES

To determine the prevalence of foreign minors in protection centers, their demographic characteristics, and reasons for entry, as well as the relation with geographic area, family, social and health risk factors, and high-priority health needs.

PATIENTS AND METHODS

We performed a retrospective cross-sectional study over an 11-year period (1992-2002). The health and socio-familial reports of 1,619 minors who were admitted to protection centers were reviewed and those from a foreign country were included. Compilation of information, definition of concepts, and health assessments were performed according to standard protocols.

RESULTS

Two hundred forty-one foreign minors (males 66.4 %) with a mean age (SD) of 11 (3.2) years (adolescents 64.7 %, infants-preschoolers 26.1 %) were admitted during the study period. The prevalence was 4.6 times higher than that expected. Origin: Africa 68.9 % (Maghreb 56.4 %, sub-Saharan 12.5 %), Europe 23.6 % (west 14.5 %, east 9.1 %), Latin-America 5.4 %, and Asia 2.1 %. Reasons for entry, demography and relation with geographic area were as follows: 1. Being an abandoned illegal immigrant 41.1 % (all male adolescents, 98 % from the Maghreb); 2. Maltreatment 33.2 % (passive maltreatment-to-active ratio 2.3:1, no difference by sex, age mode 2 years; Asia 80 %; Europe 61.5 %, west-to-east ratio 4.8:1, gypsy ethnicity from Portugal and Rumania 90.3 %; Latin-America 38.4 %; Africa 21.7 %, no difference by geographic area); 3. Temporary incapacity for their care 18.7 % (female-to-male ratio 1.8:1, age mode 1 year; Latin-America 38.4 %, Africa 18.1 %, Europe 17.5 %); 4. Other causes 7 %.

RISK FACTORS

at least one (78.4 %) and more than one (33.6 %); housing problems and especially living in a single parent family. Health disorders: at least one (65.1 %); disabling disease (2.1 %); main problems: dental (36.3 %), immunization (27.6 %), dermatologic (19.1 %), growth and nutrition (13.7 %), and infectious and parasitic diseases (13.3 %).

CONCLUSIONS

Being a minor immigrant in a foreign country with problems of documentation, housing or family regrouping and especially if there are language, cultural or racial (ethnic minorities) barriers is a major risk factor for living in a situation of vulnerability, risk or neglect/abandonment that requires social protection measures. Continuous follow-up by the social services of the adoptive community is required for the prevention and early detection of children in need of protection.

[Nutritional rickets in childhood: analysis of 62 cases]

BACKGROUND AND OBJECTIVE

Until recently, rickets secondary to vitamin D deficiency was considered a medical oddity rather than a clinical reality in Catalonia (Spain). However, recent data show a reemergence of the disease in the infancy.

PATIENTS AND METHOD

Retrospective clinical survey of epidemiologic and clinical features of infants and children (34 boys and 28 girls) diagnosed of nutritional rickets in pediatric departments of Catalonia (Spain) over the last 10 years.

RESULTS

Mean age (SD) at diagnosis was 9.9 (7) months (range: 3-36), 35.5% were under 6 months. Race distribution: blacks 61.3%, dark-skinned 36%; white 6.4%. Country of origin: Sub-Saharan Africa 59.7%, Morocco 33.9%, Catalonia 3.2%, Pakistan 1.6%. Seasonal distribution: 60% were diagnosed in autumn and winter. At diagnosis, 72% were following an exclusive milk diet (48% maternal milk alone) without vitamin D supplementation. Most common clinical presentation in infants under 6 months was: hypocalcemic tetany/seizures; in children aged 6-12 months: failure to thrive; and in children over 12 months: skeletal deformities. Weight and height expressed as z-score value at diagnosis was 0.67 and 0.91, respectively.

CONCLUSIONS

Nutritional rickets is a current reality in Catalonia and it mainly affects immigrant infants and children from Sub-Saharan Africa and Morocco, black or dark-skinned, fed with maternal milk alone, without vitamin D supplementation and with little sun exposure. Systematic, preventive supplementation with vitamin D is essential in these populations.