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Yıldırım R, Ünal E, Tekmenüray A. Evaluation of Clinical Characteristics of Vitamin D Dependent Rickets Type 1 (VDDR-1) Patients and Importance of Early Diagnosis. GÜNCEL PEDIATRI 2022. [DOI: 10.4274/jcp.2022.66564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Alpert PT, Shaikh U. The Effects of Vitamin D Deficiency and Insufficiency on the Endocrine and Paracrine Systems. Biol Res Nurs 2016; 9:117-29. [PMID: 17909164 DOI: 10.1177/1099800407308057] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Individuals are capable of producing vitamin D with proper exposure to sunlight. However, several factors can interfere with the effectiveness of this process. Most sunscreens filter out UVB light, thus inhibiting vitamin D production. Individuals with more darkly pigmented skin have greater difficulty producing vitamin D because melanin acts as an effective natural sunscreen, requiring longer sun exposure to produce an adequate daily allotment of vitamin D. Additionally, solely breastfed infants whose mothers suffered from vitamin D deficiency or insufficiency when pregnant have smaller reserves of the nutrient and are at greater risk of developing nutritional rickets. Vitamin D deficiency leads to rickets, osteomalacia, and osteoporosis. Long-term vitamin D insufficiency can lead to paracrine effects such as type 1 diabetes, cancer, and multiple sclerosis. This article reviews the current literature on vitamin D deficiency and insufficiency and their relation to different disease states. Potential areas for research are discussed.
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Papandreou D, Karabouta Z, Rousso I. Effects of low vitamin D status in rickets and type 1 diabetes in children. ACTA ACUST UNITED AC 2010. [DOI: 10.1108/00346651011076956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tuorkey MJ, Abdul-Aziz KK. Strategies for diabetes and pathways of vitamin D. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 2010. [DOI: 10.1016/j.dsx.2009.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Papandreou D, Malindretos P, Karabouta Z, Rousso I. Possible Health Implications and Low Vitamin D Status during Childhood and Adolescence: An Updated Mini Review. Int J Endocrinol 2010; 2010:472173. [PMID: 20011095 PMCID: PMC2778445 DOI: 10.1155/2010/472173] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Accepted: 06/17/2009] [Indexed: 12/22/2022] Open
Abstract
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.
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Affiliation(s)
- Dimitrios Papandreou
- 2nd Department of Pediatrics, Aristotle University of Thessaloniki, School of Medicine, Ahepa General Hospital, St. Kiriakidi 1, 54636 Thessaloniki, Greece
| | - Pavlos Malindretos
- Department of Pathology, Aristotle University of Thessaloniki, School of Medicine, Ahepa General Hospital, St. Kiriakidi 1, 54636 Thessaloniki, Greece
| | - Zacharoula Karabouta
- 2nd Department of Pediatrics, Aristotle University of Thessaloniki, School of Medicine, Ahepa General Hospital, St. Kiriakidi 1, 54636 Thessaloniki, Greece
| | - Israel Rousso
- 2nd Department of Pediatrics, Aristotle University of Thessaloniki, School of Medicine, Ahepa General Hospital, St. Kiriakidi 1, 54636 Thessaloniki, Greece
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Abstract
It is well-established that prolonged and severe vitamin D deficiency leads to rickets in children and osteomalacia in adults. More marginal vitamin D deficiency is likely to be a significant contributing factor to osteoporosis risk. However, recent emerging data from studies of adults suggest that low vitamin D status (serum 25-hydroxyvitamin D levels <50 nmol/l) may be contributing to the development of various chronic diseases, including cardiovascular disease, hypertension, diabetes mellitus, some inflammatory and autoimmune diseases, and certain cancers. Adequacy of vitamin D status in children and adolescents has been the focus of a number of recent investigations, and these studies have shown a high prevalence of low vitamin D status during the winter (especially in adolescents), with lower prevalence during the summer. Therefore, consideration of potential corrective strategies to allow children and adolescents to maintain adequate vitamin D status throughout the year, even in the absence of adequate summer sun exposure, is warranted.
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Affiliation(s)
- Kevin D Cashman
- Department of Food and Nutritional Sciences, Department of Medicine, University College, Cork, Ireland.
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Kubota T, Namba N, Kurotobi S, Kogaki S, Hirai H, Kitaoka T, Nakajima S, Ozono K. Beneficial Effect of Oral Bisphosphonate Treatment on Bone Loss Induced by Chronic Administration of Furosemide without Alteration of Its Administration and Urinary Calcium Loss. Clin Pediatr Endocrinol 2006; 15:101-7. [PMID: 24790329 PMCID: PMC4004841 DOI: 10.1297/cpe.15.101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Accepted: 04/25/2006] [Indexed: 11/29/2022] Open
Abstract
Bisphosphonate is widely used to treat patients with primary and secondary osteoporosis.
The chronic administration of furosemide is considered a risk factor for osteoporosis
mainly due to the increased urinary excretion of calcium, leading to a long-term negative
balance of calcium. We describe two patients with mild heart failure who took furosemide
for more than 5 yr and developed hyperparathyroidism and lumbago associated with low bone
mineral density. Their serum levels of intact parathyroid hormone and bone mineral density
(BMD) of the lumbar spine (L2-L4) were 180.8 and 144.3 pg/ml, and 71% and 80% of the mean
of healthy women, respectively. The oral administration of alendronate or risedronate was
effective for lumbago and improved BMD, although the urinary excretion of calcium and
hyperparathyroidism were not changed. For the medical treatment of lumbago and decreased
bone mass secondary to the long-term administration of furosemide, bisphosphonate is
proposed when the dose of furosemide cannot be reduced. However, it may be important to
give sufficient calcium and vitamin D to patients to improve secondary
hyperparathyroidism.
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Affiliation(s)
- Takuo Kubota
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Noriyuki Namba
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan ; The First Department of Oral and Maxillofacial Surgery, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Shunji Kurotobi
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shigetoyo Kogaki
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Haruhiko Hirai
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Taichi Kitaoka
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shigeo Nakajima
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Keiichi Ozono
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
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Abstract
OBJECTIVE The purpose of this work was to assess the vitamin D status of breastfed infants living in Iowa (latitude: 41 degrees N). METHODS Blood samples and dietary records from 84 breastfed infants participating in another study were used for a survey of vitamin D status at 280 days of age. The vitamin D status of those (35 infants) who did not receive preformed vitamin D at 280 days of age (unsupplemented infants) was assessed longitudinally between 112 days and 15 months of age. Plasma 25-hydroxyvitamin D and, in most cases, parathyroid hormone and alkaline phosphatase were determined. RESULTS At 280 days of age, 10% of breastfed infants were vitamin D deficient (25-hydroxyvitamin D < 11 ng/mL). Deficiency was significantly more prevalent among dark-skinned infants and during winter and occurred exclusively in unsupplemented infants. During winter, 78% of unsupplemented infants were vitamin D deficient. During summer, only 1 infant who had dark skin pigmentation was vitamin D deficient. Longitudinal assessment of unsupplemented infants similarly showed that the majority of breastfed infants were vitamin D deficient during winter. Severe deficiency (25-hydroxyvitamin D < 5 ng/mL) was common and was accompanied by elevation of parathyroid hormone and alkaline phosphatase. The prevalence of vitamin D deficiency decreased with age but was still 12% at 15 months of age if no preformed vitamin D was received. CONCLUSIONS Vitamin D deficiency, including severe deficiency, was common among breastfed infants in Iowa who did not receive preformed vitamin D. Deficiency occurred mostly during winter but was not completely absent during summer. It affected infants with light as well as dark skin pigmentation. Consumption of preformed vitamin D from vitamin supplements or formula is effective in preventing vitamin D deficiency. Vitamin D supplementation should be provided to all breastfed infants.
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Affiliation(s)
- Ekhard E Ziegler
- Department of Pediatrics, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, Iowa 52242, USA.
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Kubota T, Kotani T, Miyoshi Y, Santo Y, Hirai H, Namba N, Shima M, Shimizu K, Nakajima S, Ozono K. A spectrum of clinical presentations in seven Japanese patients with vitamin d deficiency. Clin Pediatr Endocrinol 2006; 15:23-8. [PMID: 24790316 PMCID: PMC4004900 DOI: 10.1297/cpe.15.23] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Accepted: 09/20/2005] [Indexed: 11/04/2022] Open
Abstract
Recently, the reemergence of vitamin D deficiency in developed countries has been pointed out. Vitamin D deficiency is diagnosed based on the serum 25-hydroxyvitamin D (25OHD) level. However, its normal range is still controversial, making the diagnosis of vitamin D deficiency difficult. Here, we present seven Japanese patients diagnosed with vitamin D deficiency. Three patients complained of leg bowing, and the other four of tetany. The patients with leg bowing were toddlers. Radiographic surveys demonstrated evidence of rickets. Laboratory findings showed decreased levels of serum inorganic phosphorus and increased levels of alkaline phosphatase (ALP) and intact-parathyroid hormone (iPTH). The serum levels of 25OHD were relatively low, ranging from 13 to 15.2 ng/ml. Of the patients with tetany, three were young infants. Laboratory findings showed decreased levels of serum calcium and increased levels of ALP and iPTH. The serum levels of 25OHD were markedly decreased (below 8 ng/ml). Thus, these results indicate that relatively low levels of 25OHD can cause rickets, a symptom of vitamin D deficiency, and that clinicians should therefore carefully evaluate the levels of 25OHD.
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Affiliation(s)
- Takuo Kubota
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomoo Kotani
- Department of Pediatrics, Toyonaka Municipal Hospital, Osaka, Japan
| | - Yoko Miyoshi
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoko Santo
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Haruhiko Hirai
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Noriyuki Namba
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan ; The First Department of Oral and Maxillofacial Surgery, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Masaaki Shima
- Department of Pediatrics, NTT West Osaka Hospital, Osaka, Japan
| | - Kazuo Shimizu
- Department of Pediatrics, Toyonaka Municipal Hospital, Osaka, Japan
| | - Shigeo Nakajima
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Keiichi Ozono
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
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Abstract
For infants and children, vitamin D deficiency causes a bone-deforming disease known as rickets. As breastfeeding rates have increased, so have the incidences of rickets. The current recommendation from the American Academy of Pediatrics, to supplement all breastfed infants with vitamin D, is controversial. The role of the nurse is to understand the vitamin D dilemma, promote breastfeeding, and prevent vitamin D deficiency rickets.
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Weisberg P, Scanlon KS, Li R, Cogswell ME. Nutritional rickets among children in the United States: review of cases reported between 1986 and 2003. Am J Clin Nutr 2004; 80:1697S-705S. [PMID: 15585790 DOI: 10.1093/ajcn/80.6.1697s] [Citation(s) in RCA: 191] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Reports of hypovitaminosis D among adults in the United States have drawn attention to the vitamin D status of children. National data on hypovitaminosis D among children are not yet available. Reports from 2000 and 2001 of rickets among children living in North Carolina, Texas, Georgia, and the mid-Atlantic region, however, confirmed the presence of vitamin D deficiency among some US children and prompted new clinical guidelines to prevent its occurrence. We reviewed reports of nutritional rickets among US children <18 y of age that were published between 1986 and 2003. We identified 166 cases of rickets in 22 published studies. Patients were 4-54 mo of age, although in 17 studies the maximal age was <30 mo. Approximately 83% of children with rickets were described as African American or black, and 96% were breast-fed. Among children who were breast-fed, only 5% of records indicated vitamin D supplementation during breast-feeding. The American Academy of Pediatrics (AAP) recently recommended a minimal intake of 200 IU/d vitamin D for all infants, beginning in the first 2 mo of life. AAP recommends a vitamin D supplement for breast-fed infants who do not consume at least 500 mL of a vitamin D-fortified beverage. Given our finding of a disproportionate number of rickets cases among young, breast-fed, black children, we recommend that education regarding AAP guidelines emphasize the higher risk of rickets among these children. Education should also emphasize the importance of weaning children to a diet adequate in both vitamin D and calcium.
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Affiliation(s)
- Pamela Weisberg
- Maternal Child Nutrition Branch, Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA
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Abrams SA, Atkinson SA. Calcium, magnesium, phosphorus and vitamin D fortification of complementary foods. J Nutr 2003; 133:2994S-9S. [PMID: 12949399 DOI: 10.1093/jn/133.9.2994s] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Provision of the bone minerals and vitamin D as fortificants in food or as dietary supplements designed for older infants and toddlers in Latin America is likely to be beneficial and safe. Currently available data are inadequate to establish the precise amounts of these nutrients that would be required for such a supplement. These amounts would vary according to the local base diet. However, reasonable estimates can be made on the basis of current dietary recommendations as well as existing data on bioavailability and customary intake. The strongest case can be made for calcium and vitamin D supplementation. Because excessive dietary calcium can reduce zinc absorption as a result of interactive effects within the intestine, an appropriate ratio of calcium to zinc should be used, even if this means adding zinc as a fortificant or supplement. Magnesium supplementation may be appropriate in some circumstances but it cannot be routinely advocated at present. It is unlikely that phosphorus supplementation is needed for most population groups because of the relatively high usual dietary phosphorus intakes, primarily from phosphate salts added to carbonated beverages and as food preservatives.
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Affiliation(s)
- Steven A Abrams
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030, USA.
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