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Kısa B, Kansu-Celik H, Candar T, Erol Koc EM, Sert UY, Uzunlar O. Severe 25-OH vitamin D deficiency as a reason for adverse pregnancy outcomes. J Matern Fetal Neonatal Med 2019; 33:2422-2426. [PMID: 30614393 DOI: 10.1080/14767058.2018.1554040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: There is a growing concern about the unfavorable effects of vitamin D deficiency in general population, including pregnant women, worldwide. The aim of this study is to evaluate the effect of severe maternal serum 25-OH vitamin D levels on adverse pregnancy outcomes in first trimester.Material and methods: Serum samples of 86 pregnant women in first trimester were collected prospectively from May 2017 to June 2017. Serum 25-OH vitamin D levels were analyzed by enzyme immunoassay method. Patients were classified according to maternal serum 25-OH vitamin D levels as group 1 (n = 34) <10 ng/ml and group 2 (n = 52) >10 ng/ml. The two groups were compared in terms of adverse pregnancy outcomes.Results: The mean 25-OH vitamin D levels of the total 86 pregnant women were 13.83 (6-48) ng/ml. 40% of the pregnant women had low level of 25-OH vitamin D levels (<10 ng/ml). The adverse pregnancy outcomes were significantly increased in group 1 (p<.018).Conclusions: Maternal serum 25-OH vitamin D levels <10 ng/ml is a risk factor for adverse pregnancy outcomes. 25-OH vitamin D levels should be screened in high-risk pregnant women and treated in case of deficiency.
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Affiliation(s)
- Burcu Kısa
- Obstetrics and Gynecology, University of Health Science, Zekai Tahir Burak Education and Research Hospital, Ankara, Turkey
| | - Hatice Kansu-Celik
- Obstetrics and Gynecology, University of Health Science, Zekai Tahir Burak Education and Research Hospital, Ankara, Turkey
| | - Tuba Candar
- Department of Biochemistry, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Esin Merve Erol Koc
- Obstetrics and Gynecology, University of Health Science, Zekai Tahir Burak Education and Research Hospital, Ankara, Turkey
| | - Umit Yasemin Sert
- Obstetrics and Gynecology, University of Health Science, Zekai Tahir Burak Education and Research Hospital, Ankara, Turkey
| | - Ozlem Uzunlar
- Obstetrics and Gynecology, University of Health Science, Zekai Tahir Burak Education and Research Hospital, Ankara, Turkey
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Yakoob MY, Salam RA, Khan FR, Bhutta ZA. Vitamin D supplementation for preventing infections in children under five years of age. Cochrane Database Syst Rev 2016; 11:CD008824. [PMID: 27826955 PMCID: PMC5450876 DOI: 10.1002/14651858.cd008824.pub2] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Vitamin D is a micronutrient important for bone growth and immune function. Deficiency can lead to rickets and has been linked to various infections, including respiratory infections. The evidence on the effects of supplementation on infections in children has not been assessed systematically. OBJECTIVES To evaluate the role of vitamin D supplementation in preventing pneumonia, tuberculosis (TB), diarrhoea, and malaria in children under five years of age. This includes high-, middle-, and low-income countries. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Library, MEDLINE, EMBASE, LILACS, the WHO International Clinical Trials Registry Platform (ICTRP; http://www.who.int/ictrp/en/) , ClinicalTrials.gov and the ISRCTN registry (http://www.isrctn.com/) up to 16 June 2016. SELECTION CRITERIA We included randomized controlled trials (RCTs) that evaluated preventive supplementation of vitamin D (versus placebo or no intervention) in children under five years of age. DATA COLLECTION AND ANALYSIS Two review authors independently screened the titles and abstracts, extracted the data, and assessed the risk of bias of included trials. MAIN RESULTS Four trials met the inclusion criteria, with a total of 3198 children under five years of age, and were conducted in Afghanistan, Spain, and the USA. Prevalence of vitamin D deficiency varied widely in these populations (range: 73.1% in Afghanistan, 10 to 12% in USA, and 6.2% in Spain). The included trials evaluated mortality (two trials), pneumonia incidence (two trials), diarrhoea incidence (two trials), hospitalization (two trials), and mean serum vitamin D concentrations (four trials).We do not know whether vitamin D supplementation impacts on all-cause mortality because this outcome was underpowered due to few events (risk ratio (RR) 1.43, 95% confidence interval (CI) 0.54 to 3.74; one trial, 3046 participants, low quality evidence).For pneumonia, episodes of 'radiologically confirmed' first or only episode of pneumonia were little different in the supplemented and unsupplemented group (Rate Ratio: 1.06, 95% confidence interval (CI) 0.89 to 1.26; two trials, 3134 participants, moderate quality evidence), and similarly for children with confirmed or unconfirmed pneumonia (RR 0.95, 95% CI 0.87 to 1.04; one trial, 3046 participants). In these two trials there were no obvious differences between supplemented and unsupplemented children regarding episodes of diarrhoea.In the single large trial from Afghanistan, the trial authors reported that vitamin D supplementation was associated with an increase in repeat episodes of pneumonia confirmed by chest radiograph (RR 1.69, 95% CI 1.28 to 2.21; one trial, 3046 participants), but not reflected in the outcome of confirmed or unconfirmed pneumonia (RR 1.06, 95% CI 1.00 to 1.13; one trial, 3046 participants).For hospital admission measured in one small trial, there was no difference detected (RR 0.86, 95% CI 0.20 to 3.62; one trial, 88 participants; very low quality evidence).The mean serum vitamin D concentrations were higher in supplemented compared to unsupplemented children at the end of supplementation (MD 7.72 ng/mL, 95% CI 0.50 to 14.93; four trials, 266 participants, low quality evidence). These results were driven primarily by two smaller trials with large magnitudes of effect. In the other two bigger trials, serum vitamin D concentrations were elevated in the intervention group for most of the trial duration but not at the end of supplementation. This may be due to time elapsed at measurement from the last dose, incomplete compliance, or increased need of vitamin D with infant age.We did not find any trial that reported on the incidence of TB, malaria or febrile illness, duration of pneumonia, duration of diarrhoea, severity of infection, and cause-specific mortality (due to TB, diarrhoea, or malaria). AUTHORS' CONCLUSIONS Evidence from one large trial did not demonstrate benefit of vitamin D supplementation on the incidence of pneumonia or diarrhoea in children under five years. To our knowledge, trials that evaluated supplementation for preventing other infections, including TB and malaria, have not been performed.
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Affiliation(s)
- Mohammad Y Yakoob
- Harvard School of Public HealthDepartments of Epidemiology and Nutrition677 Huntington AvenueBostonMAUSA02115
| | - Rehana A Salam
- Aga Khan University HospitalDivision of Women and Child HealthStadium RoadPO Box 3500KarachiSindPakistan74800
| | - Farhan R Khan
- Aga Khan University HospitalDepartment of SurgeryStadium RoadPO Box 3500KarachiSindhPakistan74800
| | - Zulfiqar A Bhutta
- Hospital for Sick ChildrenCenter for Global Child HealthTorontoONCanadaM5G A04
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Munns CF, Shaw N, Kiely M, Specker BL, Thacher TD, Ozono K, Michigami T, Tiosano D, Mughal MZ, Mäkitie O, Ramos-Abad L, Ward L, DiMeglio LA, Atapattu N, Cassinelli H, Braegger C, Pettifor JM, Seth A, Idris HW, Bhatia V, Fu J, Goldberg G, Sävendahl L, Khadgawat R, Pludowski P, Maddock J, Hyppönen E, Oduwole A, Frew E, Aguiar M, Tulchinsky T, Butler G, Högler W. Global Consensus Recommendations on Prevention and Management of Nutritional Rickets. Horm Res Paediatr 2016; 85:83-106. [PMID: 26741135 DOI: 10.1159/000443136] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 09/17/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Vitamin D and calcium deficiencies are common worldwide, causing nutritional rickets and osteomalacia, which have a major impact on health, growth, and development of infants, children, and adolescents; the consequences can be lethal or can last into adulthood. The goals of this evidence-based consensus document are to provide health care professionals with guidance for prevention, diagnosis, and management of nutritional rickets and to provide policy makers with a framework to work toward its eradication. EVIDENCE A systematic literature search examining the definition, diagnosis, treatment, and prevention of nutritional rickets in children was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system that describes the strength of the recommendation and the quality of supporting evidence. PROCESS Thirty-three nominated experts in pediatric endocrinology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. RESULTS This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. CONCLUSION Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required.
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Munns CF, Shaw N, Kiely M, Specker BL, Thacher TD, Ozono K, Michigami T, Tiosano D, Mughal MZ, Mäkitie O, Ramos-Abad L, Ward L, DiMeglio LA, Atapattu N, Cassinelli H, Braegger C, Pettifor JM, Seth A, Idris HW, Bhatia V, Fu J, Goldberg G, Sävendahl L, Khadgawat R, Pludowski P, Maddock J, Hyppönen E, Oduwole A, Frew E, Aguiar M, Tulchinsky T, Butler G, Högler W. Global Consensus Recommendations on Prevention and Management of Nutritional Rickets. J Clin Endocrinol Metab 2016; 101:394-415. [PMID: 26745253 PMCID: PMC4880117 DOI: 10.1210/jc.2015-2175] [Citation(s) in RCA: 628] [Impact Index Per Article: 78.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Vitamin D and calcium deficiencies are common worldwide, causing nutritional rickets and osteomalacia, which have a major impact on health, growth, and development of infants, children, and adolescents; the consequences can be lethal or can last into adulthood. The goals of this evidence-based consensus document are to provide health care professionals with guidance for prevention, diagnosis, and management of nutritional rickets and to provide policy makers with a framework to work toward its eradication. EVIDENCE A systematic literature search examining the definition, diagnosis, treatment, and prevention of nutritional rickets in children was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system that describe the strength of the recommendation and the quality of supporting evidence. PROCESS Thirty-three nominated experts in pediatric endocrinology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. RESULTS This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. CONCLUSION Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required.
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Yang N, Wang L, Li Z, Chen S, Li N, Ye R. Effects of vitamin D supplementation during pregnancy on neonatal vitamin D and calcium concentrations: a systematic review and meta-analysis. Nutr Res 2015; 35:547-56. [DOI: 10.1016/j.nutres.2015.04.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 04/08/2015] [Accepted: 04/14/2015] [Indexed: 12/11/2022]
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Das JK, Salam RA, Lassi ZS, Bhutta ZA. Food fortification with calcium and vitamin D: impact on health outcomes. Cochrane Database Syst Rev 2012. [DOI: 10.1002/14651858.cd010201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Jai K Das
- Aga Khan University Hospital; Division of Women and Child Health; Stadium Road, P.O. Box 3500 Karachi Sind Pakistan
| | - Rehana A Salam
- Aga Khan University Hospital; Department of Paediatrics, Division of Women and Child Health; Stadium Road PO Box 3500 Karachi Sind Pakistan 74800
| | - Zohra S Lassi
- Aga Khan University Hospital; Division of Women and Child Health; Stadium Road, P.O. Box 3500 Karachi Sind Pakistan
| | - Zulfiqar A Bhutta
- Aga Khan University Hospital; Division of Women and Child Health; Stadium Road, P.O. Box 3500 Karachi Sind Pakistan
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Lindsay KL, Gibney ER, McAuliffe FM. Maternal nutrition among women from Sub-Saharan Africa, with a focus on Nigeria, and potential implications for pregnancy outcomes among immigrant populations in developed countries. J Hum Nutr Diet 2012; 25:534-46. [PMID: 22594552 DOI: 10.1111/j.1365-277x.2012.01253.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Pregnant women in countries of Sub-Saharan Africa (SSA) are at risk of poor nutritional status and adverse outcomes as a result of poverty, food insecurity, sub-optimal healthcare facilities, frequent infections and frequent pregnancies. Studies from Nigeria, for example, have revealed a high prevalence of both under- and over-nutrition, as well as nutrient deficiencies, including iron, folate, vitamin D and vitamin A. Subsequently, obstetric complications, including hypertension, anaemia, neural tube defects, night-blindness, low birth weight and maternal and perinatal mortality, are common. Migration patterns from SSA to the Western world are on the rise in recent years, with Nigerians now representing the most prevalent immigrant African population in many developed countries. However, the effect of immigration, if any, on the nutritional status and pregnancy outcomes of these women in their host countries has not yet been studied. Consequently, it is unknown to what extent the nutritional deficiencies and pregnancy complications occurring in Nigeria, and other countries of SSA, present in these women post-emigration. This may result in missed opportunities for appropriate antenatal care of a potential high-risk group in pregnancy. The present review discusses the literature regarding nutrition in pregnancy among SSA women, using Nigeria as an example, the common nutrition-related complications that arise and the subsequent obstetric outcomes. The concept of dietary acculturation among immigrant groups is also discussed and deficiencies in the literature regarding studies on the diets of pregnant immigrant women are highlighted.
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Affiliation(s)
- K L Lindsay
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, National Maternity Hospital, Dublin 2, Ireland
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Mannaa F, El-Shamy KA, El-Shaikh KA, El-Kassaby M. Efficacy of fish liver oil and propolis as neuroprotective agents in pilocarpine epileptic rats treated with valproate. PATHOPHYSIOLOGY 2011; 18:287-94. [DOI: 10.1016/j.pathophys.2011.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 04/17/2010] [Accepted: 04/20/2011] [Indexed: 11/17/2022] Open
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Cesur Y, Doğan M, Ariyuca S, Basaranoglu M, Bektas MS, Peker E, Akbayram S, Caksen H. Evaluation of children with nutritional rickets. J Pediatr Endocrinol Metab 2011; 24:35-43. [PMID: 21528813 DOI: 10.1515/jpem.2011.108] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To evaluate the clinical findings, risk factors, therapy and outcome in 946 children with nutritional rickets. PATIENTS AND METHODS This retrospective study included a review of medical records of patients with nutritional rickets between March 2004 and 2009. Patients who displayed both the biochemical inclusion criteria and the clinical signs/symptoms or radiological signs of rickets were included in the study. RESULTS The present study included 946 patients aged between 4 months and 15 years. Distribution of the cases showed a density between December and May. The age at diagnosis, showed two peaks and most of the patients were in the age range 0-23 months and 12.0-15 years. In infants and young children, most of the patients had been admitted to the hospital due to infectious diseases. In older children, short stature and obesity were the most common complaints. CONCLUSION Children aged between 0-23 months and 12.0-15 years were under most risk for nutritional rickets, especially in winter and spring and vitamin D should be given to them as supplementation dose.
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Affiliation(s)
- Yasar Cesur
- Department of Pediatrics, School of Medicine, Yuzuncu Yil University, Van, Turkey
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10
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Abstract
Rickets is a mineralization disorder of the growing bone. Nutritional rickets is still prevalent in many parts of the developing world and is re-emerging in developed countries. Although vitamin D deficiency plays a central role in the pathogenesis of this disease, calcium deficiency and genetic factors may also cause or contribute to the development of rickets. This review will focus on the classical form of nutritional rickets, in other words, vitamin D-deficiency rickets. The epidemiology, ethiopathogenesis, risk factors, clinical picture, diagnosis, treatment and prevention of nutritional rickets are reviewed.
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Affiliation(s)
- Abdullah Bereket
- Marmara University, School of Medicine, Division of Pediatric Endocrinology, Istanbul, Turkey
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11
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12
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Ergür AT, Berberoğlu M, Atasay B, Şıklar Z, Bilir P, Arsan S, Söylemez F, Öcal G. Vitamin D deficiency in Turkish mothers and their neonates and in women of reproductive age. J Clin Res Pediatr Endocrinol 2009; 1:266-9. [PMID: 21274307 PMCID: PMC3005757 DOI: 10.4274/jcrpe.v1i6.266] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Accepted: 09/16/2009] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Materno-fetal vitamin D deficiency (VDD) may occur in the early neonatal period. We aimed to evaluate the vitamin D (vitD) status and risk factors for VDD in healthy newborns and their mothers, and also in fertile women. METHODS Serum 25 hydroxyvitamin D3 (25(OH)D), calcium (Ca), phosphorus (P) and alkaline phosphatase (ALP) levels were measured in 70 mothers (study group) and their newborns, and in umbilical cord samples. 104 nonpregnant fertile women comprised the control group. Demographic factors such as education and clothing habits of the mother, number of pregnancies and month of delivery were recorded. A serum 25(OH)D level below 11 ng/ml was accepted as severe, 11-25 ng/ml as moderate VDD, and a value over 25 ng/ml as normal. RESULTS Severe VDD was found in 27% of the mothers, and moderate deficiency in 54.3%. Severe VDD was detected in 64.3% of the neonates, and moderate deficiency in 32.9%. Only 18.6% of the mothers and 2.9% of the neonates had normal vitD levels. In the control group, severe VDD was observed in 26.9%, and moderate deficiency in 45.2%. Only 27.8% of the controls had normal vitD levels. In the control group, the 25(OH)D levels of the women dressed in modern clothes were significantly higher than those of the women wearing traditional clothes. This difference was not observed in the study group because 75% of these 70 mothers wore modern clothes. Mothers giving birth during the summer months and their neonates had significantly higher serum 25(OH)D levels than those of the mothers giving birth during the winter months and their neonates. CONCLUSION The study has shown that in Turkey VDD is an important problem in women of reproductive age, in mothers and their neonates. The 25(OH)D levels obtained from the cord may serve as a guide in the determination of the high risk groups.
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Affiliation(s)
- Ayça Törel Ergür
- Ankara University, School of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey.
| | - Merih Berberoğlu
- Ankara University, School of Medicine, Departments of Pediatric Endocrinology, Ankara, Turkey
| | - Begüm Atasay
- Ankara University, School of Medicine, Departments of Neonatology, Ankara, Turkey
| | - Zeynep Şıklar
- Ankara University, School of Medicine, Departments of Pediatric Endocrinology, Ankara, Turkey
| | - Pelin Bilir
- Ankara University, School of Medicine, Departments of Pediatric Endocrinology, Ankara, Turkey
| | - Saadet Arsan
- Ankara University, School of Medicine, Departments of Neonatology, Ankara, Turkey
| | - Feride Söylemez
- Ankara University, School of Medicine, Departments of Gynecology and Obstetrics, Ankara, Turkey
| | - Gönül Öcal
- Ankara University, School of Medicine, Departments of Pediatric Endocrinology, Ankara, Turkey
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13
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Khanna PK, Nair CKK. Synthesis of Silver Nanoparticles Using Cod Liver Oil (Fish Oil): Green Approach to Nanotechnology. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/19430870902909759] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ozkan B, Doneray H, Karacan M, Vançelik S, Yildirim ZK, Ozkan A, Kosan C, Aydin K. Prevalence of vitamin D deficiency rickets in the eastern part of Turkey. Eur J Pediatr 2009; 168:95-100. [PMID: 18762977 DOI: 10.1007/s00431-008-0821-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Accepted: 08/12/2008] [Indexed: 11/28/2022]
Abstract
Turkey, especially its eastern part, has been accepted as endemic for vitamin D deficiency rickets (VDDR). In a study performed by our team in the region in 1998, the incidence of VDDR was 6.09% in children aged between 0-3 years. In 2005, the Ministry of Health initiated a free vitamin D supplementation campaign nationwide for every infant to eradicate VDDR. In this study, we aimed to investigate the prevalence of VDDR in children aged between 0-3 years in order to evaluate the effectiveness of this campaign. Between March 2007 and February 2008, 39,133 children aged between 0-3 years who were brought to different pediatric outpatient clinics in Erzurum, Turkey, were examined for VDDR. VDDR diagnosis was made by radiological and biochemical findings in the cases who were initially suspected of having clinical VDDR. During a one-year period, 39 (0.099%) of the 39,133 patients were diagnosed with VDDR. None of the cases with rickets was taking vitamin D supplementation. The most frequent physical findings were rachitic rosary, enlargement of the wrists, and craniotabes. The laboratory findings of the cases were compatible with VDDR; serum calcium (Ca) 7.5 +/- 1.9 mg/dL, PO4 4.4 +/- 1.3 mg/dL, alkaline phosphatase (ALP) 1,341 +/- 823, 25-hydroxyvitamin D (25 (OH) D) 5.8 +/- 2.9 ng/mL, intact parathyroid hormone (iPTH) 240 +/- 106 pg/mL. It was concluded that, although VDDR has been a continuing childhood health problem, a nationwide free vitamin D supplementation campaign initiated by the government appeared to be effective in eliminating VDDR.
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Affiliation(s)
- Behzat Ozkan
- Department of Pediatric Endocrinology, Ataturk University, Erzurum, Turkey,
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15
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Laing CJ, Fraser DR. Changes with malnutrition in the concentration of plasma vitamin D binding protein in growing rats. Br J Nutr 2007. [DOI: 10.1079/bjn2002611] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The work presented here examines the possible effects of nutritional deficiencies on the characteristics of the plasma transport protein for vitamin D and its metabolites (vitamin D binding protein, DBP) in the growing rat. Deficiencies in both dietary protein intake and dietary energy intake may decrease the concentration of DBP in the circulation, although plasma DBP was not affected by dietary Ca deficiency. None of the dietary factors examined appears to influence the affinity of DBP for its major ligand, 25-hydroxycholecalciferol (25(OH)D3). Protein-deficient rats seemed to have difficulty in maintaining adequate concentrations of 1,25-dihydroxycholecalciferol (1,25(OH)2D3) in the circulation. The sensitivity of DBP to dietary protein and energy intake may constitute a novel mechanism that may help to explain the observed associations between malnutrition and the development of metabolic bone disease, through alterations to the cellular availability of vitamin D ligands to DBP.
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16
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Bereket A. Nutritional rickets: nature or nurture? Expert Rev Endocrinol Metab 2006; 1:661-671. [PMID: 30754094 DOI: 10.1586/17446651.1.5.661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Rickets is a mineralization disorder of the growing bone. Nutritional rickets is still prevalent in many parts of the world. Although vitamin D deficiency plays a central role in the pathogenesis of this disease, calcium deficiency and genetic factors may also cause or contribute to the development of rickets. This review will focus on the classical form of nutritional rickets: vitamin D deficiency rickets. Epidemiology, ethiopathogenesis, risk factors, the current clinical picture, diagnosis, treatment and prevention of nutritional rickets will be reviewed.
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Affiliation(s)
- Abdullah Bereket
- a Professor of Pediatrics and Pediatric Endocrinology, Marmara University, School of Medicine, Division of Pediatric Endocrinology, Bozkir sokak No: 4/7 Selamiçesme, Istanbul, Turkey.
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Abstract
Rickets, once thought vanquished, is reappearing. In some less developed countries it hardly went away. This seminar reviews the effects of genes, stage of development, and environment on clinical expression of the disease. Rickets can be secondary to disorders of the gut, pancreas, liver, kidney, or metabolism; however, it is mostly due to nutrient deficiency and we concentrate on this form. Although calcium deficiency contributes in communities where little cows' milk is consumed, deficiency of vitamin D is the main cause. There are three major problems: the promotion of exclusive breastfeeding for long periods without vitamin D supplementation, particularly for babies whose mothers are vitamin D deficient; reduced opportunities for production of the vitamin in the skin because of female modesty and fear of skin cancer; and the high prevalence of rickets in immigrant groups in more temperate regions. A safety net of extra dietary vitamin D should be re-emphasised, not only for children but also for pregnant women. The reason why many immigrant children in temperate zones have vitamin D deficiency is unclear. We speculate that in addition to differences in genetic factors, sun exposure, and skin pigmentation, iron deficiency may affect vitamin D handling in the skin or gut or its intermediary metabolism.
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Affiliation(s)
- Brian Wharton
- MRC Childhood Nutrition Research Centre, Institute of Child Health, WC1N 1EH, London, UK.
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Affiliation(s)
- Akhil C Biswas
- Department of Pediatrics, Al Yamamah Hospital, Riyadh, Saudi Arabia
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Oginni LM, Sharp CA, Badru OS, Risteli J, Davie MWJ, Worsfold M. Radiological and biochemical resolution of nutritional rickets with calcium. Arch Dis Child 2003; 88:812-7; discussion 812-7. [PMID: 12937108 PMCID: PMC1719645 DOI: 10.1136/adc.88.9.812] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
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) micro g/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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Affiliation(s)
- L M Oginni
- Department of Orthopaedic Surgery, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
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Abstract
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.
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Affiliation(s)
- Diego Yeste
- Unidad de Endocrinología Pediátrica. Servicio de Pediatría. Hospital Universitario Maternoinfantil Vall d'Hebron. Barcelona. España.
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