Role of calcium deficiency in development of nutritional rickets in Indian children: a case control study.

Abstract

CONTEXT:

Nutritional rickets is usually attributed to vitamin D deficiency. Studies from some tropical countries have postulated low dietary intake of calcium as the cause of nutritional rickets. Both vitamin D and dietary calcium deficiency are highly prevalent in India. Information on their relative contribution in the development of rickets in Indian children is limited.

OBJECTIVE:

The aim was to study the role of calcium and vitamin D deficiency in causation of nutritional rickets in young Indian children.

DESIGN AND METHODS:

In a case-control study, 67 children with nutritional rickets and 68 age- and sex-matched healthy controls were compared for demographic factors, nutritional status, sun exposure (UV score), dietary calcium and phytate intake (for subjects not breast-fed at presentation), and biochemical parameters [serum calcium, inorganic phosphate, alkaline phosphatase, 25-hydroxyvitamin D (25OHD), and PTH].

RESULTS:

Mean intake of calcium (204±129 vs. 453±234 mg/d; P<0.001) and proportion of calcium from dairy sources (41.7 vs. 88.6%; P<0.001) were significantly lower in cases vs. controls. The dietary intake of phytate was also significantly higher in cases (P=0.01). Median serum 25OHD level (interquartile range) in both cases and controls was in the range of deficiency [13.7 (10; 17.9) and 19.4 (12.3; 24.6) ng/ml, respectively]. There was no significant difference in the serum 25OHD level (P=0.08) or sun exposure as measured by UV score (P=0.39) among the cases and controls. In cases with rickets, significant negative correlations were seen between dietary calcium intake and radiological score (r=-0.28; P=0.03) and PTH (r=-0.26; P=0.02). No correlation was found between serum 25OHD level and radiological score or biochemical parameters of rickets.

CONCLUSIONS:

Rickets develops when low dietary calcium intake coexists with a low or borderline vitamin D nutrition status.

• Authors: Varun Aggarwal, Anju Seth, Satinder Aneja, Bhawna Sharma, Pitamber Sonkar, Satveer Singh, Raman K Marwaha
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 97 Issue 10 Pg. 3461-6 (Oct 2012) ISSN: 1945-7197 [Electronic] United States
• PMID: 22893720 (Publication Type: Journal Article)

Chemical References

• Calcium, Dietary
• Vitamin D
• Calcium

Topics

• Breast Feeding (statistics & numerical data)
• Calcium (deficiency)
• Calcium, Dietary (metabolism)
• Case-Control Studies
• Child, Preschool
• Female
• Humans
• India (epidemiology)
• Infant
• Infant Nutrition Disorders (ethnology, metabolism)
• Male
• Nutritional Status
• Prevalence
• Rickets (ethnology, metabolism)
• Vitamin D (metabolism)
• Vitamin D Deficiency (ethnology, metabolism)