Friday, August 12, 2016
Strategies for prevention and treatment of nutritional rickets in children
Nutritional rickets (NR) is characterized by defective bone mineralization in children and is commonly caused by vitamin D and/or calcium deficiencies. The consequences of NR can be alarming if NR continues into adulthood; NR may even cause death. In spite of the established role of vitamin D in health and disease, there has been a worldwide failure in eradicating NR. A systematic review published in the journal Hormone Research in Paediatrics focused on the diagnosis, prevention, and management of NR.
A group of experts examined the current best practices in the diagnosis and management of NR and formulated evidence-based recommendations. The evidence was assessed based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. The recommendations about the definition and diagnosis of NR, vitamin D status and its toxicity, dietary calcium intake, etc. were based on high quality evidence.
The risk factors associated with NR in children are vitamin D deficiency, supplementation with low levels of vitamin D or calcium, prolonged breast-feeding without introducing appropriate complementary feeding from 6 months, restricted sunlight exposure and malnutrition. The incidence of NR in children should be determined by population-based samples, by case reports from sentinel centres, or by mandatory reporting.
NR in children should be diagnosed on the basis of history, physical examination, biochemical testing and radiographs. Vitamin D supplementation as a preventive measure for NR should be targeted for children who are at risk and have a history of symptomatic vitamin D deficiency. In infants up to 12 months of age, a dose of 400 IU/d for at least 3 months should be administered for prevention of NR. However, some children may require longer duration of treatment. Older children and women of child bearing age require 600 IU/d of vitamin D. Elemental calcium of about 500 mg/d must be provided during childhood and adolescence.
Health care providers, policy makers and general public should be educated on the importance of adequate vitamin D and calcium intake in children; pregnant and lactating women. Implementing international rickets prevention programmes, supplementation, and food fortification is important for preventing NR, and vitamin D and calcium deficiencies in children and adults.
News source - Munns CF, Shaw N, Kiely M, Specker BL, Thacher TD, Ozono K, Michigami T, Tiosano D, Mughal MZ, Mäkitie O, Ramos-Abad L. Global consensus recommendations on prevention and management of nutritional rickets. Hormone Research in Paediatrics. 2016 Jan 8; 85 (2):83–106.