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A major health problem facing immigrant children: nutritional rickets.

Erdal Kurnaz1, Semra Çetinkaya1, Selin Elmaoğulları1

  • 1Clinic of Pediatric Endocrinology, University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Ankara, Turkey.

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Summary

Nutritional rickets (NR) is a significant health issue, particularly among immigrant children. Many cases present with severe vitamin D deficiency, highlighting the need for public health interventions.

Keywords:
immigrantsnutritional ricketsrefugeevitamin D deficiency

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Area of Science:

  • Pediatric Endocrinology
  • Nutritional Deficiencies
  • Public Health

Background:

  • Nutritional rickets (NR) remains a prevalent health concern, exacerbated by increasing immigrant populations.
  • This study focuses on immigrant children diagnosed with NR in a pediatric endocrinology clinic.

Purpose of the Study:

  • To evaluate cases of nutritional rickets in predominantly immigrant children.
  • To understand the clinical presentation and biochemical markers of NR in this population.

Main Methods:

  • Retrospective analysis of 20 pediatric cases diagnosed with NR between 2017 and 2020.
  • Review of patient records for demographic data, biochemical parameters (calcium, phosphate, alkaline phosphatase, parathyroid hormone, 25-hydroxyvitamin D), and treatment outcomes.

Main Results:

  • Eighty-five percent of the 20 included patients were immigrants.
  • All patients had low 25-hydroxyvitamin D levels (<20 ng/mL); 17 had hypocalcemia and 13 had hypophosphatemia.
  • Elevated parathyroid hormone (PTH) and alkaline phosphatase (ALP) were observed in most cases, indicating severe disease. Treatment with high-dose vitamin D led to improvement in 14 patients.

Conclusions:

  • Elevated PTH levels suggest that only the most severe NR cases are seen in clinics, indicating a larger burden of subclinical disease.
  • Public health strategies should prioritize universal vitamin D supplementation, adequate calcium intake, and integration into child surveillance programs.
  • Informing families about risks and ensuring adequate nutrition, sunlight exposure, and support are crucial for both resident and immigrant children.