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An outbreak of vitamin D deficiency rickets in a susceptible population
Insights
Vitamin D deficiency rickets has resurged in urban infants due to nutritional, cultural, and environmental factors. This study highlights the need for vitamin D supplementation and awareness in at-risk populations.
Area of Science:
- Pediatrics
- Nutritional Science
- Public Health
Background:
- Vitamin D deficiency rickets, a preventable bone disease, has seen a resurgence.
- Multiple factors contribute to this public health issue, particularly in urban environments.
Observation:
- A study at the Children's Hospital of Philadelphia identified 24 cases of rickets in infants aged 4-58 months between 1974-1978.
- Affected infants were predominantly black, breast-fed, and from families with dietary restrictions (e.g., exclusion of dairy/meat) or religious practices limiting sun exposure.
- Risk factors included dark skin, limited sun exposure due to clothing, and urban air pollution.
Findings:
- Laboratory results confirmed vitamin D deficiency in both infants and nursing mothers.
- Dietary vitamin D intake was insufficient, with no consistent use of vitamin supplements.
- Patients presented with symptoms such as seizures, fractures, and growth impairment.
Implications:
- Effective management requires addressing nutritional deficiencies and respecting cultural/religious practices.
- While treatment corrected biochemical and skeletal issues, catch-up growth was limited in many cases.
- This resurgence underscores the importance of vitamin D screening and supplementation in vulnerable infant populations.
Abstract:
Nutritional, racial, cultural, and environmental factors have combined to produce a resurgence of vitamin D deficiency rickets in urban Philadelphia. Between January 1974 and June 1978, 24 cases were diagnosed at the Children's Hospital of Philadelphia. Patients' ages ranged from 4 to 58 months. Presenting complaints included seizures, swollen wrists, pathologic fractures, and developmental regression. Sixteen patients were below the third percentile for length and weight. Laboratory results indicated vitamin D deficiency in nursing mothers as well as in infants. All infants had been breast-fed and all were black. Ingestion of vitamin D was limited by exclusion of meat and/or dairy products in 21, and no infants had consistently taken supplemental vitamins. Nineteen were members of Muslim or Seventh Day Adventist faiths. Endogenous synthesis of vitamin D was limited by dark skin, by dressing in long garments with hoods and veils, and by air pollution in a densely populated northern city. The return to a more "natural" diet, free of food additives, has been accompanied by the return of a classic disease of industrial society. Effective management required patience and respect for religious convictions. With treatment, there was correction of chemical and skeletal abnormalities, but few patients showed catch-up growth.