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Persistence of Vitamin D-deficiency rickets in Toronto in the 1990s
Insights
Vitamin D deficiency rickets persists in Toronto, primarily affecting infants with dark skin from immigrant families. Exclusive breastfeeding without supplementation and limited sun exposure were key contributing factors.
Area of Science:
- Pediatrics
- Nutritional Science
- Public Health
Background:
- Vitamin D deficiency rickets is a preventable condition.
- Recent immigration trends may alter the prevalence of nutritional deficiencies.
- Dark skin pigmentation reduces cutaneous synthesis of vitamin D.
Purpose of the Study:
- To describe the clinical characteristics and risk factors of vitamin D deficiency rickets in a Canadian pediatric population.
- To identify demographic and environmental factors associated with vitamin D deficiency rickets.
- To inform public health strategies for preventing rickets.
Main Methods:
- Retrospective chart review of all rickets cases diagnosed between 1988 and 1993 at a children's hospital in Toronto.
- Analysis of patient demographics, clinical presentation, biochemical and radiographic findings, feeding practices, and environmental exposures.
- Case series analysis.
Main Results:
- Seventeen cases of vitamin D deficiency rickets were identified in children aged 7–33 months.
- All affected children were symptomatic, exhibiting biochemical and radiographic abnormalities, including hypocalcemic seizures in two.
- Twelve cases involved children of Asian or African origin with dark skin, exclusively breastfed without supplementation and with minimal sun exposure.
Conclusions:
- Vitamin D deficiency rickets remains an environmental/nutritional disease in Toronto.
- Targeted prevention efforts should focus on infants with pigmented skin from immigrant families.
- Public health initiatives should address vitamin D supplementation for breastfed infants and promote adequate sun exposure.
Abstract:
To assess the current picture of vitamin D deficiency, we reviewed all 17 cases of vitamin D-deficiency rikets seen in the referral clinic of a children's hospital in Toronto between 1988 and 1993. The diagnosis was made at 7 to 33 months of age. All the children were symptomatic all had biochemical and radiographic abnormalities, two suffered hypocalcemic seizures, and all had bowing of the extremities. Twelve of the children were born to parents who were recent immigrants to Canada. All were of Asian or African origin with dark skin. All the children had been exclusively breastfed with no vitamin D supplementation, and had had little or no sunlight exposure. All the patients responded to vitamin D therapy. We conclude that vitamin D-deficiency rickets remains an environmental/nutritional deficiency disease in this city and that efforts at prevention should target children with pigmented skin from families who are recent immigrants.