Incidence of vitamin D deficiency rickets among Australian children: an Australian Paediatric Surveillance Unit study

Munns, Craig F; Simm, Peter; Rodda, Christine; Garnett, Sarah P.; Zacharin, Margaret; Ward, Leanne M.; Geddes, Janet; Cherian, Sarah; Zurynski, Yvonne; Cowell, Christopher T.

doi:10.5694/mja11.10662

Cited by 118 publications

(126 citation statements)

References 9 publications

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“…However, although there has been a suggestion that cases of rickets are increasing in many developed countries, including the UK [3], Australia [4], the USA [6,5] and Denmark [7], overt rickets remains uncommon. Surveys in the UK, Canada and Australia have reported the incidence of symptomatic VDD (radiographic rickets or hypocalcaemic seizures due to VDD) to be between 2.9 and 7.5 per 100,000 children [20][21][22], but VDD rickets is rare in white Caucasian children and the majority of cases are reported in children of African and Asian ethnicity [3,4,20,21]; a 2001 survey of VDD rickets in children aged less than 5 years in the West Midlands, UK, estimated the incidence in Caucasian children to be 0.4 per 100,000 compared with 38 per 100,000 in Asian children and 95 per 100,000 in children of Black-African or Afro-Caribbean ethnicity [20]. Furthermore, in Southern Denmark, the overall incidence of VDD rickets had increased in 1995-2005 compared with 1985-1994, yet the incidence actually decreased in ethnic Danish children [7].…”

Section: Serum 25-hydroxyvitamin D [25(oh)d] Is Currently Considered mentioning

confidence: 99%

Vitamin D and skeletal health in infancy and childhood

et al. 2014

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During growth, severe vitamin D deficiency in childhood can result in symptomatic hypocalcaemia and rickets. Despite the suggestion from some studies of a secular increase in the incidence of rickets, this observation may be driven more by changes in population demographics than a true alteration to age, sex and ethnicity-specific incidence rates; indeed rickets remains uncommon overall and is rarely seen in fair-skinned children. Additionally, the impact of less severe vitamin D deficiency and insufficiency has received much interest in recent years, and in this review we consider the evidence relating vitamin D status to fracture risk and bone mineral density (BMD) in childhood and adolescence. We conclude that there is insufficient evidence to support the suggestion that low serum 25-hydroxyvitamin D [25(OH)D] increases childhood fracture risk. Overall, the relationship between 25(OH)D and BMD is inconsistent across studies and across skeletal sites within the same study; however there is evidence to suggest that vitamin D supplementation in children with the lowest levels of 25(OH)D might improve BMD. High quality randomised trials are now required to confirm this benefit.

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Section: Serum 25-hydroxyvitamin D [25(oh)d] Is Currently Considered mentioning

confidence: 99%

Vitamin D and skeletal health in infancy and childhood

et al. 2014

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“…From these data, calculations were made for estimations of consumed quantities (in g per day) and total energy intake (in kcal per day), on the basis of a food composition database, modified to accommodate the particularities of the Greek diet [21]. 3 . Serum Ca and P determinations were performed using the Cobas INTEGRA clinical chemistry system (D-68298; Roche Diagnostics, Mannheim, Germany).…”

Section: Demographics and Dietmentioning

confidence: 99%

“…The resurgence of rickets in some Western countries highlights the potential risks of not gaining sufficient vitamin D through diet, supplementation or exposure to sunlight [2,3]. Vitamin D deficiency is frequently defined as serum concentrations less than 20 ng/mL with concentrations between 21-29 ng/mL treated as insufficiency and greater than 30 ng/mL as sufficient [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

An observational study reveals that neonatal vitamin D is primarily determined by maternal contributions: implications of a new assay on the roles of vitamin D forms

Karras¹,

Shah²,

Petróczi³

et al. 2013

EJEA

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Background: Vitamin D concentrations during pregnancy are measured to diagnose states of insufficiency or deficiency. The aim of this study is to apply accurate assays of vitamin D forms forms compared to neonates (17.9 ± 13.2 vs. 15.9 ± 13.6 ng/mL, p = 0.289) with a ratio of 1:3. The epimer concentrations, which contribute approximately 25% to the total vitamin D levels, were similar in mothers and neonates (4.8 ± 7.8 vs. 4.5 ± 4.7 ng/mL, p = 0.556). No correlation was observed in mothers between the levels of the circulating form (25OHD 3 ) and its active form. Neonatal 25(OH)D 2 was best predicted by maternal characteristics, whereas 25(OH)D 3 was strongly associated to maternal vitamin D forms (R 2 = 0.253 vs. 0.076 and R 2 = 0.109 vs. 0.478, respectively). Maternal characteristics explained 12.2% of the neonatal 25(OH)D, maternal 25(OH)D concentrations explained 32.1%, while epimers contributed an additional 11.9%. Conclusions: By applying a novel highly specific vitamin D assay, the present study is the first to quantify 3-epi-25 (OH)D concentrations in mother -newborn pairs. This accurate assay highlights a considerable proportion of vitamin D exists as epimers and a lack of correlation between the circulating and active forms. These results highlight the need for accurate measurements to appraise vitamin D status. Maternal characteristics and circulating forms of vitamin D, along with their epimers explain 56% of neonate vitamin D concentrations. The roles of active and epimer forms in the maternal -neonatal vitamin D relationship warrant further investigation.

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“…There have been reports of increased incidence of rickets cases in children born to vitamin D deficient mothers [13]. The results of a large recently published prospective study has, however, found no evidence of an association between the maternal vitamin D status in pregnancy and late childhood bone mineral content (average age 10 yrs) [14].…”

Section: Introductionmentioning

confidence: 99%

Maternal vitamin D status in Type 1 diabetic pregnancy: Impact on neonatal vitamin D status and association with maternal glycaemic control

Bennett

McPeake

McCance

et al. 2014

Pregnancy Hypertension: An International Journal of Women's Car

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Objective: The first aim of this study was to assess 25-hydroxy vitamin D (25OHD) concentrations in women with type 1 diabetes (T1DM) during pregnancy, post-delivery and also foetal (cord blood) 25OHD concentrations and to examine relationships between these. The second aim of the study was to investigate potential interactions between maternal body mass index (BMI) and foetal vitamin D status. A further study aim was to examine potential relationships between maternal 25OHD and glycosylated haemoglobin (HbA 1c ) throughout pregnancy. Research Design and Methods:This was an observational study of 52 pregnant controls without diabetes and 65 pregnant women with T1DM in a university teaching hospital. Maternal serum 25OHD was measured serially throughout the pregnancy and post-delivery. Cord blood 25OHD was measured at delivery. 25OHD was measured by liquid chromatography tandem mass spectrometry (LC-MS/MS).Results: Vitamin D deficiency (25OHD ,25 nmol/L) was apparent in both the T1DM subjects and controls at all 3 pregnancy trimesters. Vitamin D levels in all cord blood were ,50 nmol/L. Maternal 25OHD correlated positively with cord 25OHD at all 3 trimesters in the T1DM group (p = 0.02; p,0.001; p,0.001). 25OHD levels within cord blood were significantly lower for women with diabetes classified as obese vs. normal weight at booking [normal weight BMI ,25 kg/m 2 vs. obese BMI .30 kg/m 2 (nmol/L6SD); 19.93611.15 vs. 13.7364.74, p = 0.026]. In the T1DM group, HbA 1c at booking was significantly negatively correlated with maternal 25OHD at all 3 trimesters (p = 0.004; p = 0.001; p = 0.05). Conclusion:In T1DM pregnancy, low vitamin D levels persist throughout gestation and post-delivery. Cord blood vitamin D levels correlate with those of the mother, and are significantly lower in obese women than in their normal weight counterparts. Maternal vitamin D levels exhibit a significant negative relationship with HbA 1c levels, supporting a potential role for this vitamin in maintaining glycaemic control.

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Incidence of vitamin D deficiency rickets among Australian children: an Australian Paediatric Surveillance Unit study

Abstract: Vitamin D deficiency rickets is a significant problem in Australia among known high-risk groups. Public health campaigns to prevent, identify and tre@vitamin D deficiency, especially in high-risk groups, are essential.

Cited by 118 publications

References 9 publications

Vitamin D and skeletal health in infancy and childhood

Vitamin D and skeletal health in infancy and childhood

An observational study reveals that neonatal vitamin D is primarily determined by maternal contributions: implications of a new assay on the roles of vitamin D forms

Maternal vitamin D status in Type 1 diabetic pregnancy: Impact on neonatal vitamin D status and association with maternal glycaemic control

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