Presentation of vitamin D deficiency

Abstract

To describe the various ways in which vitamin D deficiency presents in children in selected districts of London and to identify which factors, if any, determine the mode of presentation. Methods: Retrospective review of patients presenting to Newham General, Royal London, Great Ormond Street, and King's College Hospitals between 1996 and 2001with either hypocalcaemia or rickets caused by vitamin D deficiency. Children with plasma 25-hydroxyvitamin D levels ,25 nmol/l (10 ng/ml) were considered to have vitamin D deficiency. Results: Sixty five children, mostly from Black or Asian ethnic minority groups, were identified, 29 of whom had hypocalcaemic symptoms. Seventeen of these had no radiological evidence of rickets. The remainder (48 children) had radiological evidence of rickets with or without clinical signs. Symptoms and signs reverted to normal in all cases with vitamin D supplementation. All children who presented with symptomatic hypocalcaemia were aged either ,3 or .10 years. There was a strong correlation between age at presentation and population growth velocity reference data. Conclusions: Rickets remains a problem in the UK especially in ''at risk'' ethnic minority groups. Symptomatic hypocalcaemia is an important, but under-recognised presenting feature. Growth rate is likely to be an important factor in determining the mode of presentation. Unexplained hypocalcaemia should be attributed to vitamin D deficiency in ''at risk'' ethnic minority groups until proved otherwise.

Impact of national fortification of fluid milks and margarines with vitamin D on dietary intake and serum 25-hydroxyvitamin D concentration in 4-year-old children

“…Indeed, a low dietary intake has been reported particularly in children, the vitamin D intake being only half of that recommended (Lagström et al, 1999;LehtonenVeromaa et al, 1999;Laitinen et al, 2005). Additionally, a low serum 25-hydroxyvitamin D concentration, indicator of vitamin D status, has been measured in European and US children and adolescents, again particularly during wintertime (Lamberg-Allardt et al, 1986;Lehtonen-Veromaa et al, 1999;Gordon et al, 2004;Ladhani et al, 2004), this suggesting an inadequate dietary intake.…”

Vitamin D and skeletal health in infancy and childhood

“…Overall, across various case series, up to 20% of cases present in this way, compared with up to 80% of cases presenting with hypocalcaemic seizures and up to 70% with skeletal deformity (Table 1). However, the mode of presentation varies depending upon age, with hypocalcaemic seizures being documented particularly during early infancy [50,51]. Therefore, owing to the high incidence of fracture in healthy children, and that few Moon et Three studies have examined fracture incidence in children with a diagnosis of rickets.…”

Banning children and youth under the age of 18 years from commercial tanning facilities

“…Rickets, widespread in industrialized cities in 19 th century Europe, is being increasingly diagnosed in ethnic minority populations in Northern and Southern Europe and can be attributed to vitamin D deficiency (Pedersen, 2003;Yeste and Carrascossa, 2003;Ladhani et al, 2004;Mallet et al, 2004). There is also emerging evidence, as yet mainly ecologic (i.e.…”