Vitamin D deficiency and rickets in the Eastern Province of Saudi Arabia

Al-Mustafa, Zaki H.; Al-Madan, Mohammed; Al-Majid, Hussain; Al-Muslem, Sami; Al-Ateeq, Suad; Al-Ali, Amein K.

doi:10.1179/146532807x170529

Cited by 41 publications

(31 citation statements)

References 11 publications

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“…Epidemiological data show that hypocalcemia and rickets due to vitamin D deficiency are not usually diagnosed until weeks to months after birth; the peak incidence is between 6 and 18 mo, even in regions where vitamin D deficiency is endemic (17,49,332,510). Clinically recognized cases within the first few weeks after birth are rare and the subject of individual case reports.…”

Section: Observational Studies and Case Reportsmentioning

confidence: 99%

Bone Development and Mineral Homeostasis in the Fetus and Neonate: Roles of the Calciotropic and Phosphotropic Hormones

Kovacs

2014

Physiological Reviews

211

188

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Mineral and bone metabolism are regulated differently in utero compared with the adult. The fetal kidneys, intestines, and skeleton are not dominant sources of mineral supply for the fetus. Instead, the placenta meets the fetal need for mineral by actively transporting calcium, phosphorus, and magnesium from the maternal circulation. These minerals are maintained in the fetal circulation at higher concentrations than in the mother and normal adult, and such high levels appear necessary for the developing skeleton to accrete a normal amount of mineral by term. Parathyroid hormone (PTH) and calcitriol circulate at low concentrations in the fetal circulation. Fetal bone development and the regulation of serum minerals are critically dependent on PTH and PTH-related protein, but not vitamin D/calcitriol, fibroblast growth factor-23, calcitonin, or the sex steroids. After birth, the serum calcium falls and phosphorus rises before gradually reaching adult values over the subsequent 24 -48 h. The intestines are the main source of mineral for the neonate, while the kidneys reabsorb mineral, and bone turnover contributes mineral to the circulation. This switch in the regulation of mineral homeostasis is triggered by loss of the placenta and a postnatal fall in serum calcium, and is followed in sequence by a rise in PTH and then an increase in calcitriol. Intestinal calcium absorption is initially a passive process facilitated by lactose, but later becomes active and calcitriol-dependent. However, calcitriol's role can be bypassed by increasing the calcium content of the diet, or by parenteral administration of calcium.

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Section: Observational Studies and Case Reportsmentioning

confidence: 99%

Bone Development and Mineral Homeostasis in the Fetus and Neonate: Roles of the Calciotropic and Phosphotropic Hormones

Kovacs

2014

Physiological Reviews

211

188

View full text Add to dashboard Cite

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“…Abundant global observational data report an association between restricted epidermal exposure and NR as a consequence of vitamin D deficiency [85,[139][140][141][142][143] . UV radiation causes skin cancer, and exposure to UV radiation from sunlight and artificial sources early in life elevates the risk of developing skin cancer [144] .…”

Section: Evidencementioning

confidence: 99%

Global Consensus Recommendations on Prevention and Management of Nutritional Rickets

Munns¹,

Shaw²,

Kiely³

et al. 2016

Horm Res Paediatr

363

477

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Background: Vitamin D and calcium deficiencies are common worldwide, causing nutritional rickets and osteomalacia, which have a major impact on health, growth, and development of infants, children, and adolescents; the consequences can be lethal or can last into adulthood. The goals of this evidence-based consensus document are to provide health care professionals with guidance for prevention, diagnosis, and management of nutritional rickets and to provide policy makers with a framework to work toward its eradication. Evidence: A systematic literature search examining the definition, diagnosis, treatment, and prevention of nutritional rickets in children was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system that describes the strength of the recommendation and the quality of supporting evidence. Process: Thirty-three nominated experts in pediatric endocrinology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. Results: This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. Conclusion: Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required. nology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. Results: This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. Conclusion: Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required. Key WordsRickets · Nutrition · Vitamin D · Calcium · Consensus recommendations Abstract Background: Vitamin D and ca...

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“…However, few data are available comparing vitamin D status and bone health in school-aged boys and girls within the same study design in the Middle East region generally and in the Kingdom of Saudi Arabia (KSA) specifically (4,5) .…”

mentioning

confidence: 99%

Differences in vitamin D status and calcium metabolism in Saudi Arabian boys and girls aged 6 to 18 years: effects of age, gender, extent of veiling and physical activity with concomitant implications for bone health

Al-Ghamdi

Lanham-New

Kahn

2012

Public Health Nutr.

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Objective: Few data exist looking at vitamin D status and bone health in schoolaged boys and girls from Saudi Arabia. The present study aimed to determine the extent of poor vitamin D status in school boys and girls aged 6-18 years and to examine if there was any difference in status with age, physical activity and veiling and concomitant effects on bone. Design: Cross-sectional study. Setting: Jeddah, Kingdom of Saudi Arabia. Subjects: A total of 150 boys (7-16 years) and 150 girls (6-18 years) from local schools were divided into age categories: 6-9 years (elementary school); 10-12 years (secondary school); 13-14 years (middle years); 15-18 years (high school). Results: Vitamin D status was significantly lower in girls than boys in all age groups (P , 0?01), with the 15-18-year-old girls having the lowest level (22?0 (SD 9?4) nmol/l) in comparison to the 15-18-year-old boys (39?3 (SD 14?0) nmol/l) and the 6-9-year-old girls (41?2 (SD 9?3) nmol/l). Parathyroid hormone status was highest in the 15-18-year-old girls in comparison to boys of the same age. A total of 64 % of 15-18-year-old girls had 25-hydroxyvitamin D (25OHD) status ,25 nmol/l in comparison to 31 % in the 13-14 years age category, 26 % in the 10-12 years category and 2?5 % in the 6-9 years category. No boys had 25OHD status ,25 nmol/l. Fully veiled girls had lower 25OHD status than partly veiled or unveiled girls (P , 0?05). Low 25OHD and high parathyroid hormone was associated with lower bone mass in the 6-9 years and 13-14 years age groups (P , 0?05). Conclusions: These data suggest significant hypovitaminosis D in older adolescent females, which is a cause for concern given that there is currently no public health policy for vitamin D in the Kingdom of Saudi Arabia.

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Vitamin D deficiency and rickets in the Eastern Province of Saudi Arabia

Abstract: Apparently healthy children living in areas where rickets is prevalent have risk factors for rickets and a small proportion will have evidence of biochemical rickets.

Cited by 41 publications

References 11 publications

Bone Development and Mineral Homeostasis in the Fetus and Neonate: Roles of the Calciotropic and Phosphotropic Hormones

Bone Development and Mineral Homeostasis in the Fetus and Neonate: Roles of the Calciotropic and Phosphotropic Hormones

Global Consensus Recommendations on Prevention and Management of Nutritional Rickets

Differences in vitamin D status and calcium metabolism in Saudi Arabian boys and girls aged 6 to 18 years: effects of age, gender, extent of veiling and physical activity with concomitant implications for bone health

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