Aetiology of rickets and its dietary management

Introduction

At the turn of the 20th century, nutritional rickets was an epidemic among infant and young children in many areas of Asia North America, and North – Europe. With the discovery of the role of ultraviolet light (sunlight) in curing vitamin D deficiency rickets and the isolation of Vitamin D effectively in expansive method of preventing and treating nutritional rickets became available. Despite these development, rickets remain a major public health problem in many developing countries and its prevalence is reported to be increasing is several developing countries until recently, it was generally accepted that nutritional rickets  is caused by vitamin D deficiency alone and that dietary calcium deficiency might exacerbate the disease in the presence of vitamin D deficiency but by itself is not responsible before nutritional rickets, in the past 25 years census regarding, the pathogenesis of nutritional  rickets has shifted as studies have suggested that among older children in developing countries in particular dietary calcium deficiency plays role. Nutrition rickets is caused by both vitamin D deficiencies and dietary development of the disease among children.

The term rickets, comes from the old English word wrecking, meaning to twist oil bead, rickets was common in the UK and U.S.A. during the 19th century. For proper absorption of calcium and phosphorus from the gut, we need vitamin D. If vitamin D level in a child is low, providing the child with extra vitamin D and some minerals usually resolves the rickets problems.

What is rickets?

Linus Pauling Institute discovered rickets as a disease characterized by soft weak bones in children. The symptom of rickets includes pain and tenderness in the bone especially in spine, arms, pelvis, and leg; slow growth and/or short height, muscle cramps and abnormal teeth.

Rickets is caused by a deficiency in at least one of three essential nutrients, vitamin D, calcium or phosphorus. Therefore a diet to reverse rickets needs to contain foods rich at least one of these nutrients.

According to writer, Stephanie Brunne (BA), rickets is a childhood bone disorder including burn soften and become prone to fracture and deformity. Although rare in industrialized nations, it is still common in some developing countries. The main causes of rickets is lack of vitamin D; not having enough calcium in ones diet may also be the cause of rickets, other causes such as many vomiting and diarrhoea, some childhood kidney and liver disease can cause rickets as may a digestive disorder complication that affect calcium and phosphorus absorption.

Rickets affect mainly children; although the disorder may also affect adults (osteomalacia) in most cases the child suffer from severe and long terms malnutrition usually during eating childhood.

Interestingly, in the Middle East, despite high rate of sun exposure has the highest rates of rickets worldwide. This can be explained by limited sun exposure to calcium practices and lack of vitamin D supplementation for breastfeeding women. Up to 70% and 80% of adolescent girls in Iran and Saudi Arabia respectively that has limited sunlight exposure and vitamin D insufficiency. Socio-economic factors that limit a vitamin D rich diet also play a role in the United States. Vitamin D insufficiency varies dramatically by ethnicity among males age 70 – year and older. The prevalence of low serum 25 (OH)D levels was 23% for non-Hispanic blacks.

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Among women, the prevalence was 28.50%, 55% and 68% respecting; Asian immigrants living in Europe have an increased risk for vitamin D deficiency vitamin D, insufficiency was found in 40% of non western immigrants in the hinterlands, and in more than 80% of Turkish and European immigrants.

Signs and symptoms of rickets

A symptom is something the patient feels and reports, while a sign is something other people such as doctor detect. For example pain may be a symptoms while rash may be a sign many including bone pain, bone tenderness. Bone breaks easily; costochondral swelling-prominent knobs of the bone at the bone at the costochondral joint are prominent large beads show up under the skin of the ribs cage.

  • Horizon groove- a horizontal line is visible at the lower margins of the thorax where the diaphragm attaches to the ribs.
  • Low calcium blood levels (hypocalcaemia older children may have knock knees (Gena-talgum.
  • Soft child physical growth (height) weight may be affected.
  • There may be spinal pelvic or genial deformity.
  • Toddles may have bowed legs (genu-tarmin)
  • Uncontrolled muscle spasms, which may affect the entire body (tetan)
  • Widening wrists.

Other symptoms include:

  • Sore arms, legs back and hip.
  • Bone growth problem, like bowed legs.
  • Late teeth and problem, with took enamels.
  • Swelling around the wrist and ankle joints.
  • Fracture (Broken bones) for unknown reasons.

The shape of the skull; a sauce head. Some disease; some renal (kidney/hepatic (liver) and intestinal disease can interfere with the way the body absorb and metabolize minerals and vitamins, resulting in rickets

Causes of rickets

Lack of vitamin D is the main cause of rickets. Our bodies need vitamin D in order to absorb calcium from the intestines. Ultraviolet light (from sunlight) helps our skin cells to convert vitamin D from an inactive state into an active state. If we do not have enough vitamin D in calcium that we get from the food we eat is not absorbed property, causing hypocalcemia (lower than normal blood calcium to develop teeth) as well as neuromuscular problem.

  • Not enough vitamin D or calcium in the food your child eats.
  • Vegetarian, daily free or lactose free diet that are not nutritionally balanced.
  • Less time spent in the sun.
  • Breast feeding babies- whose mothers that have low vitamin D levels- (breast milk is still the best food for babies.

Children with darker skin who absorb less sunlight than fair-skinned children existing medical conditions like bowel symptom, kidney tubular acidosis, liver disorder affecting low fat is absorbed and hyperparatharoldish genetic defect; hypophosphatemie rickets is a rare genetic fault that under mines that way the kidney process phosphate . Phosphate blood levels are too low, leading to weak and soft bones.

Risk factors of rickets

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Risk factors are something which increases the likelihood of developing a condition or disease for example; obesity significantly raises the risk of developing diabetes types 2.

  • Poverty: Rickets is more likely to occur among those that are poor.
  • Sunlight: Children who do not get enough sunlight are more dependent on excellent nutrition to make sure they get enough vitamin D.
  • Malnutrition: Rickets is more common in areas of the world where severe drought and starvation occur.

Complications of rickets

If left untreated, a child with rickets is more prone to fractures of the bone. If the rickets is severe and prolonged, there may be permanent bone deformities. Severely low blood calcium levels can head to cramps, seizures and breathing problems.

Treatments of rickets

The patient’s dietary intake of calcium phosphate and vitamin D is increased. This may involve exposure to sunlight (ultraviolet B light) consuming fish oils and volsterol.

If enough ultraviolet B light exposure is available it can be used as well as consuming adequate amount of dietary and phosphorous, rickets can usually be reversed and prevented.

The W.H.O (World Health Organization) recommends 400 lus (International Units) of vitamin D a day for babies and children if the rickets is caused by bad diet. The patient should be given daily calcium and vitamin D supplement, vitamin D injection, as well as being encourage to eat vitamin D rich foods.

Eat food that contain vitamin D, spend a little time in the sun each day. The x-rays from the sun stimulant skin to make vitamin D and calcium supplement.

In the treatment of genetic rickets, the patient will be encouraged to take phosphorus medication and active vitamin D hormones.

Other medical condition of rickets has an underline medical cause, such as kidney disease that needs to be treated and controlled.

The following foods are known to be rich on vitamin D; eggs, fish oils, margarines, some fortified milk and juices.

Some oily fishes and some milk products that have vitamins D added beneath sunshine every day and including foods with vitamin D and calcium in your child diet can prevent rickets. However foods only provide a small amount (10-25%) of daily vitamin D needs for most people in Australia. If your children has fair skin, about 20 minutes of sunshine either early in the morning or late in the afternoon is enough for than to get plenty of vitamin D. if your children have darker skin they will need more time in the sun because their skin does not absorbed the sunlight as quickly it is important for people with fair to olive skin to use some cream and follow skin cancer prevention advice.

Diagnosis of rickets

Blood test-serum calcium may revive inadequate level of calcium and phosphorus serum alkaline phosphorus level maybe high metabolic acidosis may be revealed by arterial blood gases x-rays. These may reveal calcium loss in bones or attention in the in structure non shape of the bones. Bone biopsy- this can confirm rickets (ravel used).

Prevention of rickets

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Osteopathy the exact vitamin D needs of each human is very difficult, because it is hard to measure how much of the vitamin is synthesized in the skin under the influence of ultraviolet rays (sunlight) in countries that are not near the tropics where the sunlight intensity is lower. It is important to provide a supplement intake of vitamin D when it is impossible for social economic reason to provide a vitamin supplement in area with a lot of sunlight. The best way to prevent rickets is exposure to sunlight. It is a good source but excess sunlight exposure can lead to sunburn and eventually skin cancer.

Dietary management of rickets

Rickets can be managed by the consumption of food rich vitamin D. Getting enough vitamin D support strong bones and can be prevented when ultraviolet rays from the sun heats the skin, the result is synthesis of vitamin D. However children with very dark skin or who do not get enough sun exposure are susceptible to a vitamin D deficiency and therefore rickets. Eating foods rich in vitamin D can supply all the nutrient to support strong bones. Good dietary source of vitamin D include cod liver oil, salmon, mackerel, tuna, eggs and yoghurt. Many food have also been fortified with vitamin D such as orange, Juice, Milk, Margarine and breakfast cereals.

Foods that contain vitamin D includes:

  • Egg yolks,
  • Oily fish like salmon,
  • Mackerel tuna and sardines
  • Liver
  • Breaks fat that have vitamin D added Dairy product that have Vitamin D added.
  1. Calcium: A diet for rickets should also contain foods rich in the essential mineral and calcium. More than 99 percent of calcium in the body accumulates in the bone and this mineral is necessary conjunction with vitamin D and phosphorus to prevent rickets. Foods rich in calcium are dairy-based foods such as milk, yogurt and cheese leaf green vegetable like kale and spinach also contain a good amount of calcium
  2. Phosphorus: Because phosphorus is necessary for strong bones, a rickets diet should also contain foods that provide essential mineral. Good dietary source of phosphorus include some of the same foods that are rich in calcium dairy-based on foods like milk cheese and yogurt eggs and salmon other foods that contain phosphorus are whole-wheat and enriched bread halibut, beef, chicken and turkey and cola. However, it is important to consume milk and milk product for fortified milk is a beneficial addition to a rickets diet because it contains vitamin D, calcium and phosphorus. Some people do not drink milk for one more reason, such as not liking milk, avoid animal-based foods in general or being lactose intolerant for these children it is important that their rickets diet contain several of the other foods rich in vitamin D

References

John, J. (1974). Magnesium and Vitamin D Cofactors.

Lancet (1974).Vitamin D Resistant Rickets Reappeared.

Leah, 0. (2008). Diet for Rickets.

Linus Pauling Institute: Phosphorus. Jane Highon: April, 2003.

Plotkin, H. & Finberg, L; Disorder of Bone Mineralization. October 2005

Whitter, S. (2008). Rickets all Information