Nutritional rickets: Historic overview and plan for worldwide eradication
The Journal of Steroid Biochemistry and Molecular Biology, https://doi.org/10.1016/j.jsbmb.2019.105563
Roger Bouillon Leen Antonio
Overview of Rickets and vitamin D contains the following overview
Rate of rickets is usually < 0.1% of births, unless dark skin, breastfed, preemie, twin, Mongolian, or Russian
Rate of rickets has greatly increased with the drop in vitamin D levels during the past 40 years
400 IU can prevent/treat most rickets Turkey gave vitamin D to EVERY child and eliminated Rickets
Can have rickets without a low serum level of vitamin D (~20% of the time)
Giving enough Vitamin D to the mother (before and after birth) PREVENTS most forms of Rickets
Rate of rickets in some countries varies from 10% to 70% (typically poor health overall)
Rickets has been more than doubling in many countries
Rickets is strongly associated with severe breathing problems (weak ribs)
Bowed legs is not the primary indication of rickets (3 other indications of rickets are seen more often)
Rickets is typically due to low cellular Vitamin D - April 2024
Some Rickets is due to poor genes - Vitamin D needed lifelong – June 2020
Vitamin D and Rickets consensus took 80 years
Fortification works, even if food is cooked, but govts rarely fortifiy with enough
Govts, food producers, and families can fortify:
milk, yogurt, beer, bread, cereals, cooking oil, soups, jams, jellys, honey, snack bars, etc.
Some interesting fortification articles
- Biofortification with Vitamin D - several studies
- Vitamin D fortification in Europe preventing 27,000 Cancer deaths, could prevent 129,000 – May 2022
- Vitamin D fortification could eliminate 1 in 10 Cancer deaths in the EU – May 2022
- After years of adding vitamin D, Finland now has 38 ng levels - March 2022
- Fortification with Vitamin D works – 16 studies of Danish experience – July 2021
- Vitamin D fortification of beverages – Review March 2022
- Bread fortified with Vitamin D - many studies 13+ studies
- International Conference of Vitamin D Fortification of Food (India) – Sept 2018
- 2400 IU of vitamin D needed to get most Northern adults above 20 ng – June 2020
- Vitamin D home fortification- don't wait 100 years for your govt
4,000 IU of Vitamin D is OK - 19 organizations agree - 2018 has the folllowing
US
Institute of Medicine
Endocrine Society, Vitamin D Council
American Academy of Pediatrics (AAP)
American Academy of Dev. Medicine and Dentistry
Europe
Scientific Advisory Committee on Nutrition (UK)
European Food Safety Authority
Central Europe consensus
Italian Endocrinologists, Italian Consensus
Nutrition - French Society of Paediatrics
European Society for Paediatric Gastroenterology ....
European Society for Clinical and Economic Aspects of Osteo...
The Nordic Council of Ministers
Health Council of the Netherlands
Highlights
- Rickets is the tip of an iceberg of vitamin D deficiency disorders
- Nutritional rickets can be due to vitamin D and or calcium deficiency
- Rickets has been largely eradicated in countries with a systematic vitamin D supplementation of all infants
- Rickets is still endemic in many countries or risk groups
- A strategy is needed to implement a strategy to eradicate nutritional rickets, similar to the WHO eradication project for iodine deficiency disorders
Rickets was first described in great detail in the mid 17th century and was affecting a great number of children in major European cities. The disease, however, existed already in the Roman times. The etiology of this disease remained enigmatic until the 1920s when two different mechanisms, lack of exposure to sunlight and lack of a dietary factor were finally solved by the discovery of vitamin D and its dual origin.
Soon thereafter, the implementation of vitamin D supplementation for all infants and small children largely eliminated nutritional rickets in Europe and North America. It took nearly a century to elucidate the complex chemistry, metabolism, mode and spectrum of activity of the vitamin D endocrine system.
Nutritional rickets, whether due to simple vitamin D or calcium deficiency or both, remains widely ravaging many infants and children around the world.
- Asian countries and the Middle East are mainly confronted with vitamin D deficiency whereas
- many African and some Asian countries face calcium deficiency rickets
Immigrants and refugees or in general people with a darker skin living in moderate climate zone are also confronted with this disease. There is great consensus how this disease could be prevented or cured. In collaboration with most international professional societies, we prepare a memorandum, in line with the successful battle against iodine deficiency disorders, to convince the World Health Organization and its member states to start an implementation program to eradicate nutritional rickets by 2030.
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