Interesting abstract....food for thought.
Ellen
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The Journal of Clinical Endocrinology & Metabolism Vol. 88, No. 8 3539-3545
Copyright © 2003 by The Endocrine Society
Nutritional Rickets with Normal Circulating 25-Hydroxyvitamin D: A Call for
Reexamining the Role of Dietary Calcium Intake in North American Infants
Maria C. DeLucia, MaryAnn E. Mitnick and Thomas O. Carpenter
Departments of Pediatrics (Endocrinology) (M.C.D., T.O.C.) and Internal
Medicine (Endocrinology) (M.E.M.), Yale University School of Medicine, New
Haven, Connecticut 06520-8064
Address all correspondence and requests for reprints to: Thomas O.
Carpenter, M.D., Yale University School of Medicine, 333 Cedar Street, 3103
LMP, P.O. Box 208064, New Haven, Connecticut 06520-8064. E-mail:
[log in to unmask] <mailto:[log in to unmask]>.
The incidence of nutritional rickets appears to be increasing in North
American infants and toddlers; it is widely assumed that this is due to
vitamin D deficiency. Thus, records of 43 children with nutritional rickets
from greater New Haven, Connecticut, from 1986-2002 were identified. The
mean age of presentation was 20 months; 86% were of African-American,
Hispanic, or Middle Eastern descent. More than 93% of children had been
breastfed; however, 15% had received vitamin D supplementation. Eighty-six
percent of those with food histories available were weaned to diets with
minimal dairy content after nursing. Serum 25-hydroxyvitamin D was 20.9 ±
11.5 ng/ml and was less than 15 ng/ml in only 22% of patients. Three
representative case histories suggest that dietary calcium intake may play
a contributory role in the development of disease; 1 case documents
radiographic and biochemical resolution of rachitic abnormalities after
calcium treatment, but no vitamin D therapy. Clinicians should be aware
that low dietary calcium intake after weaning may result in the development
of nutritional rickets, and that attention to calcium intake as well as
that of vitamin D is important in the establishment of optimal dietary
practices for North American infants and children.
Abbreviations: 25-OHD, 25-Hydroxyvitamin D; 1,25-OH2D, 1,25-
dihydroxyvitamin D; VDR, vitamin D receptor.
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