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Vitamin D deficiency causes rickets in an urban informal settlement in Kenya and is associated with malnutrition.
Matern Child Nutr. 2018 01; 14(1)MC

Abstract

The commonest cause of rickets worldwide is vitamin D deficiency, but studies from sub-Saharan Africa describe an endemic vitamin D-independent form that responds to dietary calcium enrichment. The extent to which calcium-deficiency rickets is the dominant form across sub-Saharan Africa and in other low-latitude areas is unknown. We aimed to characterise the clinical and biochemical features of young children with rickets in a densely populated urban informal settlement in Kenya. Because malnutrition may mask the clinical features of rickets, we also looked for biochemical indices of risk in children with varying degrees of acute malnutrition. Twenty one children with rickets, aged 3 to 24 months, were identified on the basis of clinical and radiologic features, along with 22 community controls, and 41 children with either severe or moderate acute malnutrition. Most children with rickets had wrist widening (100%) and rachitic rosary (90%), as opposed to lower limb features (19%). Developmental delay (52%), acute malnutrition (71%), and stunting (62%) were common. Compared to controls, there were no differences in calcium intake, but most (71%) had serum 25-hydroxyvitamin D levels below 30 nmol/L. These results suggest that rickets in young children in urban Kenya is usually driven by vitamin D deficiency, and vitamin D supplementation is likely to be required for full recovery. Wasting was associated with lower calcium (p = .001), phosphate (p < .001), 25-hydroxyvitamin D (p = .049), and 1,25-dihydroxyvitamin D (p = 0.022) levels, the clinical significance of which remain unclear.

Authors+Show Affiliations

KEMRI-Wellcome Trust Research Programme, Kenya. Section of Paediatrics and Centre for Global Health Research, Imperial College, London, UK.No affiliation info availableKEMRI-Wellcome Trust Research Programme, Kenya.MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK.MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK. Department of Medicine, Faculty of Medicine and Health Science, University of East Anglia, Norwich, UK.Baraka Health Centre, German Doctors Nairobi, Nairobi, Kenya.Baraka Health Centre, German Doctors Nairobi, Nairobi, Kenya.Baraka Health Centre, German Doctors Nairobi, Nairobi, Kenya.MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK. MRC Keneba, The Gambia.KEMRI-Wellcome Trust Research Programme, Kenya. Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28470840

Citation

Jones, Kelsey D J., et al. "Vitamin D Deficiency Causes Rickets in an Urban Informal Settlement in Kenya and Is Associated With Malnutrition." Maternal & Child Nutrition, vol. 14, no. 1, 2018.
Jones KDJ, Hachmeister CU, Khasira M, et al. Vitamin D deficiency causes rickets in an urban informal settlement in Kenya and is associated with malnutrition. Matern Child Nutr. 2018;14(1).
Jones, K. D. J., Hachmeister, C. U., Khasira, M., Cox, L., Schoenmakers, I., Munyi, C., Nassir, H. S., Hünten-Kirsch, B., Prentice, A., & Berkley, J. A. (2018). Vitamin D deficiency causes rickets in an urban informal settlement in Kenya and is associated with malnutrition. Maternal & Child Nutrition, 14(1). https://doi.org/10.1111/mcn.12452
Jones KDJ, et al. Vitamin D Deficiency Causes Rickets in an Urban Informal Settlement in Kenya and Is Associated With Malnutrition. Matern Child Nutr. 2018;14(1) PubMed PMID: 28470840.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vitamin D deficiency causes rickets in an urban informal settlement in Kenya and is associated with malnutrition. AU - Jones,Kelsey D J, AU - Hachmeister,C Ulrich, AU - Khasira,Maureen, AU - Cox,Lorna, AU - Schoenmakers,Inez, AU - Munyi,Caroline, AU - Nassir,H Samira, AU - Hünten-Kirsch,Barbara, AU - Prentice,Ann, AU - Berkley,James A, Y1 - 2017/05/03/ PY - 2016/10/08/received PY - 2017/02/28/revised PY - 2017/03/01/accepted PY - 2017/5/5/pubmed PY - 2018/8/4/medline PY - 2017/5/5/entrez KW - Africa KW - acute malnutrition KW - poverty KW - rickets KW - urbanization KW - vitamin D JF - Maternal & child nutrition JO - Matern Child Nutr VL - 14 IS - 1 N2 - The commonest cause of rickets worldwide is vitamin D deficiency, but studies from sub-Saharan Africa describe an endemic vitamin D-independent form that responds to dietary calcium enrichment. The extent to which calcium-deficiency rickets is the dominant form across sub-Saharan Africa and in other low-latitude areas is unknown. We aimed to characterise the clinical and biochemical features of young children with rickets in a densely populated urban informal settlement in Kenya. Because malnutrition may mask the clinical features of rickets, we also looked for biochemical indices of risk in children with varying degrees of acute malnutrition. Twenty one children with rickets, aged 3 to 24 months, were identified on the basis of clinical and radiologic features, along with 22 community controls, and 41 children with either severe or moderate acute malnutrition. Most children with rickets had wrist widening (100%) and rachitic rosary (90%), as opposed to lower limb features (19%). Developmental delay (52%), acute malnutrition (71%), and stunting (62%) were common. Compared to controls, there were no differences in calcium intake, but most (71%) had serum 25-hydroxyvitamin D levels below 30 nmol/L. These results suggest that rickets in young children in urban Kenya is usually driven by vitamin D deficiency, and vitamin D supplementation is likely to be required for full recovery. Wasting was associated with lower calcium (p = .001), phosphate (p < .001), 25-hydroxyvitamin D (p = .049), and 1,25-dihydroxyvitamin D (p = 0.022) levels, the clinical significance of which remain unclear. SN - 1740-8709 UR - https://www.unboundmedicine.com/medline/citation/28470840/Vitamin_D_deficiency_causes_rickets_in_an_urban_informal_settlement_in_Kenya_and_is_associated_with_malnutrition_ L2 - https://doi.org/10.1111/mcn.12452 DB - PRIME DP - Unbound Medicine ER -