Biochemical Changes Associated with Nutritional Rickets in Children up to Three Years Old in Gaza Strip

Abstract

Rickets is a deficiency of Vitamin D involves softening and weakening of bones in children. Bone softening occurs from a loss of the mineral calcium from the skeleton leading to deformities of the body structure. Rickets may be seen in young children 6 to 24 months old and is uncommon in newborns. The present study was carried out at Al-Shatea clinic (a referral health facility catering for children fromGazafor rickets). The study population constituted of 170 cases (less than 36 months) and 170 healthy children matched with cases for sex, age, locality and socioeconomic standards. Data were collected through a self constructed structured questionnaire administered to subjects' parents and from biochemical analysis of serum vitamin D, calcium, phosphorous, alkaline phosphatase, parathormone, cholesterol and hemoglobin. Clinical features of ricketic children were also recorded. Rickets was found to be more prevalent among children with less educated and unemployed parents and among children who were breast fed and who delayed in having complementary food compared to control children. Egg, milk and yogurt intake could protect children against the development of rickets. Also, rickets was more prevalent among less health educated mothers and with increased number of deliveries, less sun light exposure, full dressing and living in bedroom or flat. Weight and height at diagnosis were significantly less in rachitic children than controls (P=0.000). There was a delay in walking and teething age among richetic children compared to controls. Bowleg was the most clinical feature prevalent among ricketic children whereas open anterior fontanel was the least prevalent one. The mean level of serum 25-OH vitamin D in ricketic children (17.4±14.0) nmol/l was significantly lower than that in controls (56.1±19.5) nmol/l, (P=0.000). In general, there were significant differences in the mean levels of other biochemical parameters between control and cases, respectively as follows: calcium 9.4±0.6, 9.5±1.3 mg/dl, phosphorus: 6.8±1.5, 3.9±1.2 mg/dl, alkaline phosphatase 169.0±63.4, 1233.4±831.8 U/l, parathormone 48.1±18.7, 329.2±275.1 pg/ml hemoglobin 10.8±0.5, 10.4±1.1 gm/dl and cholesterol 161.0±34.8, 131.7±24.6 mg/dl. Analysis of the relationship between serum vitamin D and rickets' risk factors showed lower vitamin D levels among children who had longer breastfeeding without formulated food, less eating food rich in vitamin D, more mother deliveries and less sunlight exposure. The study contributes in highlighting biochemical changes in ricketic children and their relation to rickets' risk factors. This will provide hints for implementing strategies that could contribute in prevention of rickets. The preventive measures would include sunlight exposure, improvment of housing, enhancment of maternal health education as well as vitamin D supplementation.