Vitamin D deficiency rickets, revisited
1980
Severely restricted vegetarian diets and other factors (racial, cultural, and environmental) were considered as etiologically significant in the observed resurgence of rickets in infants and adolescents living in western cultures. Twenty-four patients (12 males, 12 females) were diagnosed as having rickets from 1974-78 in 1 hospital; all were black; 16 were members of black Muslim families, and some had total dietary restriction of animal-derived products (including milk and eggs). All infants were breast fed, a factor of interest since recent study indicates human milk is a poor vitamin D source. Metaphyseal flaring was present in 19 patients; about half showed abnormally low calcium and phosphorus levels. Chemical and skeletal abnormalities were corrected by vitamin D therapy, but only a small number of patients showed catch-up growth. It was concluded that vegetarians who ingest a diet low in vitamin D and calcium (and usually high in phytates) exaggerate other factors (reduced sunlight exposure; deeply pigmented skin) that have contributed to nutritional rickets re-emergence in infants and adolescents whose requirements are high. (wz)
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