Rickets Is a Nutritionally Related Disease Term Paper

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Rickets is a nutritionally related disease that affects the skeletal structure and bone structure of the patient. The most rapid period of bone development occurs during the bone mass in the fetus and infant. This slows somewhat during childhood until puberty. While all bone marrow has small holes within its structure, a bone in a child or adult with rickets will have a softer or less dense quality, even in the outer, harder protective structure and the bones will be weaker through the marrow. (Mughal, Salama, Greenaway, Laing, Mawer, 1999)

Characteristic of disorder

Rickets is a bone disease that affects children when nutritional deficiencies that build bones occur for sociological or gastrointestinal reasons. It causes progressive softening and weakening of the bones' structure in the afflicted individual. There is a loss of calcium and phosphate from the bones, which eventually causes destruction of the supportive matrix of the bone structure. (Goldenring, 2004)

Clinical manifestations

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When the body is deficient in vitamin D, it is unable to properly regulate calcium and phosphate levels. If the blood levels of these minerals become too low, other body hormones may stimulate release of calcium and phosphate from the bones to the bloodstream to elevate the blood levels. Nutritional causes of rickets occur because of a lack of Vitamin D in the patient's diet. Rickets can also occur in association with malabsorption disorders, even when the patient has enough calcium and Vitamin D in his or her diet.(Goldenring, 2004) For instance, in a patient with a disorder characterized by poor fat absorption, or in people who are lactose intolerant and have trouble digesting milk products, rickets may develop, even if their diet would be balanced for individuals lacking this sort of gastrointestinal complaint. (Goldenring, 2004)

Term Paper on Rickets Is a Nutritionally Related Disease That Assignment

Macrobiotic diets can result in vitamin D deficiency, says Martin Ward Platt, MD, of Newcastle-on-Tyne's Royal Victoria Infirmary. The increased popularity of macrobiotic diets is often blamed for the increase of rickets, caused by the vitamin D deficiency in these diets, due to the absence of dairy products. "It is possible to get the recommended daily allowance of vitamins on these diets," but much more difficult, espeically for young children during a growth spurt. ("Rickets Return," Vegetarian Times, 2004)


Rickets has been fairly rare in the United States, at least in comparison to other nations. It is most likely to occur during periods of rapid growth, when the body demands high levels of calcium. There has been an increase in rickets in the developing world, however, due to "exclusive breast feeding, extensive use of sunscreens, increased use of day care facilities," that deprive children of daily sulight. ("Rickets Return," Vegetarian Times, 2004) Also, unusual diets that provide little vitamin D and calcium are becoming more popular wrote Brian Wharton, MD, of London's Institute of Child Health and co-author of the report in a October 25,2003 issue of The Lancet, according to the Vegetarian Times (2004).

Because of this troubling increase, the American Academy of Pediatrics suggests all healthy infants within the first two months of life, children, and adolescents should receive vitamin D supplementation to prevent rickets and vitamin D deficiency. (Morantz & Torrey, 2003)

Rickets caused by a dietary lack of these minerals has been so rare in developed countries because calcium and phosphorous are present in milk and green vegetables. The popularity of vegan, vegetarian, macrobiotic, and low-carbohydrate diets has decreased the consumption of these foods, along with an increase in the consumption of soda. But a change in diet cannot guard against hereditary rickets, an inherited form of the disease caused when the kidneys are unable to retain phosphate. Rickets may also be caused by kidney disorders involving renal tubular acidosis. It can also affect children who have disorders of the liver, do not adequately absorb fats and vitamin D, or cannot convert vitamin D to its active form. (Goldenring, 2004) Renal osteodystrophy occurs in people with chronic renal failure and can prevent vitamin D absorbtion in adults. The manifestation of this disorder virtually identical to that of rickets in children and can cause osteomalacia or osteoporosis in adults. (Goldenring, 2004)

Symptoms, Treatment & Cure

The American Association of Pediatrics report cautions that an infant may be vitamin D-deficient long before being diagnosed with rickets because the symptoms are not obvious. (Morantz & Torrey, 2003) Thus it is important for physicans to look for the symptoms of rickets, even if he or she does not fall into the traditional target group of the impoverished. When describing six young patients with the clinical signs and symptoms of rickets, the British Medical Jounal noted the subjects had "bow legs, rickety rosary, swelling of the ends of long bones, frontal bossing of the skull, delayed dentition, poor growth, and slow motor development. They all had classic radiological features of rickets, including generalised osteopenia, widening of the growth plates, and cupping of metaphyseal regions of long bones." (Mughal, Salama, Greenaway, Laing, Mawer, 1999)

The best cure for rickets is prevention. Rickets may be avoided by having a child maintain an adequate intake of calcium, phosphorus, and vitamin D, and watching for symptoms even if a balanced and supplemented diet is being followed, as patients with gastrointestinal or other disorders may require dietary supplements. (Goldenring, 2004) Another factor is exposure to sunlight. Sunlight is a major source of vitamin D, but sunlight exposure is difficult to measure, and often parents keep their children away from the sun, to protect the children against skin cancer. Some exposure is necessary for calcium to be absorbed by the bone. (Goldenring, 2005)

The cure for rickets is usually the same for preventing the disorder -- adequate supplementation, or, in the case of an absorption disorder, appropriate treatment of the disorder, usually with supplementation. The role of supplementation cannot be dismissed in the prevention of rickets -- in fact, one surprising note from current research is that exclusively breastfed infants are at increased risk of vitamin D deficiency and rickets, despite the presumption that breastfed infants flourish more than formula-fed inflants. (ADA, 2004) This is because the amount of vitamin D contained in human milk is not sufficient to prevent rickets. (Mughal, Salama, Greenaway, Laing, Mawer, 1999)

The American Academy of Pediatrics suggests a supplement of 200 IU per day of vitamin D for all breastfed infants. When the infants are weaned to this can be decreased 500 mL per day of vitamin D-fortified formula or milk. Vitamin D supplementation should begin within the first two months of life nonbreastfed infants who are ingesting less than 500 mL per day of vitamin D-fortified formula or milk. Children and adolescents who do not get regular sunlight exposure, do not ingest at least 500 mL per day of vitamin D-fortified milk, or do not take a daily multivitamin supplement containing at least 200 IU of vitamin D(Morantz & Torrey, 2003)

The American Dietetic Association supports exclusive breastfeeding of infants, and quotes the World Health Organization as supporting this position "with appropriate supplemetnation," but does not state what that supplementation should be nor if other sources of nutrition might be a good idea if the populartion does not have sufficent access to education or supplementation. (ADA, "Promoting and Supporting Breastfeeding, 2005)

Current research

Rickets currently ranked among the top five childhood diseases in developing countries. Inadequate vitamin D from dietary sources or sunlight has long been thought to be the cause of rickets, and heartening recent studies and case reports show that children with rickets respond to calcium regardless of the rest of their diet. In children with normal absorbtion, calcium supplementation alone or in combination with vitamin D is an effective treatment for rickets. "All findings support the hypothesis "that a deficiency of calcium plays a major role in the occurrence of rickets in children," and that adequate… [END OF PREVIEW] . . . READ MORE

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