Nutritional Rickets among Children in a Sun Rich Country

Nutritional rickets (NR) is a disease that afflicts children and adolescents during times of rapid growth [1]. Vitamin D deficiency and/or nutritional rickets remain prevalent in developing regions of the world and rank among the 5 most common diseases in children [2, 3]. Prevalence of nutritional rickets in developed countries appears to be rising [2–7]. Suggested reasons in the literature for its reemergence include complacency in fortifying food, changing lifestyles where children spend most of their time indoors on various forms of technology and globalization which has resulted in immigration of different peoples to different geographic locations [3, 8, 9].NR is distinct from other types of rickets in that it is merely caused by a simple deficiency in vitamins and nutrition and thus can be easily corrected if detected early [8]. A growing body of literature has highlighted that NR should be viewed as having a spectrum of pathogenetic mechanisms which lie between the following three milestones [6, 10]. On one side of the spectrum are those with classic vitamin D deficiency, as studies have found among nonsupplemented breastfed infants [5], while on the other side of the spectrum are those with pure calcium deficiency, yet with normal vitamin D stores as cases from Nigeria and Bangladesh have shown [11–14]; and in between these two are those with marginal to low vitamin D stores and a diet deficient in calcium or high in phytates which impair intestinal absorption of dietary calcium and may be the main cause of rickets globally [6].Those particularly affected live in certain latitudes as is evident from numerous studies about immigrants to other nations [9, 15, 16]; winter season, atmospheric pollution and geographical latitude are also known to impair vitamin D absorption [17] and finally children spending prolonged hours inside on TV/computers rather than in the sun [18]. The second category of at risk individuals are those with an insufficient dietary intake o