Management of Nutritional Rickets in Indian Children: A Randomized Controlled Trial
被引:28
作者:
Aggarwal, Varun
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机构:
Kalawati Saran Childrens Hosp, Dept Pediat, New Delhi, India
Lady Hardinge Med Coll & Hosp, New Delhi, IndiaKalawati Saran Childrens Hosp, Dept Pediat, New Delhi, India
Aggarwal, Varun
[1
,2
]
Seth, Anju
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机构:
Kalawati Saran Childrens Hosp, Dept Pediat, New Delhi, India
Lady Hardinge Med Coll & Hosp, New Delhi, IndiaKalawati Saran Childrens Hosp, Dept Pediat, New Delhi, India
Seth, Anju
[1
,2
]
Marwaha, Raman K.
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机构:
Inst Nucl Med & Allied Sci, Dept Endocrinol, New Delhi, IndiaKalawati Saran Childrens Hosp, Dept Pediat, New Delhi, India
Marwaha, Raman K.
[3
]
Sharma, Bhavna
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机构:
Inst Nucl Med & Allied Sci, Dept Endocrinol, New Delhi, IndiaKalawati Saran Childrens Hosp, Dept Pediat, New Delhi, India
Sharma, Bhavna
[3
]
Sonkar, Pitamber
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机构:
Lady Hardinge Med Coll & Hosp, New Delhi, India
Kalawati Saran Childrens Hosp, Dept Radiodiag, New Delhi, IndiaKalawati Saran Childrens Hosp, Dept Pediat, New Delhi, India
Sonkar, Pitamber
[2
,4
]
Singh, Satveer
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机构:
Inst Nucl Med & Allied Sci, Dept Endocrinol, New Delhi, IndiaKalawati Saran Childrens Hosp, Dept Pediat, New Delhi, India
Singh, Satveer
[3
]
Aneja, Satinder
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机构:
Kalawati Saran Childrens Hosp, Dept Pediat, New Delhi, India
Lady Hardinge Med Coll & Hosp, New Delhi, IndiaKalawati Saran Childrens Hosp, Dept Pediat, New Delhi, India
Aneja, Satinder
[1
,2
]
机构:
[1] Kalawati Saran Childrens Hosp, Dept Pediat, New Delhi, India
[2] Lady Hardinge Med Coll & Hosp, New Delhi, India
[3] Inst Nucl Med & Allied Sci, Dept Endocrinol, New Delhi, India
[4] Kalawati Saran Childrens Hosp, Dept Radiodiag, New Delhi, India
Introduction: Rickets is usually attributed to vitamin D deficiency. However, recent studies have implicated dietary calcium deficiency in its etiology. Information on relative efficacy of calcium, vitamin D or both together in healing of rickets is limited. Objective: To study effect of treatment with calcium, vitamin D or a combination of these two on healing of nutritional rickets in young children. Design: Randomized controlled trial. Methods: Sixty-seven cases of nutritional rickets in the age group of 6 months to 5 years were randomly allocated to receive vitamin D (600 000 IU single intramuscular dose), calcium (75 mg/kg/day elemental calcium orally) or a combination of the above two for a period of 12 weeks. The demographic parameters, nutritional status, dietary calcium and phytate intake were assessed for all. Radiographs (wrist and knee) and biochemical parameters (serum calcium, inorganic phosphate, alkaline phosphatase, 25-hydroxycholecalciferol and parathyroid hormone) were evaluated at baseline, 6 and 12 weeks for evidence of healing. Results: Mean dietary intake of calcium in all cases was low (204 +/- 129 mg/day). Mean serum 25-hydroxycholecalciferol D level was 15.9 +/- 12.4 ng/ml, and 82.1% of patients had serum vitamin D levels < 20 ng/ml, indicative of vitamin D deficiency. After 6 and 12 weeks of treatment, radiological and biochemical evidence of healing rickets was observed in all treatment groups, albeit to a variable extent. The combined end point of normal serum alkaline phosphatase and complete radiological healing at 12 weeks was observed in 50% subjects on combination therapy as compared with 15.7% subjects on vitamin D alone and 11.7% on calcium alone. Conclusions: Children with rickets had a low serum vitamin D level and a low dietary calcium intake. The best therapeutic response was seen with a combination of vitamin D and calcium than either of them given alone. Trial registration number: CTRI/2010/091/000448.
机构:Southampton Gen Hosp, Biomed Res Unit, Southampton SO16 6YD, Hants, England
Davies, Justin H.
;
Reed, Joseph M.
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机构:Southampton Gen Hosp, Biomed Res Unit, Southampton SO16 6YD, Hants, England
Reed, Joseph M.
;
Blake, Elizabeth
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Southampton Gen Hosp, Biomed Res Unit, Southampton SO16 6YD, Hants, EnglandSouthampton Gen Hosp, Biomed Res Unit, Southampton SO16 6YD, Hants, England
Blake, Elizabeth
;
Priesemann, Max
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机构:Southampton Gen Hosp, Biomed Res Unit, Southampton SO16 6YD, Hants, England
Priesemann, Max
;
Jackson, Alan A.
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机构:
Southampton Gen Hosp, Biomed Res Unit, Southampton SO16 6YD, Hants, EnglandSouthampton Gen Hosp, Biomed Res Unit, Southampton SO16 6YD, Hants, England
Jackson, Alan A.
;
Clarke, Nicholas M. P.
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机构:
Southampton Gen Hosp, Biomed Res Unit, Southampton SO16 6YD, Hants, EnglandSouthampton Gen Hosp, Biomed Res Unit, Southampton SO16 6YD, Hants, England
机构:
Tufts Univ, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USATufts Univ, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA
Dawson-Hughes, B.
;
Mithal, A.
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机构:
Indraprastha Apollo Hosp, New Delhi 110044, IndiaTufts Univ, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA
Mithal, A.
;
Bonjour, J. -P.
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机构:
Univ Hosp Geneva, Div Bone Dis, Univ Hosp & Fac Med, CH-1211 Geneva, SwitzerlandTufts Univ, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA
Bonjour, J. -P.
;
Boonen, S.
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机构:
Univ Louvain, Ctr Metab Bone Dis, B-3000 Louvain, Belgium
Univ Louvain, Div Geriatr Med, B-3000 Louvain, BelgiumTufts Univ, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA
Boonen, S.
;
Burckhardt, P.
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机构:
Assoc Suisse Osteoporose, Clin Bois Cerf, CH-1006 Lausanne, SwitzerlandTufts Univ, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA
Burckhardt, P.
;
El-Hajj Fuleihan, Ghada
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h-index: 0
机构:
Amer Univ Beirut, Med Ctr, Calcium Metab & Osteoporosis Program, Beirut 2020, LebanonTufts Univ, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA
El-Hajj Fuleihan, Ghada
;
Josse, R. G.
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h-index: 0
机构:
Univ Toronto, St Michaels Hosp, Ctr Hlth, Div Endocrinol & Metab, Toronto, ON M5C 2T2, CanadaTufts Univ, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA
Josse, R. G.
;
Lips, P.
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机构:
Vrije Univ Amsterdam, Med Ctr, Div Internal Med, Endocrine Sect, NL-1007 MB Amsterdam, NetherlandsTufts Univ, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA
Lips, P.
;
Morales-Torres, J.
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机构:
Hosp Aranda Parra, Leon 37000, GTO, MexicoTufts Univ, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA
机构:Southampton Gen Hosp, Biomed Res Unit, Southampton SO16 6YD, Hants, England
Davies, Justin H.
;
Reed, Joseph M.
论文数: 0引用数: 0
h-index: 0
机构:Southampton Gen Hosp, Biomed Res Unit, Southampton SO16 6YD, Hants, England
Reed, Joseph M.
;
Blake, Elizabeth
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h-index: 0
机构:
Southampton Gen Hosp, Biomed Res Unit, Southampton SO16 6YD, Hants, EnglandSouthampton Gen Hosp, Biomed Res Unit, Southampton SO16 6YD, Hants, England
Blake, Elizabeth
;
Priesemann, Max
论文数: 0引用数: 0
h-index: 0
机构:Southampton Gen Hosp, Biomed Res Unit, Southampton SO16 6YD, Hants, England
Priesemann, Max
;
Jackson, Alan A.
论文数: 0引用数: 0
h-index: 0
机构:
Southampton Gen Hosp, Biomed Res Unit, Southampton SO16 6YD, Hants, EnglandSouthampton Gen Hosp, Biomed Res Unit, Southampton SO16 6YD, Hants, England
Jackson, Alan A.
;
Clarke, Nicholas M. P.
论文数: 0引用数: 0
h-index: 0
机构:
Southampton Gen Hosp, Biomed Res Unit, Southampton SO16 6YD, Hants, EnglandSouthampton Gen Hosp, Biomed Res Unit, Southampton SO16 6YD, Hants, England
机构:
Tufts Univ, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USATufts Univ, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA
Dawson-Hughes, B.
;
Mithal, A.
论文数: 0引用数: 0
h-index: 0
机构:
Indraprastha Apollo Hosp, New Delhi 110044, IndiaTufts Univ, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA
Mithal, A.
;
Bonjour, J. -P.
论文数: 0引用数: 0
h-index: 0
机构:
Univ Hosp Geneva, Div Bone Dis, Univ Hosp & Fac Med, CH-1211 Geneva, SwitzerlandTufts Univ, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA
Bonjour, J. -P.
;
Boonen, S.
论文数: 0引用数: 0
h-index: 0
机构:
Univ Louvain, Ctr Metab Bone Dis, B-3000 Louvain, Belgium
Univ Louvain, Div Geriatr Med, B-3000 Louvain, BelgiumTufts Univ, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA
Boonen, S.
;
Burckhardt, P.
论文数: 0引用数: 0
h-index: 0
机构:
Assoc Suisse Osteoporose, Clin Bois Cerf, CH-1006 Lausanne, SwitzerlandTufts Univ, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA
Burckhardt, P.
;
El-Hajj Fuleihan, Ghada
论文数: 0引用数: 0
h-index: 0
机构:
Amer Univ Beirut, Med Ctr, Calcium Metab & Osteoporosis Program, Beirut 2020, LebanonTufts Univ, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA
El-Hajj Fuleihan, Ghada
;
Josse, R. G.
论文数: 0引用数: 0
h-index: 0
机构:
Univ Toronto, St Michaels Hosp, Ctr Hlth, Div Endocrinol & Metab, Toronto, ON M5C 2T2, CanadaTufts Univ, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA
Josse, R. G.
;
Lips, P.
论文数: 0引用数: 0
h-index: 0
机构:
Vrije Univ Amsterdam, Med Ctr, Div Internal Med, Endocrine Sect, NL-1007 MB Amsterdam, NetherlandsTufts Univ, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA
Lips, P.
;
Morales-Torres, J.
论文数: 0引用数: 0
h-index: 0
机构:
Hosp Aranda Parra, Leon 37000, GTO, MexicoTufts Univ, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA