title: An outbreak of vitamin D deficiency rickets in a susceptible population.
abstract: Nutritional, racial, cultural, and environmental factors have combined to produce a resurgence of vitamin D deficiency rickets in urban Philadelphia. Between January 1974 and June 1978, 24 cases were diagnosed at the Children's Hospital of Philadelphia. Patients' ages ranged from 4 to 58 months. Presenting complaints included seizures, swollen wrists, pathologic fractures, and developmental regression. Sixteen patients were below the third percentile for length and weight. Laboratory results indicated vitamin D deficiency in nursing mothers as well as in infants. All infants had been breast-fed and all were black. Ingestion of vitamin D was limited by exclusion of meat and/or dairy products in 21, and no infants had consistently taken supplemental vitamins. Nineteen were members of Muslim or Seventh Day Adventist faiths. Endogenous synthesis of vitamin D was limited by dark skin, by dressing in long garments with hoods and veils, and by air pollution in a densely populated northern city. The return to a more "natural" diet, free of food additives, has been accompanied by the return of a classic disease of industrial society. Effective management required patience and respect for religious convictions. With treatment, there was correction of chemical and skeletal abnormalities, but few patients showed catch-up growth.
mesh_terms: D001741:Black or African American; D000818:Animals; D001942:Breast Feeding; D002417:Cattle; D002675:Child, Preschool; D004196:Disease Outbreaks; D004198:Disease Susceptibility; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D007223:Infant; D007514:Islam; D008297:Male; D008892:Milk; D010414:Pennsylvania; D012279:Rickets / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D014505:Urban Population; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D014807:Vitamin D