title: Rickets in the Middle East: role of environment and genetic predisposition.
abstract: BACKGROUND
  The Middle East has a high incidence of rickets, and it is also common in Europe-dwelling children of Middle Eastern origin.
  
  
  OBJECTIVE
  The objective of the study was to explore the mechanisms leading to rickets in children of the Middle East.
  
  
  METHODS
  We conducted a prospective study in 98 rachitic and 50 controls (aged 6 months to 4 yr) from university and community outpatient hospitals in Egypt and Turkey.
  
  
  METHODS
  We collected epidemiological, maternal, nutritional, radiographic, and biochemical parameters; markers of bone turnover; and vitamin D receptor (VDR) gene polymorphisms.
  
  
  RESULTS
  Epidemiological factors had a key role in pursuit of rickets; Egyptian and Turkish patients had lower (P < 0.01) dietary calcium intake than controls and the recommended dietary intakes, and serum 25-hydroxyvitamin D levels were reduced in patients, the difference with controls being significant (P < 0.001) only in Turkey, although rickets was more severe in Egypt as determined by the x-ray score (P < 0.05). In Turkey, the F VDR allele frequency was significantly (P < 0.05) increased in patients. The BB VDR genotype was associated with lower serum 25-hydroxyvitamin D levels in both patients and controls and with severity of rickets.
  
  
  CONCLUSIONS
  In Turkey most patients had vitamin D deficiency, whereas in Egypt they had mostly calcium insufficiency combined with vitamin D deficiency. In this environ, VDR genotypes may predispose to rickets by increased frequency of the F allele. The unique environs and genetic predisposition have to be accounted for in the design of preventive measures, rather than using European or American recommended dietary intake for calcium and vitamin D.
authors.affiliation: Department of Pediatrics, University of Pisa, Via Roma 67, Pisa, Italy. g.baroncelli@med.unipi.it
authors.forename: Giampiero I
authors.initials: GI
authors.lastname: Baroncelli
authors.forename: Abdullah
authors.initials: A
authors.lastname: Bereket
authors.forename: Mohamed
authors.initials: M
authors.lastname: El Kholy
authors.forename: Laura
authors.initials: L
authors.lastname: Audì
authors.forename: Yasar
authors.initials: Y
authors.lastname: Cesur
authors.forename: Behzat
authors.initials: B
authors.lastname: Ozkan
authors.forename: Mona
authors.initials: M
authors.lastname: Rashad
authors.forename: Monica
authors.initials: M
authors.lastname: Fernández-Cancio
authors.forename: Yoseph
authors.initials: Y
authors.lastname: Weisman
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Saggese
authors.forename: Ze'ev
authors.initials: Z
authors.lastname: Hochberg
mesh_terms: D002117:Calcitriol / Q000097:blood; D002118:Calcium / Q000097:blood; D002136:Calcium, Dietary / Q000008:administration & dosage; D002675:Child, Preschool; D004777:Environment; D020022:Genetic Predisposition to Disease; D006801:Humans; D007223:Infant; D008877:Middle East / Q000453:epidemiology; D011110:Polymorphism, Genetic; D011446:Prospective Studies; D018167:Receptors, Calcitriol / Q000235:genetics*; D012279:Rickets / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics; D014807:Vitamin D / Q000097:blood
chemical_list: D002136:Calcium, Dietary; D018167:Receptors, Calcitriol; D014807:Vitamin D; D002117:Calcitriol; D002118:Calcium