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News Alert Archives
New Report Reveals a Resurgence of Rickets in the U.S.
"Health Food" Beverages Spur Growth of Outdated Diseases
Rosemont, Ill., March 29, 2001 – The childhood ailment rickets – in which vitamin D and calcium deficiency leads to soft bones and poor growth – is making a surprise comeback, according to a new report published in Pediatrics 1, the peer-reviewed scientific journal of the American Academy of Pediatrics. Virtually eradicated by the 1960s, rickets seems to be on the rise because young toddlers are not consuming adequate amounts of milk – the primary dietary source of calcium and vitamin D.
“In our report, we found cases of young children who are suffering from undernutrition simply because their parents fed them soy- or rice-based beverages that did not contain vitamin D instead of cow’s milk,” said lead author Norman F. Carvalho, MD, a pediatrician at Children’s Healthcare of Atlanta. “Rickets and other nutritional illnesses can be serious and may lead to potentially life-threatening complications.”
A previous study published in the Journal of Pediatrics 2 in August 2000 reported on 30 cases of rickets in North Carolina. The majority of the children in that study were over age one and had a history of poor intake of cow’s milk.
In addition to soy- and rice-based beverages, pediatricians also are concerned that children may be drinking excessive amounts of soft drinks, juice and juice drinks in place of milk. These beverages don’t contain the nutritional profile of cow’s milk, yet they’re increasingly being substituted for milk. Even calcium-fortified juices and juice drinks don’t contain vitamin D.
“Soy and rice beverages may look like cow’s milk, but these products may not contain the amount of calcium and vitamin D that’s needed for proper growth and development,” Carvalho said.
Rickets can result in stunted growth, delays in motor development and bow legs in children. This nutritional disease was essentially eliminated in the U.S. decades ago following the fortification of milk with vitamin D.
Carvalho and colleagues reported on the cases of malnutrition they have treated in Georgia. Their findings led the Centers for Disease Control and Prevention to investigate hospitalizations for rickets in the state of Georgia over the last few years. These cases are featured in the CDC’s Morbidity and Mortality Weekly Report (located online at cdc.gov/mmwr).
“It is likely that these cases represent only a small proportion of rickets cases because these children had such significant disease that they required hospitalization,” said Susan Baker, MD, PhD, professor of pediatrics at the Children’s Hospital of Buffalo. “We believe the problem is more widespread than is appreciated since physicians are not required to report nutritional diseases to their local public health department.”
“While nutritional deficiencies are common in developing countries, it’s unusual to see this type of problem here in the United States,” Baker said. “Even though poverty does exist in this country, we have public health programs to help ensure the availability of food.”
Diet Restrictions Often to Blame
Baker said it is typically “nutritional ignorance” in this country rather than food deprivation that leads to nutritional deficiencies, such as rickets. Because it was previously rare, many U.S. physicians may be unfamiliar with the clinical features of specific nutritional deficiencies. Today, there’s a renewed urgency for pediatricians to monitor for rickets. The American Academy of Pediatrics (AAP) has long suggested overall evaluation of a child’s diet along with detailed counseling and parental education with a registered dietitian when necessary.
“With increasing numbers of parents exploring strict vegetarian diets, many may be making inappropriate changes to their children’s diets,” Carvalho said. “Additionally, some parents may mistakenly believe their child is allergic to milk or lactose intolerant, and needlessly switch to alternative products.”
“If we are to avoid relearning the lessons of the past, we should ensure that children consume adequate amounts of calcium and vitamin D each day,” Carvalho said. “Milk is the only dairy product that is routinely fortified with vitamin D, and it’s one of the few dietary sources of this essential nutrient.” (The other major source is ultraviolet light from the sun. But with concerns about skin cancer protection, pediatricians warn against excessive sun exposure for children.)
In addition, parents should realize that rice beverages are not an appropriate milk alternative for toddlers because the protein content is inadequate, Carvalho and colleagues conclude in the Pediatrics article. If soy beverages are used, they should be fortified with vitamin D and calcium if they are to be a major part of a toddler’s diet. Not all soy beverages are fortified with calcium, and the calcium content varies dramatically by brand. Additionally, the calcium in soy beverages is not as well absorbed as the calcium in cow’s milk, research3 indicates. “Milk alternative beverages not containing appropriate quantities of protein or vitamins and minerals for toddlers should carry a warning label alerting parents to their inappropriateness for this age group,” Carvalho asserted.
The Centers for Disease Control and Prevention has received additional reports of rickets, both inpatient and outpatient, from pediatricians across the U.S.
“The rise of rickets in the U.S. is a major concern,” Baker said. “We’re trying to educate parents and alert pediatricians to the problem. If toddlers are not drinking enough milk, it is highly unlikely that they will receive enough calcium and vitamin D in their diets.”
The USDA’s Food Guide Pyramid for Young Children recommends children ages two to six get at least two 8-ounce servings of milk and milk products a day to receive the recommended amount of calcium and vitamin D that is critical for the formation of healthy bones.
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