Rickets of Vitamin D Deficiency

维生素 D 缺乏性佝偻病

Definition

Rickets is the term signifying a failure in mineralization of growing bone or osteoid tissue.

Etiology

296—310nm

ultraviolet rays

Inadequate exposure in sunlight

Prevalence

Spring > Autum

City > Countryside

Dark skin > White skin

7-dehydrocholesterol VitD3

EtiologyInsufficient intake of VitD3Insufficient intake of calcium

absoption

inhibition

VitD lactose Amino acid

P↑

fibersvegetable

Etiology

adolescentsRapid growth

Low- birth weight infants

Adolescents

Etiology

Diseases Celiac disease

Anticonvulsant therapy

Cystic disease

phenobarbital

Etiology

Others

Nutritional status of mother

Eating habit

Nutrients deficiency Zn

VitC

Protein

Feeding pattern

Pathology7

Activation of VitD

VitD3

25(OH)D3

1,25(OH)2D3

7- 脱氢胆固醇

Pathology

Resume Ca 1,25(OH)2D3↓

Ca ＆ P absorption ↓

Parathiroid ↑ calcium (±) ＆ P ↓

Ca ×P↓

DemineralizationOsteomalaci

a

deformity

Clinical manifestation-skeleton

Skull<6mon craniomalacia ( 颅骨软化 )

6-12mon cephalus quadratum ( 方颅 )

Large anterior fontanel ( 囟门大 )

Teeth eruption delay ( 出牙迟 )

Clinical manifestation-skeleton

Costochondral-rosary （肋骨串珠）

Chicken breastChicken breast （鸡胸）（鸡胸）

Harrison groove ( 哈氏沟 )

Thorax

Funnel breast （漏斗胸）

Clinical manifestation-skeleton

Extremities

6-12mon

>12mon

epiphyseal enlargement at wrists and ankles

bowlegs

knock-knees

Clinical manifestation-skeleton

Spine and pelvis

Rachitic dwarfism

ScoliosisDeformities

kyphosis

Clinical manifestation-muscle

Motor delay

Clinical manifestation-neurologic symptoms

Restless

Night cry or terror

sweat

X-ray

( 骨样组织堆积 )

( 干骺端改变 )

Periosteal osteoid

Rachitic metaphyses 钩样杯口

毛刷

Diagnosis

HistoryClinical observationSerum calcium level (±)Serum phosphorus level↓Serum alkaline phosphatase level↑

Treatment

Natural sunlight exposureOral administration of VitD

VitD 2000-6000 IU/d ×2-4w 400IU/dImpulsive injection of VitD

VitD 30-60 万 IU 2-3 timesCalcium 0.5-1.0g/dOthopedics

Prevention

Breast feeding

Exposure to sunlight

Oral administration of VitD 400IU/d

VitD for pregnant and lactating mothers

obesity

肥胖症

Definition

Energy intake > energy expenditureOverweightBody fat over-accumulated

EtiologyEtiology-primary obesity-primary obesity

More junk food or high-energy foods

Less exercise

Genetic predisposition

ob dbleptin

EtiologyEtiology- secondary obesity- secondary obesity

Genetic

Matabolic or endocrinologic diseases

Patho-physiologyPatho-physiology

Serum insulin density ↑Serum insulin density ↑Lipolysis Lipolysis ↓↓Fat synthesis ↑Fat synthesis ↑Fat tissue ↑Fat tissue ↑

Number of fat cell ↑Number of fat cell ↑

Size of fat cell ↑Size of fat cell ↑

Carbohyrate mealCarbohyrate meal

Insulin secretion ↑Insulin secretion ↑Use of fatty acid↓Use of fatty acid↓

3 mon3 mon1yr1yr

adolescentadolescent

Patho-physiologyPatho-physiology

Serum triglyceride↑

General cholerterol↑

Growth homone ↓

Clinical Manifertations

Age—infant , 5-6yr, adolescent

Excessive high caloric intake

Heavy and tall

Bone age advanced

Sleep apnea

White or purple strial

Puberty occur early

Diagonosis

Weight × > 20%( same sex , height)

Mild × >20-29%

Moderate × >30-39%

Sever × >40-45%

Extreme sever × >60%

Body mass index , BMI

BMI=weight (kg) / height (m) 2BMI (same sex , age) 95 percentile or >30

Treatment

Modification of diet and caloric content

Low fat and carbohydrates

High protein

Treatment

<6m

6-9m

<5y

5-10y

10-14y

110cal/kg.d90cal/kg.d600-800cal/kg.d

800-1000cal/kg.d

1000-1200cal/kg.d

Dietary regimen

Treatment

Energy distribution

carbohydrate proteinFat

20-25% 40-45% 30-35%

High quality protein

1.5-2.5g/kg.d

Treatment

Exercise program

Psychotherapy

Gene therapy

Family therapy

-behavior modification

Treatment

Less fat food in late pregnantBreast feedingHealthy food habitOutdoor activityNutritional monitor