Study on Subclinical Rickets Among Adolescents in Hazara

Abstract

This study has revealed that sub clinical rickets is found in adolescent students of Hazara. Although this concern is common in both genders from all geographical areas, but more cases were found in rural school student and of girl’s gender. The major root cause includes nutritional deficiencies and unavailability of sun shine. Hence the lack of synergistic effect of sun shines vitamin D and nutritional intake was seen in sub clinical rickets cases. Biochemical low serum level of vitamin D is the most prominent laboratory tool for the confirmation of this problem. Study populations consisted of school students which belonged to rural, urban and suburban areas of Hazara, Pakistan. Number and ages of all group participants were almost same and there was no significant differences among them (>0.05). Prevalence of sub clinical rickets was found to be 51(27%), out of which girls was 36(71%) and boys 15(29%) with significant differences (<0.05). Among cases of subclinical rickets, 26(51%) were from rural, 16(31%) urban area and 09(18%) from suburban region. Same gender of subclinical rickets from different areas were of similar ages, but difference noted in the ages of boys and girls sub clinical rickets cases (<0.05). Determination of nutritional status of each individual from different areas which was assigned as sub clinical rickets case reflect that, average amount of nutrients such as vitamin D, calcium and phosphorus were being taking less than the recommended amount on daily basis in their foods. No significant difference were noted in daily intakes of sub clinical cases of both genders as well as among different areas groups (>0.05). There was no difference seen significantly between daily intake of adolescents with or without sub clinical rickets (>0.05). Although both genders were taken almost similar amount of vitamin D, calcium & phosphorus on daily basis in their foods, but significant differences were noted in Sub clinical Rickets among Adolescents prevalence of sub clinical rickets & serum vitamin D level between two genders (<0.05). Area wise among different subclinical rickets groups as well as their comparison with normal cases, the significant differences were observed regarding serum 25(OH) D concentration (<0.05). In comparison of sub clinical rickets cases with normal group in similar area, calcium and alkaline phosphatase in serum of boys and girls from rural and urban territory showed significant difference (<0.05), but non significant difference was observed in phosphorus and parathyroid status in group(>0.05). No significant differences were observed regarding calcium, phosphorus, alkaline phosphatase and parathyroid hormonal level of suburban subclinical clinical cases vs. normal (>0.05). On the basis of vitamin D status the sub clinical cases divided into two categories, Insufficiency (≥25-<50nmol/l) and deficiency (<25nmol/l). Vitamin D deficiency cases was 8(16%) and 43(84%) of vitamin D insufficiency. Significant difference was noted between vitamin D deficient and vitamin D insufficient level. In sub clinical rickets groups, low level of vitamin D (51)100%, abnormality of calcium found in (28)55%, phosphorus (13)24%, high alkaline phosphatase (37)73% and none of the case with high parathyroid hormone level from upper normal reference range. Occurrence of low vitamin D level 33(92%) was found in girls having age >13 to ≤16 years but only 3(08%) having age ≥11 to ≤13 years. In boys age >13 to ≤16 years none of case had low vitamin D level, all of 15(100%) subclinical rickets cases were of age between ≥11 to ≤13 years. Significant difference in vitamin D level of lower age girl group and higher age girl group was noted (<0.050). Study concluded that, sub clinical rickets is considered as camouflagic problem among school students of both genders especially girls in Hazara. Lack of synergistic effects of sunshine vitamin D and nutritional intakes are the major cause of this problem. Low sun shine is attributed to environmental, social and traditional factors. Along with sunshine and nutritional factors, the age and sex might be contributing factors in the occurrence of low vitamin D status.