A comparison of calcium, vitamin D, or both for nutritional rickets in Nigerian children
Thacher TD, Fischer PR, Pettifor JM, Lawson JO, Isichei CO, Reading JC, Chan GM
The New England journal of medicine · 165 citas
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Cómo se estudió
- Diseño
- Ensayo controlado aleatorizado (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Marcadores de salud y funcionamiento
Quién lo pagó
- Financiación
- Financiación no declarada
Publicación
- Publicado
- 1999-08-19 · N Engl J Med · vol. 341 · número 8 · págs. 563–568
- Editorial
- Massachusetts Medical Society
- Citado
- 325 citas · más que el 95% de estudios similares · 4.9× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 18 trabajos
- Acceso
- Lectura gratuita
- Áreas de investigación
- Vitamin D Research Studies · Bone health and osteoporosis research · Child Nutrition and Water Access
- Palabras clave
- nutritional rickets, vitamin D supplementation, calcium supplementation, calcium intake, serum calcium, alkaline phosphatase, rickets treatment, Nigerian children
- MeSH
- humans, rickets, calcium, dietary, calcium, alkaline phosphatase, vitamin d, drug therapy, combination, double-blind method, child, preschool, nigeria, female, male
7 autores
- Tom D. Thacher🇳🇬University of Jos; Jos University Teaching Hospital
- Philip R. Fischer🇺🇸Mayo Clinic; University of Utah
- John Morley Pettifor🇿🇦🇺🇸University of the Witwatersrand; University of Utah; Chris Hani Baragwanath Hospital; University of Utah Health Care
- Juliana O. Lawson🇳🇬Jos University Teaching Hospital
- Christian O. Isichei🇳🇬Jos University Teaching Hospital
- James C. Reading🇺🇸University of Utah
- Gary M. Chan🇺🇸University of Utah
Resumen
El texto original del estudio, en el idioma en que se publicó.
Background
Nutritional rickets remains prevalent in many tropical countries despite the fact that such countries have ample sunlight. Some postulate that a deficiency of dietary calcium, rather than vitamin D, is often responsible for rickets after infancy.
Methods
We enrolled 123 Nigerian children (median age, 46 months) with rickets in a randomized, double-blind, controlled trial of 24 weeks of treatment with vitamin D (600,000 U intramuscularly at enrollment and at 12 weeks), calcium (1000 mg daily), or a combination of vitamin D and calcium. We compared the calcium intake of the children at enrollment with that of control children without rickets who were matched for sex, age, and weight. We measured serum calcium and alkaline phosphatase and used a 10-point radiographic score to assess the response to treatment at 24 weeks.
Results
The daily dietary calcium intake was low in the children with rickets and the control children (median, 203 mg and 196 mg, respectively; P=0.64). Treatment produced a smaller increase in the mean (+/-SD) serum calcium concentration in the vitamin D group (from 7.8+/-0.8 mg per deciliter [2.0+/-0.2 mmol per liter] at base line to 8.3+/-0.7 mg per deciliter [2.1+/-0.2 mmol per liter] at 24 weeks) than in the calcium group (from 7.5+/-0.8 [1.9+/-0.2 mmol per liter] to 9.0+/-0.6 mg per deciliter [2.2+/-0.2 mmol per liter], P<0.001) or the combination-therapy group (from 7.7+/-1.0 [1.9+/-0.25 mmol per liter] to 9.1+/-0.6 mg per deciliter [2.3+/-0.2 mmol per liter], P<0.001). A greater proportion of children in the calcium and combination-therapy groups than in the vitamin D group reached the combined end point of a serum alkaline phosphatase concentration of 350 U per liter or less and radiographic evidence of nearly complete healing of rickets (61 percent, 58 percent, and 19 percent, respectively; P<0.001).
Conclusions
Nigerian children with rickets have a low intake of calcium and have a better response to treatment with calcium alone or in combination with vitamin D than to treatment with vitamin D alone.
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