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
Etiology
?Insufficient intake of VitD3
?Insufficient intake of calcium
absoption
inhibition
VitD lactose Amino acid
P↑
fibers
vegetable
Etiology
adolescents Rapid growth
Low- birth weight infants
Adolescents
Etiology
Diseases Celiac disease
Anticonvulsant therapy
Cystic disease
phenobarbital
Etiology
Other
s
Nutritional status of mother
Eating habit
Nutrients deficiency
Zn
VitC
Protei
n
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↓
Demineralization
Osteomalaci
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 breast （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
Scoliosis Deformities
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
?History
?Clinical observation
?Serum calcium level (± )
?Serum phosphorus level↓
?Serum alkaline phosphatase level↑
Treatment
?Natural sunlight exposure
?Oral administration of VitD
VitD 2000-6000 IU/d × 2-4w 400IU/d
?Impulsive injection of VitD
VitD 30-60万 IU 2-3 times
?Calcium 0.5-1.0g/d
?Othopedics
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 expenditure
?Overweight
?Body fat over-accumulated
Etiology-primary obesity
?More junk food or high-energy foods
?Less exercise
?Genetic predisposition
ob db
leptin
Etiology- secondary obesity
Genetic
Matabolic or endocrinologic
diseases
Patho-physiology
Serum insulin density ↑
?Lipolysis ↓
?Fat synthesis ↑
Fat tissue ↑
?Number of fat cell ↑
?Size of fat cell ↑
Carbohyrate meal
?Insulin secretion ↑
?Use of fatty acid↓
3 mon
1yr
adolescent
Patho-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) 2
BMI (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.
d 90cal/kg.
d
600-800cal/kg.d
800-1000cal/kg.d
1000-1200cal/kg.d
Dietary regimen
Treatment
Energy distribution
carbohydrate protein Fat
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 pregnant
?Breast feeding
?Healthy food habit
?Outdoor activity
?Nutritional monitor