Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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모유 수유아에서의 무증상적 구루병

Subclinical rickets in breastfed infants

  • 박신영 (인하대학교 의과대학 소아과학교실) ;
  • 박성우 (인하대학교 의과대학 소아과학교실) ;
  • 강성길 (인하대학교 의과대학 소아과학교실) ;
  • 전용훈 (인하대학교 의과대학 소아과학교실) ;
  • 김순기 (인하대학교 의과대학 소아과학교실) ;
  • 손병관 (인하대학교 의과대학 소아과학교실) ;
  • 이지은 (인하대학교 의과대학 소아과학교실)
  • Park, Sin Young (Department of Pediatrics, College of Medicine, Inha University) ;
  • Park, Sung Woo (Department of Pediatrics, College of Medicine, Inha University) ;
  • Kang, Sung Kil (Department of Pediatrics, College of Medicine, Inha University) ;
  • Jun, Yong Hoon (Department of Pediatrics, College of Medicine, Inha University) ;
  • Kim, Soon Ki (Department of Pediatrics, College of Medicine, Inha University) ;
  • Son, Byong Kwan (Department of Pediatrics, College of Medicine, Inha University) ;
  • Lee, Jee Eun (Department of Pediatrics, College of Medicine, Inha University)
  • 투고 : 2007.09.07
  • 심사 : 2007.10.11
  • 발행 : 2007.12.15
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초록

목 적 : 최근 들어 개발 도상국 뿐만 아니라 여러 선진국에서도 구루병 발생이 보고되고 있다. 국내에도 모유 수유율의 증가 등의 사회 문화적인 변화가 일어나고 있지만, 비타민 D 결핍에 관한 연구는 거의 없는 상태이다. 구루병이 발생하기 쉬운 모유 수유아를 대상으로 비타민 D 결핍증 발생의 유무와 임상 양상을 알아보는 연구를 시행하였다. 방 법 : 2006년 5월부터 2007년 4월까지 감기나 건강 검진 등으로 인하대병원 소아과를 방문한 4개월에서 18개월 사이의 모유수유아를 대상으로 혈액 검사를 시행한 후 저비타민증을 보인 환아를 대상으로 연구를 시행하였다. 비교군으로 2003년 5월부터 2006년 4월까지 인하대병원 소아과에서 증상성 비타민 D 결핍성 구루병으로 진단, 치료한 환아를 대상으로 하였다. 관련인자는 의무기록과 설문을 통하여 조사하였고, 혈액 검사 및 방사선학적 검사를 시행하였다. 결 과 : 무증상군은 8명, 증상군은 4명이었다. 두 군의 발병 연령은 각각 8개월(4-11개월)과 5.5개월(5-8개월)이었다. 혈액 검사에서는 9명의 환아가 $25-OHD_3$의 농도가 20 ng/mL 미만으로 비타민 결핍증을 보이고, 3명에서는 비타민 D 불 충분증(20-30 ng/mL)을 보였다. 두 군에서 모두 ALP 와 PTH 의 정상 수치보다 증가되어 있었다. 무증상군의 $25-OHD_3$의 농도는 $19.11{\pm}4.64\;ng/mL$로 증상군의 농도인 $8.35{\pm}3.89\;ng/mL$ 와 통계적으로 유의한 차이를 보였다(P=0.008). 12명의 대상 환아 중 10명(83%)에서 철 결핍성 빈혈이 동반되었다. 결 론 : 비교적 안전하다고 생각하던 국내에서도 모유 수유로 인한 비타민 D 결핍증이 발생되고 있음을 알 수 있다. 또한 증상은 보이지 않지만 비타민 D의 농도가 떨어져 있는 무증상적 구루병이 발생함을 알 수 있었다. 국내에서 발생하는 비타민 D 결핍증에 대한 역학 조사가 필요할 것으로 보인다.

Purpose : The prevalence of rickets in the world is on the rise not only in developing but also in developed countries. In Korea, breastfeeding has increased. There have been few studies on the possible association of rickets with breastfeeding. The purpose of this study was to identify the development and the clinical presentation of subclinical rickets in breastfed infants. Methods : We investigated patients who were breastfed and had hypovitaminosis D in the blood from May 2006 to April 2007, and who were diagnosed with vitamin D deficient rickets from May 2003 to April 2006. We evaluated the results of blood tests, x-rays and other relevant information in the medical record. A questionnaire that included questions on the diet of patients, the mothers activity during pregnancy and place of residence was administered. Results : Twelve patients (66%: male, 34%: female) were enrolled in this study. There were eight in the asymptomatic and four in the symptomatic group. The median age for each group was 8 months (range 4-11 month) and 5.5 months (5-8 month). All patients in the symptomatic group were breastfed until diagnosed. In the asymptomatic group, they were breastfed for four to six months, and then weaned with only thin rice soup and vegetables. Nine patients had a vitamin D concentration below 20 ng/mL and three patients had levels between 20 and 29 ng/mL. Alkaline phosphatase (ALP) and parathyroid hormone (PTH) were elevated in both groups. There were statistically significant $25-OHD_3$ levels in the blood in both groups (P=0.008). Ten of the patients (83%) also had iron deficient anemia. Conclusion : Vitamin D deficiency and subclinical rickets has been identified in Korea. However, the prevalence of this disease has not been determined. The main limitation of this study was the small number of patients and the absence of a control group.

키워드

과제정보

연구 과제 주관 기관 : 인하대학교

참고문헌

  1. Holick MF. Resurrection of vitamin D deficiency and rickets. J Clin Invest 2006;116:2062-72 https://doi.org/10.1172/JCI29449
  2. Blok BH, Grant CC, McNeil AR, Reid IR. Characteristics of children with florid vitamin D deficient rickets in the Auckland region in 1998. N Z Med J 2000;113:374-6
  3. Rowe PM. Why is rickets resurgent in the USA? Lancet 2001;357:1100
  4. Shaw NJ, Pal BR. Vitamin D deficiency in UK Asian families: activating a new concern. Arch Dis Child 2002;86:147-9 https://doi.org/10.1136/adc.86.3.147
  5. Ladhani S, Srinivasan L, Buchanan C, Allgrove J. Presentation of vitamin D deficiency. Arch Dis Child 2004;89:781-4 https://doi.org/10.1136/adc.2003.031385
  6. Karrar ZA. Vitamin D deficiency rickets in developing countries. Ann Trop Paediatr 1998;18 suppl:S89-92 https://doi.org/10.1080/02724936.1998.11833490
  7. Nozza JM, Rodda CP. Vitamin D deficiency in mothers of infants with rickets. Med J Aust 2001;175:253-5
  8. Al-Mustafa ZH, Al-Madan M, Al-Majid HJ, Al-Muslem S, Al-Ateeq S, Al-Ali AK. Vitamin D deficiency and rickets in the Eastern Province of Saudi Arabia. Ann Trop Paediatr 2007;27:63-7 https://doi.org/10.1179/146532807X170529
  9. Ziegler EE, Hollis BW, Nelson SE, Jeter JM. Vitamin D deficiency in breastfed infants in Iowa. Pediatrics 2006;118: 603-10 https://doi.org/10.1542/peds.2006-0108
  10. Gartner LM, Greer FR; Section on Breastfeeding and Committee on Nutrition. American Academy of Pediatrics. Prevention of rickets and vitamin D deficiency: new guidelines for vitamin D intake. Pediatrics 2003;111:908-10 https://doi.org/10.1542/peds.111.4.908
  11. Hochberg Z, Bereket A, Davenport M, Delemarre-Van de Waal HA, De Shepper J, Levine MA, et al; European Society for Pediatric Endocrinology (ESPE) Bone Club. Consensus development for the supplementation of vitamin D in childhood and adolescence. Horm Res 2002;58:39-51
  12. Moy R, Shaw N, Mather I. Vitamin D supplementation in pregnancy. Lancet 2004;363:574
  13. Mahomed K, Gulmezoglu AM. Vitamin D supplementation in pregnancy. Cochrane Database Syst Rev 2000;(2):CD000228
  14. The State of the World's Children Report. Unicef, 2007. Available from: URL: //http://www.unicef.or.kr/bfhi/archive/ statistic.html
  15. Holick MF. Vitamin D deficiency. N Engl J Med 2007;357: 266-81 https://doi.org/10.1056/NEJMra070553
  16. Wharton B, Bishop N. Rickets. Lancet 2003;362:1389-400 https://doi.org/10.1016/S0140-6736(03)14636-3
  17. Munns C, Zacharin MR, Rodda CP, Batch JA, Morley R, Cranswick NE, et al. Prevention and treatment of infant and childhood vitamin D deficiency in Australia and New Zealand: a consensus statement. Med J Aust 2006;185:268-72
  18. Kim LT, Ko SH, Kim ST. Vitamin D Deficiency Rickets. J Korean Pediatr Soc 1977;20:981-7
  19. Kim CS, Shin WZ, Lee HS. Vitamin D Deficiency Rickets. J Korean Pediatr Soc 1981;24:70-4
  20. Bae SN, Rho EJ, Lim JW, Cheon EJ, Ko KO, Lee YH. A case of hypocalcemia due to vitamin D deficiency in exclusively breast-fed infant. J Korean Soc Pediatr Endocrinol 2006;11:205-8
  21. Robinson PD, Hogler W, Craig ME, Verge CF, Walker JL, Piper AC, et al. The re-emerging burden of rickets: a decade of experience from Sydney. Arch Dis Child 2006;91:564-8 https://doi.org/10.1136/adc.2004.069575
  22. Song JY, Shin YL, Yoo HW. Clinical characteristics of symptomatic hypocalcemic infants. J Korean Soc Pediatr Endocrinol 2002;7:95-104
  23. Strand MA, Perry J, Jin M, Tracer DP, Fischer PR, Zhang P, et al. Diagnosis of rickets and reassessment of prevalence among rural children in northern China. Pediatr Int 2007; 49:202-9 https://doi.org/10.1111/j.1442-200X.2007.02343.x
  24. Heaney RP, Dowell MS, Hale CA, Bendich A. Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. J Am Coll Nutr 2003;22:142-6 https://doi.org/10.1080/07315724.2003.10719287
  25. Holick MF. High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc 2006;81:353-73 https://doi.org/10.4065/81.3.353
  26. Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 2006;84:18-28 https://doi.org/10.1093/ajcn/84.1.18
  27. Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R. Estimates of optimal vitamin D status. Osteoporos Int 2005;16:713-6 https://doi.org/10.1007/s00198-005-1867-7
  28. Wayse V, Yousafzai A, Mogale K, Filteau S. Association of subclinical vitamin D deficiency with severe acute lower respiratory infection in Indian children under 5 y. Eur J Clin Nutr 2004;58:563-7 https://doi.org/10.1038/sj.ejcn.1601845
  29. Dahifar H, Faraji A, Yassobi S, Ghorbani A. Asymptomatic rickets in adolescent girls. Indian J Pediatr 2007;74:571-5 https://doi.org/10.1007/s12098-007-0095-x
  30. Maiya S, Sullivan I, Allgrove J, Archer N, Tulloh R, Daubeney P, et al. Hypocalcaemia and vitamin D deficiency: an important, but preventable cause of life threatening infant heart failure. Heart. In press 2007
  31. Dijkstra SH, van Beek A, Janssen JW, de Vleeschouwer LH, Huysman WA, van den Akker EL. High prevalence of vitamin D deficiency in newborns of high-risk mothers. Arch Dis Child Fetal Neonatal Ed. In press 2007
  32. Specker BL, Tsang RC, Hollis BW. Effect of race and diet on human-milk vitamin D and 25-hydroxyvitamin D. Am J Dis Child 1985;139:1134-7
  33. Clemens TL, Adams JS, Henderson SL, Holick MF. Increased skin pigment reduces the capacity of skin to synthesise vitamin D3. Lancet 1982;1:74-6
  34. Grover SR, Morley R. Vitamin D deficiency in veiled or dark-skinned pregnant women. Med J Aust 2001;175:251-2
  35. Heinig MJ. Vitamin D and the breastfed infant: Controversies and concerns. J Hum Lact 2003;19:247-9 https://doi.org/10.1177/0890334403255420

피인용 문헌

  1. 철결핍빈혈 영유아의 식이력 조사 및 이유지식의 평가 vol.52, pp.2, 2009, https://doi.org/10.3345/kjp.2009.52.2.159
  2. 비타민 D 결핍성 구루병 영.유아의 임상적 특징 vol.53, pp.2, 2007, https://doi.org/10.3345/kjp.2010.53.2.152
  3. 모유수유아에서의 철결핍 빈혈과 비타민 D 결핍 vol.13, pp.2, 2007, https://doi.org/10.5223/kjpgn.2010.13.2.164
  4. 모유수유아의 비타민 D 섭취에 대한 한국형 가이드라인 제안 vol.26, pp.1, 2012, https://doi.org/10.7778/jpkm.2012.26.1.070
  5. The Study in Vitamin D Concentration in the Blood for Infants with High Level of Alkaline Phosphatase vol.27, pp.1, 2007, https://doi.org/10.7180/kmj.2012.27.1.17