Abstract
In order to describe the growth of 0–5-year-old Tibetan children living in a Kashin–Beck disease (KBD) endemic rural area and to examine the relationship between anthropometric indicators and clinical signs of rickets, we analyzed the baseline data of a cohort of 668 children enrolled in a prospective program of calcium and vitamin D supplementation. Tibetan children suffer from growth retardation. Z score of weight-for-age, height-for-age, weight-for-height was below −2 in 32.5%, 27.7%, and 12.1% of the children, respectively. Clinical signs of severe rickets are highly prevalent. Underweight, stunting, and clinical rickets increases with age. Prevalence of malnutrition was higher in the presence of signs of rickets. The proportion of children with a head circumference Z score < -2 was lowest when signs of rickets were observed. Conclusion: Stunting and underweight are frequent and probably associated with rickets.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Abbreviations
- HC:
-
Head circumference
- KBD:
-
Kashin–Beck disease
- MUAC:
-
Mid upper arm circumference
- P25:
-
25th percentile
- P50:
-
50th percentile
- P75:
-
75th percentile
- SD:
-
Standard deviation
- TAR:
-
Tibet Autonomous Region
- WHO:
-
World Health Organization
References
Al-Mustafa ZH, Al-Madan M, Al-Majid HJ, Al-Muslem S, Al-Ateeq S, Al-Ali AK (2007) Vitamin D deficiency and rickets in the Eastern Province of Saudi Arabia. Ann Trop Paediatr 27:63–67
Craviari T, Pettifor JM, Thacher TD, Meisner C, Arnaud J, Fischer PR, Rickets Convergence Group (2008) Rickets: an overview and future directions, with special reference to Bangladesh. J Health Popul Nutr 26:112–121
Cui Y, Yang L, Zhao YX, Wu Q, Tian XB (2008) Study on status of nutrition in children under three years old in rural area in China. Zhonghua Liu Xing Bing Xue Za Zhi 29:230–234
Dang S, Yan H, Yamamoto S, Wang X, Zeng L (2004) Poor nutritional status of younger Tibetan children living at high altitudes. Eur J Clin Nutr 58:938–946
Dutta A, Pant K, Puthia R, Sah A (2009) Prevalence of undernutrition among children in the Garhwal Himalayas. Food Nutr Bull 30:77–81
Fisher AM (2005) State growth and social exclusion in Tibet: the challenges of recent economic growth. NIAS, Copenhagen
Hall A, Kassa T, Demissie T, Degefie T, Lee S (2008) National survey of health and nutrition of schoolchildren in Ethiopia. Trop Med Int Health 13:1518–1526
Harris NS, Crawford PB, Yangzom Y, Pinzo L, Gyaltsen P, Hudes M (2001) Nutritional and health status of Tibetan children living at high altitudes. N Engl J Med 344:341–347
Harris NS, Yangzom Y, Pinzo L, Gyaltsen P, Crawford PB (1996) Effects of age, community location, and illness on nutritional status of high altitude Tibetan children, 0–7 years. Int Child health 8:99–114
Kolsteren P, Atkinson S, Maskall K (1995) Une enquète nutritionelle au Tibet. Cahiers Santé 5:247–252
Levinson J, Basset L (2010) Malnutrition is still a major contributor to child deaths. Washington, DC: Population reference bureau. Available online at: http:// www.prb.org. Accessed November 09, 2010
Malaisse F, Mathieu F (2008) The land ecosystem. In: Malaisse F, Mathieu F (eds) Big Bone Disease, a multidisciplinary approach of Kashin–Beck disease in Tibet Autonomous Region (PR China). Les presses universitaires de Gembloux, Gembloux, pp 37–50
Mathieu F, Begaux F, Lan ZY, Suetens C, Hinsenkamp M (1997) Clinical manifestations of Kashin–Beck disease in Nyemo valley, Tibet. Int Orthop 21:151–156
Moore LG, Niermeyer S, Zamudio S (1998) Human adaptation to high altitude: regional and life-cycle perspectives. Am J Phys Anthropol Suppl 27:25–64
Needlman RD (2004) Growth and development. In: Behrman RE, Kliegman RM, Jenson HB (eds) Nelson Textbook of Pediatrics, 17th edn. Saunders, Philadelphia, pp 23–67
Pawson IG (1976) Growth and development in high altitude population: a review of Ethiopian, Peruvian, and Nepalese studies. Proc R Soc Lond (B) 194:83–98
Romaguera D, Samman N, Farfan N, Labo M, Pons A, Tur JA (2007) Nutritional status of Andean population of Puna and Quebrada of Humahuaca, Jujuy, Argentina. Public Health Nutr 11:606–615
Suetens C, Moreno-Reyes R, Chasseur C, Mathieu F, Begaux F, Haubruge E, Durand MC, Nève J, Vanderpas J (2001) Epidemiological support for a multifactorial aetiology of Kashin–Beck disease in Tibet. Int Orthop 25(3):180–187
United Nations Economic and Social Commission for Asia and Pacific.Tibet. Basic data and population situation. Bangkok: United Nation Economic and Social Commission for Asia and Pacific Available online at www.unescap.org/esid/psis/population/database/chinadata/tibet.htm. Accessed November10, 2010
WHO child growth standards, Genava World Health Organisation. Available on http://www.who.int/childgrowth/standards/en/. Accessed November 10, 2010
WHO, Geneva World Health Organisation 10 facts on nutrition. Available on www.who.int/features/factfiles/nutrition/facts/en/index1.html. Accessed November 09, 2010
Zhang WH, Neve J, Xu JP, Vanderpas J, Wang ZL (2001) Selenium, iode and fungal contamination in Yulin district (People’s Republic of China) endemic for Kashin–Beck disease. Int orthop 25(3):188–190
Zheng Du, Zhang Q, Shaohong Wu (2000) Mountain geoecology and sustainable development of the Tibetan Plateau. Kluwer academic publishers, Dordrecht
Acknowledgments
This study was made possible thanks to our close collaboration with the Center of Disease Control and Prevention of Tibet Autonomous Region. We are related to Kadoorie Charitable Foundation and Parthenon Trust who supported financially this study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rooze, S., Dramaix-Wilmet, M., Mathieu, F. et al. Growth, nutritional status, and signs of rickets in 0–5-year-old children in a Kashin–Beck disease endemic area of Central Tibet. Eur J Pediatr 171, 1185–1191 (2012). https://doi.org/10.1007/s00431-012-1699-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00431-012-1699-3