Hostname: page-component-7c8c6479df-995ml Total loading time: 0 Render date: 2024-03-28T13:14:05.943Z Has data issue: false hasContentIssue false

Meat consumption reduces the risk of nutritional rickets and osteomalacia

Published online by Cambridge University Press:  08 March 2007

Matthew G. Dunnigan
Affiliation:
University Department of Human Nutrition, Royal Infirmary, Glasgow, UK
Janet B. Henderson
Affiliation:
Department of Psychiatry, Hairmyres Hospital, East Kilbride, UK
David J. Hole*
Affiliation:
Public Health & Health Policy, Division of Community Based Sciences, University of Glasgow, UK
E. Barbara Mawer
Affiliation:
University Department of Medicine, Royal Infirmary, Manchester, UK
Jacqueline L. Berry
Affiliation:
University Department of Medicine, Royal Infirmary, Manchester, UK
*
*Corresponding author: Professor David J. Hole, fax +44 141 330 3283, email d.j.hole@clinmed.gla.ac.uk
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Endogenous vitamin D deficiency (low serum 25(OH)D3) is a necessary but insufficient requirement for the genesis of vitamin D-deficiency rickets and osteomalacia. The magnitude of the independent contributions of dietary factors to rachitic and osteomalacic risk remains uncertain. We reanalysed two weighed dietary surveys of sixty-two cases of rickets and osteomalacia and 113 normal women and children. The independent associations of four dietary variables (vitamin D, Ca, fibre and meat intakes) and daylight outdoor exposure with rachitic and osteomalacic relative risk were estimated by multivariate logistic regression. Meat and fibre intakes showed significant negative and positive associations respectively with rachitic and osteomalacic relative risk (RR; zero meat intake: RR 29·8 (95 % CI 4·96, 181), P<0·001; fibre intake: RR 1·53 (95 % CI 1·01, 2·32), P+0·043). The negative association of meat intakes with rachitic and osteomalacic relative risk was curvilinear; relative risk did not fall further at meat intakes above 60 g daily. Daylight outdoor exposure showed a significant negative association with combined relative risk (RR 0·33 (95 % CI 0·17, 0·66), P<0·001). Operation of the meat and fibre risk factors was related to sex, age and dietary pattern (omnivore/lactovegetarian), mainly determined by religious affiliation. The mechanism by which meat reduces rachitic and osteomalacic risk is uncertain and appears independent of revised estimates of meat vitamin D content. The meat content of the omnivore Western diet may explain its high degree of protection against nutritional rickets and osteomalacia from infancy to old age in the presence of endogenous vitamin D deficiency.

Type
Research Article
Copyright
Copyright © The Nutrition Society 2005

References

Awumey, EM, Mitra, DA, Hollis, BW, Kumar, R & Bell, NH (1998) Vitamin D metabolism in Asian Indians in the southern United States: a clinical research center study. J Clin Endocrinol Metab 83, 169173.Google Scholar
Bloc, BH, Grant, CG, McNeil, AR & Reid, IR (2000) Characteristics of children with florid vitamin D deficient rickets in the Auckland region in 1998. N Z Med J 113, 374376.Google Scholar
Chan, W, Brown, J, Lee, SM & Buss, DH (1995) Meat, Poultry and Game. Fifth Supplement to 5th edition of McCance and Widdowson's The Composition of Foods, 152153. Cambridge/London: The Royal Society of Chemistry/Ministry of Agriculture, Fisheries and Food.Google Scholar
Clements, MR, Johnson, L & Fraser, DR (1987) A new mechanism for induced vitamin D deficiency in calcium deprivation. Nature 324, 6265.CrossRefGoogle Scholar
Corry Mann, H (1922) Rickets. The Relative Importance of Environment and Diet as Factors of Causation: An Investigation in London. Medical Research Council Special Report Series no. 68. London: HM Stationery Office.Google Scholar
Dandona, P, Okonofua, F & Clements, RV (1985) Osteomalacia presenting as pathological fractures during pregnancy in women of high socio-economic class. Br Med J 290, 837838.Google Scholar
Dent, CE (1974) Definition of osteomalacia. Lancet i, 805.Google Scholar
Dent, CE & Gupta, MM (1975) Plasma 25-hydroxyvitamin D levels during pregnancy in Caucasians and in vegetarian and non-vegetarian Asians. Lancet ii, 10571060.Google Scholar
Dollery, CT, Fraser, HS, Davies, D & McIntyre, I (1977) Vitamin D status in different subgroups of British Asians. Br Med J 1, 104.Google Scholar
Dunnigan, MG, Glekin, BM, Henderson, JB, McIntosh, WB, Sumner, D & Sutherland, JR (1985) Prevention of rickets in Asian children: assessment of the Glasgow campaign. Br Med J 291, 239242.CrossRefGoogle ScholarPubMed
Dunnigan, MG & Henderson, JB (1997) An epidemiological model of privational rickets and osteomalacia. Proc Nutr Soc 56, 939956.Google Scholar
Dunnigan, MG, McIntosh, WB & Ford, JA (1976) Rickets in Asian immigrants. Lancet i, 1346.Google Scholar
Dunnigan, MG, Paton, JPJ, Haase, S, McNicol, GW, Gardner, MD & Smith, CM (1962) Late rickets and osteomalacia in the Pakistani community in Glasgow. Scot Med J 7, 159167.CrossRefGoogle ScholarPubMed
Dunnigan, MG & Smith, CM (1965) The aetiology of late rickets in Pakistani children in Glasgow. Report of a diet survey. Scot Med J 10, 19.Google Scholar
Finch, PJ, Ang, L, Colston, KW, Nisbet, J & Maxwell, JD (1992) Blunted seasonal variation in serum 25-hydroxyvitamin D and increased risk of osteomalacia in vegetarian London Asians. Eur J Clin Nutr 46, 509515.Google Scholar
Ford, JA, Colhoun, EM, McIntosh, WB & Dunnigan, MG (1972 a) Rickets and osteomalacia in the Glasgow Pakistani community, 1961–1971. Br Med J 2, 677680.Google Scholar
Ford, JA, Colhoun, EM, McIntosh, WB & Dunnigan, MG (1972 b) Biochemical response of late rickets and osteomalacia to a chapatti-free diet. Br Med J 3, 446447.Google Scholar
Ford, JA, Davidson, DC, McIntosh, WB, Fyfe, WM & Dunnigan, MG (1973) Neonatal rickets in Asian immigrant population. Br Med J 3, 211212.Google Scholar
Fraser, DR (1995) Vitamin D. Lancet 345, 104108.CrossRefGoogle ScholarPubMed
Gopalan, C, Sastri, BR & Balasubramanian, SC (1971) Nutritive Value of Indian Foods. Hyderabad: National Institute of Nutrition.Google Scholar
Gregory, JR, Collins, DL, Davies, PSW, Hughes, JM & Clarke, PC (1995) National Diet & Nutrition Survey: Children Aged 11/2 to 41/2 years, vol. 1. Report of the Diet and Nutrition Survey. London: HM Stationery Office.Google Scholar
Grindulis, H, Scott, PH, Belton, NR & Wharton, BA (1986) Combined deficiency of iron and vitamin D in Asian toddlers. Arch Dis Child 61, 843848.Google Scholar
Hallberg, L, Bjorn-Rasmussen, E, Howard, L & Rossander, L (1979) Dietary heme iron absorption. A discussion of possible mechanisms for the absorption-promoting effect of meat and for the regulation of iron absorption. Scand J Gastroenterol 14, 769779.Google Scholar
Heldenberg, D, Tenenbaum, G & Weisman, Y (1992) Effect of iron on serum 25-hydroxyvitamin D and 24,25-dihydroxyvitamin D concentrations. Am J Clin Nutr 56, 533536.Google Scholar
Henderson, JB, Dunnigan, MG, McIntosh, WB, Abdul-Motaal, AA, Gettinby, G & Glekin, BM (1987) The importance of limited exposure to ultraviolet radiation and dietary factors in the aetiology of Asian rickets: a risk factor model. Q J Med 63, 413425.Google Scholar
Henderson, JB, Dunnigan, MG, McIntosh, WB, Abdul-Motaal, A & Hole, D (1990) Asian osteomalacia is determined by dietary factors when exposure to ultraviolet radiation is restricted: a risk factor model. Q J Med 76, 923933.Google Scholar
Holmes, AM, Enoch, BA, Taylor, JL & Jones, ME (1973) Occult rickets and osteomalacia amongst the Asian immigrant population. Q J Med 42, 125149.Google Scholar
Hunt, SP, O'Riordan, JLH, Windo, J & Truswell, AS (1976) Vitamin D status in different subgroups of British Asians. Br Med J 2, 13511354.Google Scholar
Iqbal, SJ, Kaddam, I, Wassif, W, Nichol, F & Walls, J (1994) Continuing clinically severe vitamin D deficiency in Asians in the UK (Leicester). Postgrad Med J 70, 708714.Google Scholar
Karrar, ZA (1998) Vitamin D deficiency rickets in developing countries. Ann Trop Paediatr 18, Suppl., 8992.Google Scholar
Lawson, DEM (1979) Dietary vitamin D. Lancet ii, 1021.CrossRefGoogle Scholar
Mellanby, E (1918) The part played by an ‘accessory factor’ in the production of experimental rickets. Proc Physiol Soc January 26, xixii.Google Scholar
Mellanby, E (1921) Experimental Rickets. Medical Research Council Special Report Series no. 61. London: HM Stationery Office.Google Scholar
Mellanby, E (1949) Rickets-producing and anti-calcifying action of phytate. J Physiol 109, 488533.Google Scholar
Mughal, MZ, Salama, H, Greenaway, T, Laing, I & Mawer, EB (1999) Lesson of the week: florid rickets associated with prolonged breast feeding without vitamin D supplementation. Br Med J 318, 3940.Google Scholar
Paul, AA & Southgate, DAT (1978) McCance and Widdowson's The Composition of Foods, 4th ed. London: HM Stationery Office.Google Scholar
Pietrek, J, Windo, J, Preece, MA, O'Riordan, JL, Dunnigan, MG, McIntosh, WB & Ford, JA (1976) Prevention of vitamin D deficiency in Asians. Lancet i, 11451148.Google Scholar
Robertson, I, Ford, JA, McIntosh, WB & Dunnigan, MG (1981) The role of cereals in the aetiology of nutritional rickets: the lesson of the Irish National Nutrition Survey 1944–8. Br J Nutr 45, 1732.Google Scholar
Robertson, I, Glekin, BM, Henderson, JB, McIntosh, WB, Lakhani, A & Dunnigan, MG (1982) Nutritional deficiencies among ethnic minorities in the United Kingdom. Proc Nutr Soc 41, 243256.Google Scholar
Row, PM (2001) Why is rickets resurgent in the USA?. Lancet 357, 1100.Google Scholar
Shaw, NJ & Pal, BR (2002) Vitamin D deficiency in UK Asian families: activating a new concern. Arch Dis Child 86, 147149.Google Scholar
Stamp, TCB, Walker, PG, Perry, W & Jenkins, MB (1980) Nutritional osteomalacia and late rickets in Greater London 1974–79: clinical and metabolic studies in 45 patients. Clin Endocrin Metab 9, 81105.Google Scholar
Tanaka, Y, Frank, H & De Luca, HF (1973) Relative values for antirachitic activity as assessed by a calcium transport assay in the rat. Endocrinology 92, 417422.Google Scholar
Weisberg, P, Scanlon, KS, Li, R & Cogswell, ME (2004) Nutritional rickets among children in the United States: review of cases reported between 1986 and 2003. Am J ClinNutr 80, 1697S1705S.Google Scholar
Wharton, B & Bishop, N (2003) Rickets. Lancet 362, 13891400.Google Scholar
Wills, MR, Day, RC, Phillips, JB & Bateman, EC (1972) Phytic acid and nutritional rickets in immigrants. Lancet i, 771773.Google Scholar
Wilton, P (1995) Cod liver oil, vitamin D and the fight against rickets. Can Med Assoc J 153, 740741.Google Scholar