Ideology and disease identity : the politics of rickets, 1929-1982

How can we assess the reciprocal impacts of politics and medicine in the contemporary period? Using the example of rickets in twentieth century Britain, I will explore the ways in which a preventable, curable non-infectious disease came to have enormous political significance, first as a symbol of socioeconomic inequality, then as evidence of racial and ethnic health disparities. Between the 1920s and 1980s, clinicians, researchers, health workers, members of Parliament and later Britain's growing South Asian ethnic communities repeatedly confronted the British state with evidence of persistent nutritional deficiency among the British poor and British Asians. Drawing on bitter memories of the ‘Hungry Thirties’, postwar rickets—so often described as a ‘Victorian’ disease—became a high-profile sign of what was variously constructed as a failure of the Welfare State; or of the political parties charged with its protection; or of ethnically Asian migrants and their descendants to adapt to British life and norms. Here I will argue that rickets prompted such consternation not because of its severity, the cost of its treatment, or even its prevalence; but because of the ease with which it was politicised. I will explore the ways in which this condition was envisioned, defined and addressed as Britain moved from the postwar consensus to Thatcherism, and as Britain's diverse South Asian communities developed from migrant enclaves to settled multigenerational ethnic communities

Vitamins

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Importance of vitamin D in the antenatal period for maternal well-being

Vitamin D deficiency is widely recognised as a major public health issue around the world; and is essential for optimal development and strengthening of the musculoskeletal system including the prevention of conditions such as osteoporosis, osteopenia and rickets. The association between vitamin D and childhood rickets has led to the fortification of food sources and consequently the eradication of the rickets disease. Vitamin D levels are of particular importance for pregnant women, especially for the development of the bone and muscle development of the fetus. In the last decade there has been a substantial increase in the incidence of vitamin D deficiency and the re-emergence of the childhood rickets disease. It is vital that vitamin D levels are at optimal levels during pregnancy as maternal calcium demands increase significantly to meet the demands of the developing fetus, especially in the third trimester

Increased Metabolic Rate in X-linked Hypophosphatemic Mice

Hyp mice are a model for human X-linked hypophosphatemia, the most common form of vitamin D-resistant rickets. It has previously been observed that Hyp mice have a greater food consumption per gram body weight than do normal mice. This led to the search for some alteration in metabolism in Hyp mice. We found that oxygen consumption was significantly higher in Hyp mice than in normal C57BL/6J mice and this was accompanied by an increased percentage of cardiac output being delivered to organs of heat production (liver and skeletal muscle), to the skin, and to bone and a decreased percentage to the gastrointestinal tract of Hyp mice. The increased oxygen consumption in Hyp mice was not associated with increased plasma free T4 levels and was not affected by alterations in plasma phosphate produced by a low phosphate diet. The cause of the increased oxygen consumption is not known, and the role that this change and reported changes in distribution of cardiac output may play in the development of X-linked hypophosphatemia is also unknown. Study of the cardiovascular and thermoregulatory systems in Hyp mice should help increase understanding of the underlying mechanisms of this disease

Safety and Effectiveness of Stoss Therapy in Children with Vitamin D Deficiency

Objectives: Paediatric vitamin D (25-hydroxyvitamin D - 25OHD) deficiency can lead to nutritional rickets and extra-skeletal complications. Compliance with daily therapy can be difficult, making high dose, short-term vitamin D (stoss) therapy attractive to correct vitamin D deficiency. We compared the effectiveness and safety of standard versus stoss therapy in treating childhood 25OHD deficiency. Study Design: Children aged 2 - 16 years with 25OHD \u3c50nmol/L were randomized to either standard (5,000IU daily for 80 days) or stoss (100,000 IU weekly for 4 weeks) cholecalciferol. Participants underwent evaluation of effectiveness and safety. 25OHD, random spot calcium: creatinine ratio (Ca:Cr) and compliance were measured at 12 weeks. Results: 151 children were enrolled in the study (68 standard and 83 stoss), median age 9 years (IQR: 6 - 12 years). Baseline 25OHD levels were 26 nmol/L (IQR: 19 - 35 nmol/L) and 32 nmol/L (IQR: 24 - 39 nmol/L) in the standard and stoss groups respectively. At 12 weeks, the median 25OHD level was significantly greater in the standard vs. stoss group (81 vs. 67 nmol/L; p=0.005), however, \u3e80% of participants in both groups achieved sufficiency (25OHD\u3e50nmol/L) and had normal urinary Ca:Cr, with no significant difference seen between groups. Compliance was similar in the two groups. Conclusion: Compared to stoss, standard therapy achieved higher 25OHD levels at 12 weeks; however, in both groups there were a similar proportion of participants who achieved 25OHD sufficiency, with no evidence of toxicity. Unlike other studies, simplifying the treatment regimen did not improve compliance. These results support stoss therapy as an effective and safe alternative therapy for the treatment of paediatric vitamin D deficiency

Comparative analysis of vitamin D content in sardines canned in olive oil and water

Vitamin D is a fat-soluble hormone primarily responsible in maintaining plasma calcium and phosphorus homeostasis in humans. Vitamin D insufficiency and deficiency is a global health issue. Very few foods naturally contain vitamin D; a major source is oily fish such as salmon. Several studies have analyzed vitamin D content in various fish, however studies concerning canned fish are lacking. In particular, this study was interested in evaluating the vitamin D content in canned sardines in not only the whole fish but also in the olive oil or water it was canned in. It was hypothesized that the vitamin D content in sardines canned in water would be greater than sardines canned in olive oil due to the fat-soluble nature of vitamin D to be more easily extracted into olive oil than water. Sardines (~100g) canned in olive oil had a slightly greater vitamin D content than the sardines in water (2,555.6±234.2 and 1,993.7±2,411.3 IUs (p<0.05) respectively). An evaluation of the vitamin D3 content in the olive oil and water used to can the sardines revealed 701.4±471.1 and 149.1±42.2 IUs in the total olive oil and water respectively recovered from the cans. It was determined that of the total vitamin D content in the can (sardines in olive oil or water) 20.9%±12.8% of vitamin D3 is found in the olive oil compared to only 14.2%±10.4% (p<0.05) vitamin D3 found in water. These results support the concept that sardines packed in olive oil may have less vitamin D3 than similar sardines packed in water. The analysis of the sardines revealed that they had more than 13 times the amount of vitamin D3 than that is reported in the USDA table of nutritional facts for canned sardines. This could be because the sardines were caught in the summer months when they are more likely to be consuming food containing vitamin D3 as a result of reduced synthesis of vitamin D3 in zooplankton and other lower life forms that the sardines consume. An alternative explanation for this increase in vitamin D3 content is the process of canning the sardines. Vital Choice, the supplier of the sardines, immediately ices the fish upon retrieval from the ocean (to ensure freshness) and then are canned in less than 5 hours after being caught. This process of freshness preservation could explain why the vitamin D content was so high; possibly an accurate representation of the original vitamin D content in the sardines

Nutrition, Education and Development: The Case of Vitamin D Milk

Micronutrient deficiencies that reduce the health of children risk impeding human capital investments critical for economic development. While the developed world has largely eliminated the most pernicious of these deficiencies, they remain widespread in poorer countries. This study looks at the effects of the introduction of fortified milk, which contributed to the decline of one such micronutrient deficiency in the United States: vitamin D. At the time of vitamin D milk’s introduction in the early 1930s, vitamin D deficiency, manifested most prominently in the form of rickets, affected large numbers of children. Using previously unexamined historical sources, I compile and introduce an original dataset describing the rollout of vitamin D fortified milk across the United States throughout the decade. I then use this dataset to examine the impact of fortified milk on schooling. The gradual expansion of vitamin D milk, along with natural variation in susceptibility to vitamin D deficiency due to geographic and racial factors, permits the identification of fortification’s impact from other regional and temporal trends. Using a difference-in-difference-in-difference (DDD) estimator, I find that the availability of vitamin D milk increased schooling for the group at highest risk for vitamin D deficiency: African-American children from cities with low sunlight. A variety of sensitivity tests supports the validity of the results. They indicate that large scale food fortification initiatives merit further consideration from economists and policy makers concerned with achieving development outcomes.Food Consumption/Nutrition/Food Safety,

The Young Child and His Food

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