Interim report on vitamin D by the Panel on Child Nutrition : first report by the Panel on Nutrition of the Elderly.

  • Great Britain. Panel on Child Nutrition.
Date:
1970
Catalogue details

Licence: Public Domain Mark

Credit: Interim report on vitamin D by the Panel on Child Nutrition : first report by the Panel on Nutrition of the Elderly. Source: Wellcome Collection.

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    has been detected, but the current position, in our view, is that there are no reliable norms for microdeterminations of alkaline serum phosphatase by this method. In 1963, the World Health Organization considered the problem of detecting sub-clinical deficiency of Vitamin D in populations and stated “The serum alkaline phosphatase level in groups of children is not a generally accepted criterion . . . the relationship of this enzyme in serum with lesser degrees of Vitamin D deficiency has not been established.”’ (World Health Organization, 1963). This would still seem to be the case. 18. In the 1943 survey made by the British Paediatric Association, X-rays were the main source of evidence (British Paediatric Association, 1944); but in those days no issue of harm arising out of X-rays had been raised. The Ministry took opinion on a proposal to repeat a survey on a wide scale and accepted advice that on grounds of principle this was not desirable. 19. Ultimately, there may be evolved a system by which valid serum phospha- tase tests are used as a screen, children with abnormal values being X-rayed. But preliminary trials of such a procedure using material from the Ministry of Health and other studies revealed disagreements between radiologists and between findings of the same radiologist on two occasions as to whether a marginal degree of rickets was or was not present; in addition, in material submitted to the Panel by Dr. Alwyn Smith of the Social Paediatric Research Group, Glasgow, the biochemical and radiological determinations appeared to conflict in that about half the cases diagnosed as marginal rickets by one radiologist had normal serum phosphatase levels (King Armstrong micro-method). Since active rickets is invariably accompanied by increased osteoblastic activity, which in its turn is reflected in an increased amount of phosphatase in the serum, this finding requires elucidation before it can be accepted without reserve. It is the Panel’s view that before satisfactory ways can be evolved of determining the incidence of latent rickets in representative samples of children, a good deal of fundamental investigation will have to be done on the inter-relationships between the various tests that are indicative of Vitamin D deficiency. An expert group has been appointed to deal with this complex problem. In the meantime, the Panel is not ia a position to produce evidence on the prevalence of sub-clinical deficiency. All that can be said is that insofar as it existed in Glasgow, Newcastle and rural Buckinghamshire, its manifestations were such that radiologists disagreed and biochemists disputed as to whether it was or was not present. Dietary evidence 20. In 1960, as already stated, the Ministry of Health made an investigation through fifty local health authorities throughout England of the consumption of Vitamin D by children under the age of one year. These results have been reported (Bransby, Berry and Taylor, 1964) and are shown in the following Table which is taken from their paper.