Protein –calorie Malnutrition in Children with Vitamin D Deficiency Rickets

INTRODUCTION: Vitamin D deficiency rickets (VDDR) is a term applied to the failure of mineralization of growing bone or osteoid tissue which could be due to either inadequate direct exposure to ultraviolet rays in sunlight or to inadequate intake of vitamin D or both (1,2,3) . The vitamin D content of human milk is low (approximately 22 IU/L). However, among most breast-fed infants, the combination of breast milk and sunlight exposure provides sufficient vitamin D. American Academy of Pediatrics recommends 400 IU per day vitamin D supplementation for breast-fed infants whose mothers are vitamin D deficient or for those infants not exposed to adequate sunlight (4) .The World Health Organization (WHO) estimates that by the year 2015, the prevalence of malnutrition will have decreased to (17.6%) globally , with 113.4 millions children younger than 5 years affected as measured by low weight for age. The majority of these children will live in developing countries. In addition to PCM children may be affected by micronutrient deficiencies , most commonly , iron, iodine , zinc, and vitamin A, while deficiencies of vitamin C, B, and D, have improved in recent years (5,6,7) . It had been noticed that VDDR could occur in unsupplemented breastfed infants who had insufficient exposure to sun light .It had been also noticed that breast milk can lack adequate vitamin