Editing Rickets (section)

===Skin color theory===
Rickets is often a result of vitamin D3 deficiency. The correlation between human skin color and latitude is thought to be the result of positive selection to varying levels of solar ultraviolet radiation. Northern latitudes have selection for lighter skin that allows UV rays to produce vitamin D from 7-dehydrocholesterol. Conversely, latitudes near the equator have selection for darker skin that can block the majority of UV radiation to protect from toxic levels of vitamin D, as well as skin cancer.<ref>{{cite journal | vauthors = Loomis WF | title = Skin-pigment regulation of vitamin-D biosynthesis in man | journal = Science | volume = 157 | issue = 3788 | pages = 501–506 | date = August 1967 | pmid = 6028915 | doi = 10.1126/science.157.3788.501 | s2cid = 41681581 | bibcode = 1967Sci...157..501F }}</ref>

An anecdote often cited to support this hypothesis is that Arctic populations whose skin is relatively darker for their latitude, such as the Inuit, have a diet that is historically rich in vitamin D. Since these people acquire vitamin D through their diet, there is not a positive selective force to synthesize vitamin D from sunlight.<ref>{{cite journal | vauthors = Sharma S, Barr AB, Macdonald HM, Sheehy T, Novotny R, Corriveau A | title = Vitamin D deficiency and disease risk among aboriginal Arctic populations | journal = Nutrition Reviews | volume = 69 | issue = 8 | pages = 468–478 | date = August 2011 | pmid = 21790613 | doi = 10.1111/j.1753-4887.2011.00406.x | doi-access = free }}</ref>

Environment mismatch: vitamin D deficiency arises from a mismatch between an individual's previous and current environment. This risk of mismatch increases with advances in transportation methods and increases in urban population size at high latitudes.<ref>{{Cite journal |last1=Ames |first1=Bruce N. |last2=Grant |first2=William B. |last3=Willett |first3=Walter C. |date=2021-02-03 |title=Does the High Prevalence of Vitamin D Deficiency in African Americans Contribute to Health Disparities? |journal=Nutrients |volume=13 |issue=2 |pages=499 |doi=10.3390/nu13020499 |doi-access=free |issn=2072-6643 |pmc=7913332 |pmid=33546262}}</ref>

Similar to the environmental mismatch when dark-skinned people live at high latitudes, Rickets can also occur in religious communities that require long garments with hoods and veils.<ref>{{cite journal | vauthors = Bachrach S, Fisher J, Parks JS | title = An outbreak of vitamin D deficiency rickets in a susceptible population | journal = Pediatrics | volume = 64 | issue = 6 | pages = 871–877 | date = December 1979 | pmid = 574626 | doi = 10.1542/peds.64.6.871 | s2cid = 26050085 }}</ref> These hoods and veils act as sunlight barriers that prevent individuals from synthesizing vitamin D naturally from the sun.<ref>{{cite web |title=RISE IN RICKETS LINKED TO ETHNIC GROUPS THAT SHUN THE SUN |website=[[Independent.co.uk]] |date=24 July 2011 |url=https://www.independent.co.uk/life-style/health-and-families/health-news/rise-in-rickets-linked-to-ethnic-groups-that-shun-the-sun-2319920.html |access-date=21 November 2021}}</ref>

In a study by Mithal et al.,<ref>{{cite journal |display-authors=6 |vauthors=Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA, El-Hajj Fuleihan G, Josse RG, Lips P, Morales-Torres J |date=November 2009 |title=Global vitamin D status and determinants of hypovitaminosis D |url=https://pubmed.ncbi.nlm.nih.gov/19543765/ |journal=Osteoporosis International |volume=20 |issue=11 |pages=1807–1820 |doi=10.1007/s00198-009-0954-6 |pmid=19543765 |s2cid=52858668}}</ref> vitamin D insufficiency of various countries was measured by lower 25-hydroxyvitamin D. 25(OH) D is an indicator of vitamin D insufficiency that can be easily measured. These percentages should be regarded as relative vitamin D levels, and not as predicting evidence for development of rickets.<ref>{{Cite journal |last=Cashman |first=Kevin D. |date=2022-01-11 |title=Global differences in vitamin D status and dietary intake: a review of the data |journal=Endocrine Connections |volume=11 |issue=1 |pages=e210282 |doi=10.1530/EC-21-0282 |issn=2049-3614 |pmc=8789021 |pmid=34860171}}</ref>

Asian immigrants living in Europe have an increased risk for vitamin D deficiency. Vitamin D insufficiency was found in 40% of non-Western immigrants in the Netherlands, and in more than 80% of Turkish and Moroccan immigrants.

The Middle East, despite high rates of sun-exposure, has the highest rates of rickets worldwide.<ref>{{cite web | url = http://www.iofbonehealth.org/sites/default/files/PDFs/Audit%20Middle%20East_Africa/ME_audit-executive_summary.pdf | title = THE MIDDLE EAST & AFRICA REGIONAL AUDIT, Executive Summary, Epidemiology, costs & burden of osteoporosis in 2011 | archive-url = https://web.archive.org/web/20170825145111/https://www.iofbonehealth.org/sites/default/files/PDFs/Audit%20Middle%20East_Africa/ME_audit-executive_summary.pdf | archive-date=25 August 2017 }} The International Osteoporosis Foundation, www.iofbonehealth.org, retrieved 6 April 2017</ref> This fact can be explained by limited sun exposure due to cultural practices and lack of vitamin D supplementation for breast-feeding women. Up to 70% and 80% of adolescent girls in Iran and Saudi Arabia, respectively, have vitamin D insufficiency. Socioeconomic factors that limit a vitamin D rich diet also plays a role.
In the United States, vitamin D insufficiency varies dramatically by ethnicity. Among females aged 70 years and older, the prevalence of low serum 25(OH) D levels was 28.5% for non-Hispanic whites, 55% for Mexican Americans, and 68% for non-Hispanic blacks. Among males, the prevalence was 23%, 45%, and 58%, respectively.{{citation needed|date=September 2021}}

A systematic review published in the [[Cochrane Library]] looked at children up to three years old in Turkey and China and found a beneficial association between vitamin D and rickets. In Turkey, children getting vitamin D had only a 4% chance of developing rickets compared to children who received no medical intervention. In China, a combination of vitamin D, calcium and nutritional counseling was linked to a decreased risk of rickets.<ref>{{cite journal | vauthors = Lerch C, Meissner T | title = Interventions for the prevention of nutritional rickets in term born children | journal = The Cochrane Database of Systematic Reviews | volume = 2010 | issue = 4 | pages = CD006164 | date = October 2007 | pmid = 17943890 | pmc = 8990776 | doi = 10.1002/14651858.CD006164.pub2 }}</ref>

Parents can supplement their nutritional intake with vitamin D enhanced beverages if they feel their child is at risk for vitamin D deficiency.<ref>{{cite journal | vauthors = Weisberg P, Scanlon KS, Li R, Cogswell ME | title = Nutritional rickets among children in the United States: review of cases reported between 1986 and 2003 | journal = The American Journal of Clinical Nutrition | volume = 80 | issue = 6 Suppl | pages = 1697S–1705S | date = December 2004 | pmid = 15585790 | doi = 10.1093/ajcn/80.6.1697S | doi-access = free }}</ref>

A 2019 review linked rickets disease to exclusive consumption of [[Neocate]] baby formula.<ref>{{cite journal | vauthors = Akhtar Ali S, Mathalikunnel A, Bhardwaj V, Braskett M, Pitukcheewanont P | title = Nutritional hypophosphatemic rickets secondary to Neocate® use | journal = Osteoporosis International | volume = 30 | issue = 9 | pages = 1887–1891 | date = September 2019 | pmid = 31143989 | doi = 10.1007/s00198-019-04836-8 | s2cid = 169034641 }}</ref>