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ORIGINAL ARTICLE
Year : 2020  |  Volume : 11  |  Issue : 1  |  Page : 8-11

The utility of crab shell powder in the treatment of rickets


Department of Pediatric, Pyongyang Medical College Hospital, Kim II Sung University, Pyongyang, Democratic People's Republic of Korea

Date of Submission27-May-2019
Date of Acceptance22-May-2020
Date of Web Publication23-Dec-2020

Correspondence Address:
Dr. Ri Gon
Department of Pediatric, Pyongyang Medical College Hospital, Kim II Sung University, Ryonhwa-Dong, Central District, Pyongyang
Democratic People's Republic of Korea
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjmsr.mjmsr_22_19

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  Abstract 


Purpose: To estimate the effect of treatment for rickets by crab shell powder (CSP). Objects and Methods: We supplied children with rickets with calcium lactate and CSP and observed the serum concentrations of calcium, phosphorus, alkaline phosphatase (ALP) in preadministration and postadministration. Results: Postadministration serum concentrations of calcium, phosphorus, and ALP increased significantly compared to preadministration in both groups (P < 0.05), but significance between two groups is not recognized. Conclusion: The effective ratio of calcium lactate and CSP in the treatment for rickets has no difference, but CSP markedly decreased the incidence of concomitant disorders compared with calcium lactate.

Keywords: Calcium, crab shell powder, rickets, Vitamin D


How to cite this article:
Gon R, Pak MR, Ri OS, Kim H. The utility of crab shell powder in the treatment of rickets. Muller J Med Sci Res 2020;11:8-11

How to cite this URL:
Gon R, Pak MR, Ri OS, Kim H. The utility of crab shell powder in the treatment of rickets. Muller J Med Sci Res [serial online] 2020 [cited 2021 Jan 18];11:8-11. Available from: https://www.mjmsr.net/text.asp?2020/11/1/8/304587




  Introduction Top


Rickets is a metabolic disease occurring from the disorders of calcification in the growing bone.

It develops generally by lack of Vitamin D, as well as lack of calcium intake.

The most common causes of rickets are not only deficiency of Vitamin D but also that of calcium intake. Investigators refer that calcium intake is essential in the treatment for rickets and the use of Vitamin D helps to promote calcium intake.[1],[2],[3],[4],[5],[6]

Vitamin D and calcium intake plays an important role in the treatment of rickets; thus, various kinds of calcium supplements are being developed and used.[7],[8],[9],[10],[11]

Crab shell powder (CSP) is rich in various protein and amino acids as well as calcium and chitin so that it has the effects of antirickets and Bifidobacterium bifidum proliferation, infection suppression, and so on.

Especially, CSP has chitin that is good for the improvement of the immunological, digestive, and absorptive function of the organism and is effective for several diseases, such as the ones of cardiovascular system.

We observed that CSP is rich in calcium and phosphorus (16.39% ± 0.03% and 1.72% ± 0.004%, respectively), with its absorption rate of 64.4% which is high.

In addition, there are various amino acids and microelements including lysine that are good for the growth of children.

It is easy and cheap to produce CSP.

We conducted our research to apply CSP, the natural origin, which has high resources and simple processes, for the treatment of children's rickets.


  Objects and Methods Top


Materials

  • CSP


  • Crab shells should be cleaned by sterilized water several times, cooked at steam of 100°C for half an hour (30 min), and dried and pulverized as 50–100 μm of the granules.

  • Calcium lactate


Dose of 1 tablet calcium lactate is 0.25 g.

Objects

  • Study group (n = 55): CSP 3–5 g (orally) (divided by 3–4 times a day)


  • (CSP contains 16.4% of calcium, and daily intake was calculated into 500–800 mg)

  • Control group (n = 50): Calcium lactate 0.75 g (orally divided by three times a day).


Methods

We studied 105 children with rickets aged ½–2 years.

We administered the doses to two groups for 3 months according to severity.

300,000 IU of Vitamin D3 was injected both in study and in control groups.

All patients were tested for the serum concentrations of calcium, phosphorus, and alkaline phosphatase (ALP), and wrist X-ray was taken in preadministration and postadministration.

Evaluation of therapeutic effect is as follows:

  • Healed: Nervous and other symptoms are all relieved, and wrist X-ray showed obvious calcium accumulation in calcification line
  • Improved: Among nervous symptom and other symptoms, only 1–2 clinical manifestations remain, and wrist X-ray showed that calcium begins to accumulate in calcification line
  • Unchanged: Nothing changed in both clinical manifestation and wrist X-ray.


Moreover, during the study period, we have observed the mortality of concomitant disorders such as diarrhea, upper airway infection, and pneumonia.


  Results Top


Postadministration change of serum calcium and phosphorus concentration

[Table 1] shows the postadministration change of concentration of serum calcium and phosphorus.
Table 1: Change of serum calcium and phosphorus concentration (X̄±standard error, mg/dL)

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Postadministration concentration of serum calcium has increased significantly compared with preadministration in both groups (P < 0.05), but significance between two groups is not recognized.

Postadministration concentration of serum phosphorus has increased significantly compared to preadministration in both groups (P < 0.01), but significance between two groups is not recognized.

Postadministration change of serum alkaline phosphatase concentration

[Table 2] shows the postadministration change of serum ALP concentration.
Table 2: Change of serum alkaline phosphatase concentration (X̄±standard error, IU/L)

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Postadministration concentration of serum ALP has decreased significantly compared to preadministration in both groups (P < 0.01), but significance between two groups is not recognized.

Postadministration change of wrist X-ray findings

[Table 3] shows the postadministration change of wrist X-ray findings.
Table 3: Postadministration change of wrist X-ray findings (n)

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Postadministration efficacies of wrist X-ray findings have increased to 94.3% and 93.3%, respectively, and significance between two groups is not recognized.

Overall result of treatment

[Table 4] shows the overall result of treatment.
Table 4: The overall result of treatment

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The efficacies of treatment for rickets have increased to 94.5% in the study group and 94.0% in the control group, and significance between two groups is not recognized.

Occurrence of various diseases during study period

[Table 5] shows the occurrence of various diseases during the study period.
Table 5: During treatment, incidence of various diseases

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During the medication, some children had several concomitant diseases.

The incidence of diarrhea and upper airway infection decreased in the study group (P < 0.01) compared to the control group, the incidence of pneumonia decreased to 7.3% in the study group compared to 16% in the control group, but significance between two groups is not recognized.


  Discussion Top


Rickets is the metabolic disease occurring from the disorders of calcification in the growing bone.

The most common causes of rickets are not only deficiency of Vitamin D but also that of calcium intake. Investigators refer that calcium intake is essential in the treatment for rickets and the use of Vitamin D helps to promote calcium intake.[1],[2],[3],[4],[5],[6]

During the last decades, only lack of Vitamin D was considered as the primary cause of rickets; however, in recent years, insufficient calcium intake is thought to cause rickets.

Vitamin D and calcium intake plays an important role in the treatment of rickets; thus, various kinds of calcium supplements are being developed and used.[7],[8],[9],[10],[11]

CSP is rich in various protein and amino acids, as well as calcium and chitin, so that it has the effects of antirickets and Bifidobacterium bifidum proliferation, infection suppression, and so on.

Especially CSP has chitin that is good for the improvement of the immunological, digestive, and absorptive function of the organism and is effective for several diseases such as the diseases of cardiovascular system.

We studied that CSP is rich in calcium and phosphorus (16.39% ± 0.03%, 1.72% ± 0.004%, respectively) with its absorption rate of 64.4% which is high.

In addition, there are various amino acids and microelements including lysine that are good for the growth of children.

It is easy and cheap to produce CSP.

We examined the function of the CSP in the treatment of rickets.

The serum concentration of calcium and phosphorous increased significantly at postadministration than preadministration (P < 0.05 and P < 0.01) and the serum ALP has decreased significantly from 213.11 ± 14.08 IU/L at preadministration to 155.82 ± 13.27 IU/L; thus, there was no significant differences between study group and the contrast one.

This shows that the CSP differs little from the calcium lactate in the normal recovery of serum concentration calcium and phosphorous and the serum ALP.

The healing rates estimated by the changes of the wrist X-ray findings were 94.3% and 93.3% in the study and contrast groups and there are no significant differences between them.

These results were the same with the preceding thesis,[1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11] which says that calcium intake and vitamin D are important in the treatment of rickets, and it also shows that CSP is calcium supplementary as calcium lactate in the treatment of rickets, which has little differences with it.

The reason that the effective rate has not reached 100% is we did not consider low weight baby and set 3 months of the treatment period, not relating with the severity of rickets.

Total record was 94.5% in the study group and 94% in the contrast group, and no significant differences were recognized.

During the period of the treatment of rickets, the children might suffer from several diseases such as diarrhea, upper respiratory tract infection, and pneumonia, but the mortality rate of diarrhea and the upper respiratory tract infection in the study group was low significantly than the contrast group.

Through research, we could find out the CSP is effective as calcium supplementary and has good functions than the common calcium supplementary in the process of disease occurring often in the children.

Therefore, the CSP is superior to calcium lactate in the treatment of rickets.


  Conclusion Top


First, therapeutic effect of CSP for rickets is high as 94.5% and has no significant differences compared to control group – 94% of calcium lactate.

Second, CSP has markedly decreased the incidence of concomitant disorders (diarrhea, upper airway infection, etc.) compared to calcium lactate.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Bishop N. Rickets today-children still need milk and sunshine. N Engl J Med 1999;341:602-4.  Back to cited text no. 1
    
2.
Bronner F, Bronner LS, Putet G, Rigo J, Senterre J. Net calcium absorption prenature infants; result of 103 metabolic balances studies. Am J Chem Nutri 1992;56:1037-44.  Back to cited text no. 2
    
3.
DeLucia MC, Mitnick ME, Carpenter TO. Nutritional rachitis with normal circulating 25-hydroxyvitamin D: A call for reexamining the role of dietary calcium intake in American infants. J Clin Endocrinol Metab 2003;88:359.  Back to cited text no. 3
    
4.
Antoniucci DM, Vittinghoff E, Palermo L, Black DM, Sellmeyer DE. Vitamin D insufficiency does not affect bone mineral density response to raloxifene. J Clin Endocrinol Metab 2005;90:4566-72.  Back to cited text no. 4
    
5.
Kliegman R, Behrman R, Jenson H, Stanton B. Nelson Textbook of Pediatrics 18th Edition. Elsevier. 2007. p. 253-63.  Back to cited text no. 5
    
6.
Muhe L, Lulseged S, Mason KE, Simoes AFE. Case-control study of the role of nutritional ricket in the risk of developing pneumonia in Ethiopian children. Lancet 1997;349:1801-4.  Back to cited text no. 6
    
7.
DeLucia MC, Mitnick ME, Carpenter TO. Nutritional rachitis with normal circulating 25-hydroxyvitamin D: A call for reexamining the role of dietary calcium intake in North American infants. J Clin Endocrinol Metab 2003;88:3539-45.  Back to cited text no. 7
    
8.
Misra M, Pacaud D, Petryk A, Collett-Solberg PF. Vitamin D deficiency in children and its management: Review of current knowledge and recommendations. Pediatrics 2008;22:398.  Back to cited text no. 8
    
9.
Pfitzner MA, Thacher TD, Pettifor JM, Zoakah AI, Lawson JO. Absence of Vitamin D deficiency in Yong Nigerian children. J Pediatr 1998;133:740.  Back to cited text no. 9
    
10.
Thacher TD, Fischer PR, Pettifor JM, Lawson JO, Isichei CO, Reading JC, et al. A comparison of calcium, Vitamin D, or both for nutritional rickets in Nigerian children. N Engl J Med 1999;341:563-8.  Back to cited text no. 10
    
11.
Thacher TD, Fischer PR, Isichei CO, Pettifor JM. Early response to Vitamin D2 in children with calcium deficiency rickets. J Pediatr 2006;149:840-4.  Back to cited text no. 11
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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Abstract
Introduction
Objects and Methods
Results
Discussion
Conclusion
References
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