Cornell nutritionists and agronomists returned Oct. 20 from the Chakaria area of Bangladesh, where they have been investigating why the disease rickets has been found in such a sunny place.

Rickets, a debilitating disease affecting bone growth and resulting in gross deformities, is usually associated with a lack of sunlight. However, in this case the Cornell scientists believe that the calcium deficiency among children in that region of Bangladesh is somehow exacerbated by either soil or water conditions, or poor nutrition, or all of the above.

Characterized by flaring of lower ribs, pigeon-shaped chest, delayed teeth, widening wrists, malformed ankles or knees, the disease also can be recognized as growth retardation and laterally deformed arms and legs. The disease’s wide prevalence in the Chakaria region of the country caught the attention of the Cornell scientists.

Rickets is a disease unexpected in tropical or semitropical regions of the world, such as Bangladesh, said Gerald Combs, professor of nutrition in the College of Human Ecology. There is enough exposure to sunlight to give the children’s skin ample ability to produce enough vitamin D to stave off rickets, he explained.

To solve the problem, the scientists want to take a “food systems” approach. That approach to health and solving malnutrition was a symposium topic at the American Association for the Advancement of Science (AAAS) convention in Seattle in February 1997. Using a food systems approach to health, diets are well-balanced with essential vitamins and minerals — through food intake and not necessarily through supplements.

Currently Combs estimates that some 50,000 children are showing some form of the disease in the Chakaria region. So far in the area, which is located in southeastern Bangladesh, there had been no studies of possible heavy metal contamination in the soil or water. In addition, they are examining food security, economic status, decision-making for eating, demographic information, anthropometry and land tenure/farming practice at the household level.

The scientists postulate that diets in the area are depleted of calcium, phosphorus, zinc and iron, because the children only eat rice. But they wonder why rickets is so prevalent in Chakaria, when poor children throughout Bangladesh consume only rice, apparently without contracting the disease.

“But we don’t know if an increase in iron and zinc will help reduce the antagonists of the calcium intake,” Combs said.
Combs was joined on the trip by John M. Duxbury, Cornell professor and chair of the Department of Soil, Crop and Atmospheric Sciences; Ross M. Welch, Cornell adjunct professor of soil, crop and atmospheric sciences, and a researcher at the U.S. Plant, Soil and Nutrition Laboratory of the U.S. Department of Agriculture in Ithaca; and Craig Meisner, Cornell site coordinator for the Soil Management Collaborative Research Support Project on the Rice-Wheat Agricultural System in the Indo-Gangenic Plain.

They met with scientists from UNICEF; the International Wheat and Maize Improvement Center, Mexico; Dhaka University; the Memorial Christian Hospital, Coxs Bazaar in Bangladesh; and the University of Utah School of Medicine.

Support for this effort comes from the Cornell International Institute for Food, Agriculture and Development, the U.S. Agency for International Development and UNICEF. The scientists hope that within one year of commencing the investigation, their research will show what has been causing rickets in the area, and within three years, they hope to have viable solutions in place.

“What everyone sees in our approach — that is, our food systems view — is that this allows us to talk not only about solving rickets, but doing so in a way that is sustainable and also addresses other aspects of malnutrition,” Combs said.

By Blaine P. Friedlander Jr.