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Vitamin D status in post-medieval Northern England: Insights from dental histology and enamel peptide analysis at Coach Lane, North Shields (AD 1711–1857) [1]
['Anne Marie E. Snoddy', 'Department Of Anatomy', 'University Of Otago', 'Dunedin', 'Otago', 'New Zealand', 'Heidi Shaw', 'Department Of Archaeology', 'Durham University', 'Durham']
Date: 2024-02
Periods of poor mineral metabolism during childhood appear much more prevalent at Coach Lane than macroscopic evidence suggests. Evidence of seasonal IGD episodes indicates that northern latitude played a major role in poor VD status in the Northeast of England. The significant association of IGD with male sex may be due to sex-related differences in dentinal mineralization or a higher risk of poor VD status in males aged <5 years. More work is needed to establish an evidence-based threshold for pathological levels of IGD before the presence of this feature can confidently be used as a biomarker for poor VD status.
Ground tooth sections from 21 individuals were of suitable quality for detection of IGD, and enamel peptide analysis confirmed the chromosomal sex of ten individuals. Sixteen individuals (76.1%) exhibited ≥1 episode of IGD. Nine of these (42.8%) exhibited >1 episode and four (19%) exhibited ≥4 episodes in regular intervals. Male sex was significantly associated with the presence of IGD (p = 0.0351; 100% males vs. 54.5% females). Females were more likely to exhibit macroscopic evidence of VDD (45.5% females vs 30% males) but this was not statistically significant.
The post-medieval period in Europe saw a dramatic increase in metabolic bone disease related to vitamin D deficiency (VDD). Recent paleopathological work has utilized interglobular dentin (IGD) as a proxy for poor vitamin D status during development, while enamel peptide analysis allows the identification of chromosomal sex in non-adult remains. Here we explore the relationship between sex, the presence of IGD, and macroscopic markers of VDD in an industrial era assemblage from Northeast England.
Introduction
The post-medieval period (16th-19th centuries AD) in England was characterized by increasing urbanization and a shift away from an agrarian economy towards manufacturing [1, 2]. While the British Empire grew in wealth and power, social inequality increased dramatically, observed in decreasing life expectancy of the laboring classes compared with the wealthy [3]. By the 19th century, large portions of the population, including young children, lived in overcrowded and unsanitary conditions, and worked long hours in unventilated spaces for very little remuneration [4]. Diseases associated with poor nutrition, poor sanitation, and crowded living conditions were rife in urban centers, particularly among the lower classes [5]. Recent advances in archaeological science provide the means to explore the physical embodiment of industrialization in detail, including the relationship between gendered cultural practices, biological sex, and disease during this period.
In the popular imagination, 19th century England is associated with sickly, rachitic children, largely due to the works of Victorian novelists who brought enduring awareness to the physical consequences of poverty in Britain’s urban manufacturing centers (e.g. Oliver Twist, Mary Barton, North and South). Although much of the historical and bioarchaeological literature on rickets in Industrial England has focused on southern cities such as London [6–9], many of England’s major centers of industry were in the North [10, 11]. Coal mining, textile and ceramic production, and shipbuilding are just a few of the industries underpinning the Northern urban centers of Newcastle upon Tyne, Manchester, Leeds, and Sheffield, and each of these were associated with satellite manufacturing towns [11, 12]. In his 1855 medical survey, Hungarian physician Augustus Merei found rickets to be “common” among the laboring classes of Newcastle, and in Manchester and its satellite of Stockport. These findings were mirrored in a later 1889 British Medical Association study, which identified the Northeast as a focal zone for rickets [13–15]. Recent work [3, 16] has uncovered skeletal evidence for rickets in 19th century Northern English assemblages, with Newman and colleagues’ comparative study showing a higher prevalence of metabolic bone disease in cemetery assemblages from the Northeast of England than in those from London [16]. The prevalence of childhood rickets appears to be positively correlated with urbanization and lower socioeconomic status in the post-medieval period, suggesting that poor vitamin D status was a consequence of industrialization in the 18th and 19th centuries [17].
Understanding the epidemiological profile of vitamin D deficiency (VDD) in Northeast England during the 18th and 19th centuries has important implications beyond the identification of the metabolic bone disease it causes. Vitamin D status is closely related to the risk of developing other diseases or health conditions [18], which can be predicted based on an individual’s age and sex [19]. Vitamin D status is also tied to gendered work practices, which changed dramatically during the industrial period with the first large-scale employment of women in factories [20]. The age and sex distribution of VDD within a population, therefore, has important implications for understanding biological and cultural influences of VDD prevalence within a population.
Macroscopic skeletal lesions indicative of rickets have been previously reported for post-medieval industrial human remains recovered from Coach Lane, North Shields (AD 1711–1857) in Northeast England [3, 16, 21]. The true magnitude and distribution of poor vitamin D status in this assemblage cannot be known using macroscopic analysis alone, as this will only capture individuals of suitable preservation and with severe disease manifestations [22]. This study aims to build on previous analyses of rickets during this period through histological and new X- and Y-chromosome linked enamel peptide analysis of teeth from the Coach Lane assemblage, which have the power to provide higher resolution data on the distribution of disease. Previous bioarchaeological work on this site has been unable to explore the relationship between vitamin D deficiency during growth and sex due to the problems associated with sex estimation from non-adult remains.
Vitamin D deficiency in archaeological human remains The detection of VDD in archaeological human assemblages can provide a powerful window on health in the past [23, 24]. VDD has adverse effects on mineral metabolism [25, 26]. Physical manifestations of VDD and subclinical vitamin D insufficiency (VDI) span a spectrum in which diagnostic skeletal lesions are on the extreme end [22]. Furthermore, the active metabolite of vitamin D (1,25[OH]2D3) plays a key role in regulating several physiological processes outside of bone homeostasis and growth, including immune functions [27, 28]. VDD is clinically associated with an increased risk of type 2 diabetes mellitus, major cardiovascular events, cancers, infectious diseases, and chronic kidney disease [18]. VDD is also recognized as a marker of environmental and social conditions, influenced by factors such as latitude and seasonality, atmospheric pollution, gendered clothing practices, dietary resources, occupation, housing, and population density [23]. Vitamin D is a hormone precursor produced primarily by the action of type B ultraviolet light (UVB) on sterols in the skin [25]. Following successive activation steps in the liver and kidney, vitamin D hormone (calcitriol), works to promote the absorption of calcium and phosphorus from the intestine and reabsorption of calcium from the kidney for use by bone-producing osteoblasts [25]. Severe and prolonged deficiency of vitamin D, either through inhibition of cutaneous synthesis or poor dietary intake, is a leading cause of the metabolic bone diseases rickets and osteomalacia [26, 29]. These conditions are characterized by skeletal abnormalities occurring during endochondral growth and bone maintenance, respectively, although rickets is often used as an umbrella term for all the skeletal defects of VDD in children [26]. Here we use the term “rickets” to refer to the skeletal defects of VDD in children, “residual rickets” to refer to bone deformities of rickets that persist into adulthood, and “osteomalacia” to refer to the skeletal lesions of VDD experienced after growth is completed. The most characteristic of the gross lesions of VDD are deformities of the limbs and axial skeleton caused by muscular action and/or compressive load on soft, poorly mineralized bone [26, 30]. Macroscopically recognizable skeletal changes of VDD only occur after a prolonged period of deficiency or when the deficiency coincides with a period of rapid growth [29, 31]. It is likely that poor vitamin D status associated with shorter seasonal periods of deficiency and/or during periods of slower growth will be missed through macroscopic paleopathological analysis alone, because processes that would have occurred at the microstructural level prior to manifesting externally are not accessed and evaluated. Additionally, diagnostic lesions of childhood rickets may completely remodel in individuals who survived to adulthood, and the fragility of bone affected by this disorder means that it is less likely to survive in the post-depositional environment [30]. However, the clinical body of literature on vitamin D indicates that these archaeologically invisible periods of VDD had significant implications for population health, contributing to mortality and the burden of communicable and non-communicable diseases in the past [22].
Sex distribution of vitamin D deficiency Female sex has been found to be a clinical risk factor for VDD in both adults and children in several studies, although the reasons for this unclear [32–35], and the association is not universal [36]. Gendered social practices almost certainly play a role in some populations, with women in many cultures more likely to wear clothing that limits exposure to sunlight and to take part in indoor activities [23, 37]. However, an association with either sex has not been demonstrated in archaeological assemblages. Mays and colleagues used multivariate analysis to explore the relationship between latitude, sex, age, and settlement type (urban vs. rural) in a large cohort (N = 2,787) from Roman Europe [38]. The only variable they found to be significantly associated with VDD was northern latitude and only in the non-adult portion of the cohort [38]. This lack of association between sex and VDD here is unsurprising; VDD is notoriously difficult to recognize in adult skeletal remains and, until very recently, reliable methods of sex determination in subadult skeletal remains did not exist [39]. Traditional macroscopic sex estimation methods in bioarcheology are reliant on the presence and analysis of sexually dimorphic skeletal elements, including the pelvis and skull [40]. However, in cases where sexually dimorphic skeletal elements are absent, populations have less sexual dimorphism, or individuals are non-adults, macroscopic sex estimation methods cannot be used [41, 42]. In recent years, biochemical techniques have provided alternative methods for estimation of sex when macroscopic methods are not applicable [43–50], including in non-adults [39]. In this study, the sex of non-adults and adults of indeterminate sex is determined using the method of Stewart et al. [46, 47], which identifies X- and Y- chromosome linked dimorphic peptides of the amelogenin protein (AMELX and AMELY) recovered from tooth enamel using mass spectrometry. The method has been successfully applied to both modern and archaeological permanent and deciduous teeth, including teeth with minimal mineralization [44]. In the context of Industrial England, the presence of sex-related patterns in VDD in children is not currently known. This was a period in which for the first-time substantial numbers of women and girls were engaged in labor outside of the domestic sphere [20]. The Northeast of England was an epicenter for rickets during this period, but whether there was any sex-related pattern in prevalence has yet to be investigated.
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