A pilot randomized controlled trial of oral calcium and vitamin D supplementation using fortified laddoos in underprivileged Indian toddlers

Ekbote, Veena; Khadilkar, Anuradha; Chiplonkar, Shashi; Hanumante, N M; Khadilkar, Vaman; Mughal, M Zulf

doi:10.1038/ejcn.2010.288

Cited by 36 publications

(10 citation statements)

References 20 publications

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“…Underprivileged toddlers, fed with fortified laddoos , resulted in significant increase in serum calcium and vitamin D levels and also in total body less head (TBLH) bone mineral content (BMC) [122]. The cost of fortified laddoo was INR 20 per laddoo , which may be prohibitive in itself.…”

Section: Feasibility Of Fortification Of Foods With Vitamin D In mentioning

confidence: 99%

Vitamin D Deficiency in India: Prevalence, Causalities and Interventions

Ritu¹,

2014

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Vitamin D deficiency prevails in epidemic proportions all over the Indian subcontinent, with a prevalence of 70%–100% in the general population. In India, widely consumed food items such as dairy products are rarely fortified with vitamin D. Indian socioreligious and cultural practices do not facilitate adequate sun exposure, thereby negating potential benefits of plentiful sunshine. Consequently, subclinical vitamin D deficiency is highly prevalent in both urban and rural settings, and across all socioeconomic and geographic strata. Vitamin D deficiency is likely to play an important role in the very high prevalence of rickets, osteoporosis, cardiovascular diseases, diabetes, cancer and infections such as tuberculosis in India. Fortification of staple foods with vitamin D is the most viable population based strategy to achieve vitamin D sufficiency. Unfortunately, even in advanced countries like USA and Canada, food fortification strategies with vitamin D have been only partially effective and have largely failed to attain vitamin D sufficiency. This article reviews the status of vitamin D nutrition in the Indian subcontinent and also the underlying causes for this epidemic. Implementation of population based educational and interventional strategies to combat this scourge require recognition of vitamin D deficiency as a public health problem by the governing bodies so that healthcare funds can be allocated appropriately.

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Section: Feasibility Of Fortification Of Foods With Vitamin D In mentioning

confidence: 99%

Vitamin D Deficiency in India: Prevalence, Causalities and Interventions

Ritu¹,

2014

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“…Food fortification effectively increased dietary calcium intakes by using calcium-fortified laddoos in the diet of underprivileged Indian toddlers [240] and by calcium fortification of cereal for 7-to 12-year-old children [241] . More than 1,100 foods are calcium fortified in the United States, yet dairy food makes up more than 65% of adolescents' calcium intake [242] .…”

Section: Food Fortification With Calciummentioning

confidence: 99%

Global Consensus Recommendations on Prevention and Management of Nutritional Rickets

Munns¹,

Shaw²,

Kiely³

et al. 2016

Horm Res Paediatr

363

477

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Background: Vitamin D and calcium deficiencies are common worldwide, causing nutritional rickets and osteomalacia, which have a major impact on health, growth, and development of infants, children, and adolescents; the consequences can be lethal or can last into adulthood. The goals of this evidence-based consensus document are to provide health care professionals with guidance for prevention, diagnosis, and management of nutritional rickets and to provide policy makers with a framework to work toward its eradication. Evidence: A systematic literature search examining the definition, diagnosis, treatment, and prevention of nutritional rickets in children was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system that describes the strength of the recommendation and the quality of supporting evidence. Process: Thirty-three nominated experts in pediatric endocrinology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. Results: This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. Conclusion: Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required. nology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. Results: This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. Conclusion: Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required. Key WordsRickets · Nutrition · Vitamin D · Calcium · Consensus recommendations Abstract Background: Vitamin D and ca...

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“…9-12 22-60 Table 1 shows the baseline characteristics of the included studies. Of the 43 RCTs, 20 used dietary sources of calcium, 11 12 22 23 25 27-29 40 43-46 48 49 53 54 56 60 and 23 used calcium supplements (including calcium, calcium citrate malate and calcium phosphate). 9 10 24 26 30-39 41 42 47 50-52 55 57 59 The median baseline dietary calcium intake was 714 mg/day; the duration of calcium supplementation intervention did not exceed 2 years in most trials (38/43); and the dose of calcium intervention did not exceed 1000 mg/day in most trials (38/43).…”

Section: Resultsmentioning

confidence: 99%

The effect of calcium supplementation in people under 35 years old: A systematic review and meta-analysis of randomized controlled trials

Liu

et al. 2022

Preprint

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Background and objective: The effect of calcium supplementation on bone mineral accretion in people under 35 years old is inconclusive. To comprehensively summarize the evidence for the effect of calcium supplementation on bone mineral accretion in young populations (≤35 years). Design: This is a systematic review and meta analysis. Data sources: The Pubmed, Embase, ProQuest and CENTRAL databases were systematically searched from database inception to April 25, 2021. Eligibility: Randomized clinical trials assessing the effects of calcium supplementation on bone mineral density (BMD) or bone mineral content (BMC) in people under 35 years old. Results: This systematic review and meta analysis identified 43 studies involving 7382 subjects. Moderate certainty of evidence showed that calcium supplementation was associated with the accretion of BMD and BMC, especially on femoral neck (SMD 0.627, 95% CI 0.338 to 0.915; SMD 0.364, 95% CI 0.134 to 0.595; respectively) and total body (SMD 0.330, 95% CI 0.163 to 0.496; SMD 0.149, 95% CI 0.00 6 to 0.291), also with a slight improvement effect on lumbar spine BMC (SMD 0.163, 95% CI 0.008 to 0.317), no effects on total hip BMD and BMC and lumbar spine BMD were observed. Very interestingly, subgroup analyses suggested that the improvement of bone at femoral neck was more pronounced in the peri PBM population (20 - 35 years) than the pre PBM population (<20 years). Conclusion: Our findings provided novel insights and evidence in calcium supplementation, which showed that calcium supplementation signif icantly improves bone mass, implying that preventive calcium supplementation before or around achieving PBM may be a shift in the window of intervention for osteoporosis. Funding This work was supported by Wenzhou Medical University grant [89219029].

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A pilot randomized controlled trial of oral calcium and vitamin D supplementation using fortified laddoos in underprivileged Indian toddlers

Cited by 36 publications

References 20 publications

Vitamin D Deficiency in India: Prevalence, Causalities and Interventions

Vitamin D Deficiency in India: Prevalence, Causalities and Interventions

Global Consensus Recommendations on Prevention and Management of Nutritional Rickets

The effect of calcium supplementation in people under 35 years old: A systematic review and meta-analysis of randomized controlled trials

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