Apparent Efficacy of Food-Based Calcium Supplementation in Preventing Rickets in Bangladesh

Abstract

To determine whether increased Ca intakes can prevent rickets in a susceptible group of children living in a rickets-endemic area of Bangladesh, we conducted a 13-month long, double-blind, clinical trial with 1-to 5-year-old children who did not present with rickets but ranked in the upper decile of plasma alkaline phosphatase (AP) activity of a screening cohort of 1,749 children. A total of 158 children were randomized to a milk-powder-based dietary supplement given daily, 6 days/week, and providing either 50, 250, or 500 mg Ca, or 500 mg Ca plus multivitamins, iron, and zinc. Upon initial screening, 194 healthy children presented with no rachitic leg signs and had serum AP in the upper decile (>260 u/dl) of the cohort. When 183 of those subjects were re-screened after a 7-month pre-trial period, 23 (12.6%) had developed rachitic leg signs, suggesting an annual risk of 21.5% in this cohort. Of those still not presenting with leg signs and completing 13 months of dietary intervention, none showed rachitic leg signs, none showed significant radiological evidence of active rickets, and all showed carpal ossification normal for age after that intervention. These results are consistent with even the lowest amount of supplemental Ca (50 mg/day) being useful in supporting normal bone development in this high-risk population.

Prevalence and risk factors of vitamin D insufficiency and deficiency among 6–24-month-old underweight and normal-weight children living in an urban slum of Bangladesh

“…Studies carried out in Chakaria, Coxesbazar found that 11 % of children had active rickets and that vitamin D deficiency ranged from 6 to 21 % among the children under 5 years old in that community (18,20) . Additionally a study from same area reported that only 6 % of children (ten out of 158 participants) were suffering from severe vitamin D deficiency (13) , which supports our finding (Table 1). Recently a case-control study (15) was carried out among 1-24-month-old children of northeastern rural Bangladesh and found that 32 % of all children (including cases and controls) were severely vitamin D deficient (<25 nmol/l), with 70 % having serum vitamin D less than 40 nmol/l.…”

Awareness regarding the importance of calcium and vitamin D among the undergraduate pharmacy students in Bangladesh

“…It has re-emerged as a global public-health concern and is now presumptively linked to a range of infectious, inflammatory and neoplastic diseases throughout the life course and around the world [22]. Country specific sufficient data regarding the use, consumption of calcium and/or vitamin D for Bangladesh is not available though some studies have been conducted for the determination of vitamin D status in infants and children in different regions in Chakaria subdistrict, Cox’s Bazar, Bangladesh [19,23] and Zakiganj subdistrict in Sylhet district [14]. Calcium Research Unit, Department of Food and Environmental Sciences, University of Helsinki performed number of studies on the vitamin D status in women in Bangladesh and has observed a high prevalence of vitamin D deficiency with associated low BMD.…”

Global Consensus Recommendations on Prevention and Management of Nutritional Rickets

“…Evidence primarily from developing countries demonstrates that traditional diets low in calcium cause NR [30,43,69,93,[112][113][114] . Therefore, special diets during infancy such as those that avoid milk and dairy products, those using soy or rice milk that are not specifically designed for infants, and/or vegan and macrobiotic diets may predispose infants to NR [115][116][117][118][119][120] .…”