Modern India and Dietary Calcium Deficiency—Half a Century Nutrition Data—Retrospect–Introspect and the Road Ahead

Abstract

Calcium and vitamin D are inseparable nutrients required for bone health. In the past half a century, the dietary calcium intake of rural, tribal, and urban India has declined. Though India is the largest producer of milk and cereals, the major source of calcium in India is through non-dairy products. The highest intake of cereals and lowest intake of milk & milk products was observed in rural and tribal subjects whereas, the intake of cereals, milk & milk products were similar in both urban and metropolitan subjects. One of the reasons for lower calcium intake was the proportion of calcium derived from dairy sources. Over the past half a century, the average 30-day consumption of cereals in the rural and urban population has declined by 30%. The Per Capita Cereal Consumption (PCCC)has declined despite sustained raise in Monthly Per capita Consumption Expenditure (MPCE) in both rural and urban households. The cereal consumption was the highest in the lowest income group, despite spending smaller portion of their income, as cereals were supplied through public distribution system (PDS). About 85% of the Indian population are vitamin D deficient despite abundant sunlight. Dietary calcium deficiency can cause secondary vitamin D deficiency. Though India as a nation is the largest producer of milk, there is profound shortage of calcium intake in the diet with all negative consequences on bone health. There is a decline in dietary calcium in the background of upward revision of RDI/RDA. There is a gap in the production-consumption-supply chain with respect to dietary calcium. To achieve a strong bone health across India, it is imperative to have population based strategies addressing different segments including supplementing dietary/supplemental calcium in ICDS, mid-day-meals scheme, public distribution system, educational strategies. Other measures like mass food fortification, biofortification, bioaddition, leveraging digital technologies, investments from corporate sector are some measures which can address this problem. India is a vast country with diverse social, cultural and dietary habits. No single measure can address this problem and requires a multi-pronged strategic approach to tackle the dietary calcium deficiency to achieve strong bone health while solving the problem of nutritional deficiency.

Prevalence of specific micronutrient deficiencies in urban school going children and adolescence of India: A multicenter cross-sectional study

“…The current study shows that 59.9% (95% CI, 58.0–62.0) of study participants had calcium levels below 10 mg/dl and 39.7% (95% CI, 38.0–42.0) had Vitamin D levels below 12 ng/ml. This is consistent with the finding that about 80–85% of Indian population is suffering from various degrees of vitamin D deficiency (VDD) [ 56 ]. Various studies, in contrast to our study, have reported prevalence of VDD ranging from 88.6% to 93.0% [ 19 – 21 ], although these were small studies conducted in a particular geography.…”

“…Childhood and adolescence are crucial period for skeletal mineralization. Nutritional trends from independence (1947) to recent years (2016) shows that there is a consistent gap between the production and consumption of dietary calcium in Indian dietary pattern [ 56 ]. The current study shows that 59.9% (95% CI, 58.0–62.0) of study participants had calcium levels below 10 mg/dl and 39.7% (95% CI, 38.0–42.0) had Vitamin D levels below 12 ng/ml.…”

“…These deficiencies result in skeletal deformities, increased risk of infectious disease such as tuberculosis, upper respiratory tract infections of viral origin, auto immune disorders, type 2 diabetes mellitus and obesity, which adds burden to the public health infrastructure [ 57 ]. With this background of unsatisfactory levels of twin nutrient deficiency of calcium and vitamin D in India, strategies like population-based education, targeted supplementation and fortification may be implemented [ 56 ]. Food fortification may be one of the best strategies, as it has already shown its potential with the success of salt iodization program in India.…”

Optimization of preparation of calcium acetate from eggshell by Response Surface Methodology (RSM)

“…Calcium also played the protective role in the treatment of essential hypertension (Liu et al, 2020;Nadal et al, 2018) and prevention of colon cancer (Gutierrez et al, 2019). Some scholars have conducted long-term researches on the role of calcium in the human body, and consistently pointed out that people with white, yellow or dark skin were threatened by calcium deficiency throughout their lives (Balk et al, 2018;Harinarayan et al, 2021). It was difficult for Chinese people to obtain the dietary calcium intake (DRIS) recommended by the Chinese Nutrition Society in the daily diet (Ge & Chang, 2001).…”

Falls, Fractures, and Mortality: The Role of Calcium and Vitamin D Replacement in Rural India

“…Despite the greater proportion of milk production in rural India as compared to urban regions, rural-dwelling individuals consume less milk and milk products. [ 17 ] Therefore, it is prudent that regular supplementation of calcium and vitamin D be done in addition to encouraging more consumption of calcium from dietary sources. Long-term measures like food fortification may be a definite solution to combat the endemicity of vitamin D deficiency.…”