Modern India and the Tale of Twin Nutrient Deficiency–Calcium and Vitamin D–Nutrition Trend Data 50 Years-Retrospect, Introspect, and Prospect

Abstract

Vitamin D and calcium are essential nutrients for bone health, to achieve peak bone mass and to preserve bone as age advances. A deficiency in these nutrients casts a long shadow in later life in the form of short/long latency diseases–rickets/osteomalacia/osteoporosis. There is scant review available about the trend of these nutrients in India. For over past half a century, the intake of dietary calcium, milk, milk products, and cereals has declined drastically in the background of upward revision of RDA/RDI in modern India. This is attributed to changing lifestyle, inadequate milk consumption across various socio-economic strata, and shift in dietary intake from cereals to rice and wheat. There is a clear rural–urban divide in consumption of milk, milk products and cereals, a change in dietary habits which magnify the calcium and vitamin D deficiency. Revisiting of RDA guidelines for calcium along with public health measures is required to tackle the morbidity arising due to the deficiency in these nutrients. Any measure to addresses this issue in isolation, without achieving the desired benefits, is a disservice to the population. Population based educational strategies, government measures, leveraging technology, adequate sun exposure and food fortification help in tackling the twin nutrient deficiencies in this diverse country.

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

“…The government should consider a legislation for fortification of food with calcium and to bring the calcium supplements under price control act to make it affordable for the common people. Till these programs are implemented, it is prudent on the part of people to meet the RDA of calcium either by choosing their dietary pattern to be calcium sufficient or by supplementing calcium to meet the goals (109,116,117). India needs to introspect and to plan in prospect the way ahead to combat this dietary calcium deficiency.…”

“…In India, there is dietary calcium deficiency across various age groups and gender coupled with vitamin D deficiency. Addressing both simultaneously, is most important (109). The main source of dietary calcium across the population in India has been from nondairy sources.…”

“…Targeted Public Distribution System: Targeted, mass and market driven fortification has been extensively dealt with in our previous review (109).…”

“…300 mg per serving: a) Foods containing 10% of DV arecalcium enriched or more calcium or calcium fortified, b) 10%-19% of DV-provides calcium or contains calcium or good source of calcium, and c) >20% of DV-rich or high in calcium or excellent source of calcium. Remedial measures of vitamin deficiency is addressed in our previous publication (109).…”

Vitamin D, gut microbiota, and radiation-related resistance: a love-hate triangle

“…Vitamin D comprises a group of fat-soluble secosteroids responsible for the absorption of essential trace elements, such as calcium, magnesium, and phosphate, and having roles inmultiple biological processes [34], including cell growth, as well as in immune function and inflammation (reduction thereof). Vitamin D supplements are provided to treat or prevent many diseases, including deficiency-induced rickets and osteomalacia [35, 36]. For example, clinically, the high incidence and poor prognosis of colorectal cancer has been found to be partly attributed to insufficient vitamin D [37], and colorectal cancer patients with high levels of vitamin D have a lower risk of metastatic progression during neoadjuvant therapy before radical surgery [37].…”