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7 avril 2011 4 07 /04 /avril /2011 14:37

European Journal of Clinical Nutrition (2011) 65, 440–446; doi:10.1038/ejcn.2010.288; published online 19 January 2011

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

V H Ekbote1, A V Khadilkar1, S A Chiplonkar1, N M Hanumante2, V V Khadilkar1and M Z Mughal3

  1. 1Growth and Endocrine Unit, HCJMRI, Jehangir Hospital, Pune, India
  2. 2Department of Pediatrics, Bharati Vidyapeeth University Medical College and Hospital, Pune, India
  3. 3Department of Paediatric Medicine, Royal Manchester Children's Hospital, Manchester, UK

Correspondence: Dr AV Khadilkar, Hirabai Cowasji Jehangir Medical Research Institute, Old Building Basement, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra 411001, India. E-mail:anuradhavkhadilkar@gmail.com

Received 20 August 2010; Revised 30 November 2010; Accepted 30 November 2010; Published online 19 January 2011.



Low habitual dietary calcium intake and vitamin D deficiency are common among Indian children. Using ‘laddoo’, an Indian snack, as a vehicle for administering calcium and vitamin D supplements, a randomized double-blind controlled trial was conducted for 12 months to assess its efficacy on total body less head (TBLH) bone mineral content (BMC) in underprivileged toddlers.



A total of 60 toddlers (mean age 2.7±0.52 years, boys=31) were randomized to two groups, (i) study group receiving one calcium fortified laddoo (cereal–legume snack) containing 405mg calcium per day and (ii) control receiving a non-fortified laddoo, containing 156mg of indigenous calcium. Both groups also received a laddoo fortified with 30000IU of vitamin D3 per month. Outcome measures included TBLH bone area (BA) and TBLH BMC by GE-Lunar DPX Pro Pencil Beam Dual-Energy X-ray absorptiometry.



At baseline, mean energy, protein and calcium intakes were 71, 72 and 47% of Indian Recommended Dietary allowances. In all, 87 and 83%toddlers were hypocalcaemia and vitamin D deficient, respectively. Mean TBLH BMC was 289.5±45.8g. Post supplementation, mean TBLH BMC of study group showed a significantly greater (P<0.01) increase of 35% as against 28% in controls and the difference remained significant after adjusting for vitamin D status, calcium intake, height and TBLH BA.



Daily supplementation with calcium fortified laddoo, and monthly vitamin D supplement resulted in a significant increase in TBLH BMC of underprivileged toddlers. We believe that such strategies have the potential of addressing nutritional problems in developing countries.




bone mineral content; calcium fortification; Indian toddlers; calcium supplementation; cereal fortification

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