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
- 1Growth and Endocrine Unit, HCJMRI, Jehangir Hospital, Pune, India
- 2Department of Pediatrics, Bharati Vidyapeeth University Medical College and Hospital, Pune, India
- 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:email@example.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 405 mg calcium per day and (ii) control receiving a non-fortified laddoo, containing 156 mg of indigenous calcium. Both groups also received a laddoo fortified with 30 000 IU 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±45.8 g. 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