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Calcium and vitamin D supplementation in underprivileged indian toddlers using enriched “ladoos”
  1. V Ekbote1,
  2. A Khadilkar1,
  3. S Chiplonkar1,
  4. N Hanumante2,
  5. V Khadilkar1,
  6. MZ Mughal3
  1. 1Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
  2. 2Poona Medical Foundation Research Center, Ruby Hall Clinic, Pune, India
  3. 3Department of Paediatric Medicine, New Royal Manchester Children's Hospital, Manchester, UK

Abstract

Vitamin D deficiency is common among children in India, in spite of abundance in sunshine. Calcium intake among such children is often low. These children might benefit from calcium and vitamin D supplementation; however, oral pharmacological preparations of these nutrients are often unpalatable. The authors used “Ladoo”, a much cherished Indian sweet, as a novel vehicle for administering calcium and vitamin D supplements. Toddlers from an urban slum in Pune, India, with low dietary calcium intake (<200 mg/day) were randomised to a daily ration of a calcium enriched Ladoo containing, 700 mg elemental calcium (n=30; 2.9±0.5 years), or a control Ladoo, containing 170 mg of elemental calcium (n=30; 2.6±0.5 years), for one year. Subjects in both groups also ate a Ladoo supplemented with 30.000 i.u. of Cholecalciferol, once a month, during the trial. The main outcome measure was the increment in size adjusted total body bone mineral content (TBMC), measured using the GE-Lunar DPX Pro dual energy x-ray absorptiometry.

Serum concentration of 25-hydroxy vitamin D in the calcium enriched Ladoo group increased from 25±27 nmol/l to 40±39 nmol/l, and in the control group from 25±27 nmol/l to 39±27 nmol/l. At the end of the trial the change in serum ionised calcium concentration in the calcium enriched Ladoo group (+0.14±0.23 mmol/l) was greater (p=0.004) than in the control group (−0.07±0.19). Serum parathyroid hormone concentration and alkaline phosphatase activity fell in the both groups; however, the change was not statistically different between the groups. The increment in size adjusted TBMC in the calcium enriched Ladoo group was greater (p<0.05) than in the control group.

From these results we conclude that monthly consumption of a cholecalciferol fortified Ladoo can be used to improve the vitamin D status of underprivileged Indian toddlers. Daily consumption of a calcium fortified Ladoo has the potential of improving skeletal mineralisation of toddlers with low dietary calcium intake.

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