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.