Effect of micronutrient supplementation on height velocity of underprivileged girls in comparison with un-supplemented healthy controls.
J Pediatr Endocrinol Metab. 2013 Oct 23:1-8. doi: 10.1515/jpem-2013-0352.
Khadilkar AV, Kadam NS, Chiplonkar SA, Khadilkar VV.
The aim of this study was to investigate the effect of 1-year micronutrient supplementation on the height velocity of underprivileged premenarchal girls in comparison with the natural growth of apparently healthy girls from an affluent class. A 1-year cluster-randomisation intervention trial was conducted in 119 premenarchal girls (8-12 years) from two schools catering to the lower socioeconomic strata (LSES) in Pune, India. Three classes of age-matched girls were randomly allocated to any one of the three intervention groups:
- (i) Ca+MZn+D group (C1: zinc, 15 mg/day+multivitamins calcium, 500 mg/day; vitamin D, 30,000 IU/3 months);
- (ii) Ca+D group (C2: calcium, 500 mg/day; vitamin D, 30,000 IU/3 months); and
- (iii) M+D group (C3: multivitamins; vitamin D, 30,000 IU/3 months).
Height, weight, and Tanner stage were assessed at baseline and endline. A total of 119 age-matched, apparently healthy school girls from a higher socioeconomic group (HSES) were assessed for their growth after 1 year without any supplementation. At baseline, mean height-for-age Z-scores and weight-for-age Z-scores by Indian references were >-2 in 99% of HSES girls and 28% of LSES girls had height-for-age Z-scores <-2.
Post-intervention, increase in height-for-age Z-scores adjusted for Tanner stage was significantly higher in the Ca+MZn+D group (0.32±0.06) than in the respective age-matched controls (C1 group) (-0.02±0.05) (p<0.05) as well as in both the Ca+D group (0.18±0.06) and the M+D group (0.14±0.04) (p<0.05).
After adjusting for Tanner stage, height velocity was significantly higher for the
- Ca+MZn+D group (6.7±0.4 cm/year) than for the
- M+D group (6.1±0.2),
- Ca+D group (5.6±0.5) as well as age-matched
- controls (C1 group) (5.0±0.3) (p<0.05).
Supplementation with calcium+vitamin D, zinc and multivitamins may be effective in improving stature in underprivileged Indian premenarchal girls.
- 1.7 cm/year faster than without supplementation
- Suspect sould have been even faster if they had used more or more frequent Vitamin D (say50,000 IU/1 month)
- Not clear: does Control Group (C1) = healthy school girls from a higher socioeconomic group?