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Snack fortification – Calcium and 30000 IU vitamin D monthly helped – Jan 2011

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

Eur J Clin Nutr. 2011 Jan 19.
Ekbote VH, Khadilkar AV, Chiplonkar SA, Hanumante NM, Khadilkar VV, Mughal MZ.
Growth and Endocrine Unit, HCJMRI, Jehangir Hospital, Pune, India.

Background/Objectives: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.Subjects/Methods: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 D(3) per month. Outcome measures included TBLH bone area (BA) and TBLH BMC by GE-Lunar DPX Pro Pencil Beam Dual-Energy X-ray absorptiometry.

Results: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.

Conclusions: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.European Journal of Clinical Nutrition doi:10.1038/ejcn.2010.288. PMID: 21245882
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30,000 IU monthly = only about 1,000 IU daily

Institute of Medicine Nov 2010 said 600 IU to 2500 IU at this age

Graph of RDA and Upper Limit

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