Vitamin D supplementation and bone mass accrual in underprivileged adolescent Indian girls.

Vitamin D deficiency is common among children and adolescents in India, in spite of abundant sunshine. We conducted a pilot; double blind randomised controlled trial to investigate the effect of vitamin D supplementation on bone mineral content in underprivileged adolescent girls, in Pune, India. Fifty post-menarcheal girls aged 14 to 15 years were randomised to receive 300,000 IU (7.5 mg) of ergocalciferol or placebo orally, 4 times/year. All participants received 250 mg elemental calcium (calcium carbonate) daily. Outcome measures included change in serum 25-hydroxyvitamin D, size adjusted bone area and bone mineral content at total body and lumbar spine. Post supplementation, the median serum concentration of 25-hydroxyvitamin D was 75.2 (64.2-85.5) nmol/L in the intervention group and 28.1 (16.7-34.0) nmol/L in the placebo group. Increment in bone outcome measures was not different in the two groups. However, there was a positive effect of intervention in the size adjusted total body bone area (p<0.05), total body bone mineral content (p<0.05) and lumbar spine bone mineral content (p<0.05), and positive trend in lumbar spine bone area (p=0.07) in girls who were within 2 years of menarche. We conclude that vitamin D supplementation did not have a beneficial effect on skeletal mineralization in girls who were more than 2 years post menarcheal. However, there was a significant positive effect of the intervention on size adjusted total body and lumbar spine bone mineral content and a positive trend in lumbar spine bone area, in girls who were <= 2 years of menarche.

A study of calcium intake and sources of calcium in adolescent boys and girls from two socioeconomic strata, in Pune, India.

Adequate intake of calcium is important for skeletal growth. Low calcium intake during childhood and adolescence may lead to decreased bone mass accrual thereby increasing the risk of osteoporotic fractures. Our aim was to study dietary calcium intake and sources of calcium in adolescents from lower and upper economic strata in Pune, India. We hypothesized that children from lower economic strata would have lower intakes of calcium, which would predominantly be derived from non-dairy sources. Two hundred male and female adolescents, from lower and upper economic stratum were studied. Semiquantitative food frequency questionnaire was used to evaluate intakes of calcium, phosphorus, oxalic acid, phytin, energy and protein. The median calcium intake was significantly different in all four groups, with maximum intake in the upper economic strata boys (893 mg, 689-1295) and lowest intake in lower economic strata girls (506 mg, 380-674). The median calcium intake in lower economic strata boys was 767 mg (585-1043) and that in upper economic strata girls was 764 mg (541-959). The main source of calcium was dairy products in upper economic strata adolescents while it was dark green leafy vegetables in lower economic strata adolescents. The median calcium intake was much lower in lower economic strata than in the upper economic strata both in boys and girls. Girls from both groups had less access to dairy products as compared to boys. Measures need to be taken to rectify low calcium intake in lower economic strata adolescents and to address gender inequality in distribution of dairy products in India.