Effect of vitamin D supplementation on growth parameters of children with vitamin D deficiency: a community based randomized controlled trial
Keywords:Calcium, Children, Malnutrition, Supplementation, Vitamin D
Background: Vitamin D deficiency remains the most common cause of rickets globally and is highly prevalent in developing countries including India. This study aimed to compare the efficacy of vitamin D and calcium together with calcium alone on growth parameters of children with vitamin D deficiency in community based setting.
Methods: A randomized controlled trial was conducted in community based setting in Kanpur district. Multistage random sampling technique was used to select a total of 395 children between 2 years to 5 years from 5 villages of block Vidhunu. Of these, 138 children were randomized into two groups using balanced block randomization technique. Group 1 received vitamin D with calcium together and group 2 received calcium alone for a period of 12 months. Anthropometry, serum vitamin D, calcium, alkaline phosphatase levels were estimated at baseline and after 12 months. Data was analyzed using SPSS 20. Student’s t test was used to analyze the differences in growth and laboratory parameters in the two groups. Multiple linear regression analysis was used to assess the effect of various factors on the growth parameters.
Results: Prevalence of vitamin D deficiency was 78.7%. Baseline characteristics of both groups were similar. After 12 months, group 1 demonstrated significantly greater improvement in weight SD score (21.4%) and height SD score (10.3%) and growth velocity (9.1 cm/year) compared to group 2 (14.3%, 7.8% and 6.9 cm/ year respectively). Also subjects in group 1 showed significantly greater improvement in serum levels of vitamin D, calcium and alkaline phosphatase than group 2.
Conclusions: Vitamin D supplementation along with calcium improves the growth of children. Regular supplementation of all children with vitamin D can be considered as a policy for prevention of malnutrition.
Holick MF. Vitamin D extra skeletal health. Rheum Dis Clin North Am. 2012;38:141-60.
Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment and prevention of vitamin D deficiency: an endocrine society practice guideline. J Clin Endocrinol Metab. 2011;96:1911-30.
Marwaha RK, Tandon N, Agarwal N, Puri S, Agarwal R, Singh S, et al. Impact of two regimens of Vitamin D supplementation on calcium: vitamin D-PTH axis of schoolgirls of Delhi. Indian Pediatr. 2010;47:761-9.
Arya V, Bhambri R, Godbole M, Mithal A. Vitamin D status and its relationship with bone mineral density in healthy Asian Indians. Osteoporos Int. 2004;15:56-61.
WHO Multicentre growth reference study group: WHO child growth standards: Length/ height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development. Geneva, World Health Organization, 2006. Available at: http://www.who.int/childgrowth/standards/technical_report/en/index.html
Khadgawat R, Thomas T, Gahlot M, Tandon N, Tangpricha V, Khandelwal D, et al. The effect of puberty on interaction between Vitamin D status and insulin resistance in obese Asian-Indian children. Int J Endocrinol. 2012;2012:173581.
Garg MK, Marwaha RK, Khadgawat R, Ramot R, Obroi AK, Mehan N, et al. Efficacy of vitamin D loading doses on serum 25-hydroxy vitamin D levels in school going adolescents: an open label non-randomized prospective trial. J Pediatr Endocrinol Metab. 2013;26:515-23.
Goswami R, Vatsa M, Sreenivas V, Singh U, Gupta N, Lakshmy R, et al. Skeletal muscle strength in young Asian Indian females after vitamin D and calcium supplementation: a double blind randomized controlled clinical trail. J Clin Endocrinol Metab. 2012;97:470-1.
Agarwal N, Mithal A, Dhingra V, Kaur P, Godbole MM, Shukla M. Effect of two different doses of oral cholecalciferol supplementation on serum 25(OH) levels in healthy Indian postmenopausal women: a randomised controlled trial. Ind J Endocrinol Metab. 2013;17:883-9.
Tiwari L, Pulilyel J. Vitamin D level in slum children of Delhi. Indian Pediatr. 2004;41:1076-7.
Puri S, Marwaha RK, Agarwal N, Tandon N, Agarwal R, Grewal K, et al. Vitamin D status of apparently healthy schoolgirls from two different socioeconomic strata in relation to nutrition and lifestyle. Br J Nutr. 2008;99:876-82.
Sachan A, Gupta R, Das V, Agarwal A, Awasthi PK, Bhatia V. High prevalence of vitamin D deficiency among pregnant women and their newborns in northern India. Am J Clin Nutr. 2005;81:1060-4.
Harinarayan CV, Joshi SR. Vitamin D status in India: its implications and remedial measures. J Assoc Physicians Ind. 2009;57:40-8.
Thacher TD, Fischer PR, Pettifor JM, Lawson JO, Isichei CO, Reading JC, et al. A comparison of calcium, vitamin D or both for nutritional rickets in Nigerian children. N Engl J Med. 1999;34:563-8.
Gupta R, Sharma U, Gupta N, Kalaivani M, Singh U, Guleria R, et al. Effect of cholecalciferol and calcium supplementation on muscle strength and energy metabolism in vitamin D-deficient Asian Indians: a randomized controlled trial. Clin Endocrinol. 2010;73:445-51.
Billoo AG, Murtaza G, Memon MA, Khaskheli SA, Iqbal K, Rao MH. Comparison of oral versus injectable vitamin-D for the treatment of nutritional vitamin-D deficiency rickets. J Coll Physicians Surg Pak. 2009;19:428-31.
Hackman KL, Gagon C, Briscoe RK, Lam S, Anpalahan M, Ebleling PR. Efficacy and safety of oral continuous low dose- versus short-term high-dose vitamin D: a prospective randomised trial conducted in a clinical setting. Med J Aust. 2010;192:686-9.
Cesur Y, Caksen H, Gündem A, Kirimi E, Odabaş D. Comparison of low and high dose of vitamin D treatment in nutritional vitamin D deficiency rickets. J Pediatr Endocrinol Metab. 2003;16:1105-9.
Mondal K, Seth A, Marwaha RK, Dhanwal D, Aneja S. A randomized controlled trial on safety and efficacy of single intramuscular versus staggered oral dose of 600000IU Vitamin D in treatment of nutritional rickets. J Trop Pediatr. 2014;60:203-10.
Soliman AT, El-Dabbagh M, Adel A, Al Ali M, Bedair AEM, Elalaily RK. Clinical responses to mega dose of vitamin D3 in infants and toddlers with vitamin D deficiency rickets. J Trop Pediatr. 2010;56:19-26.
Thacher TD, Clarke BL. Vitamin D insufficiency. Mayo Clin Proc. 2011;86:50-60.
Nutrient requirements and recommended daily allowances for Indians: a report of the expert group of the Indian Council of Medical Research. Available at http://icmr.nic.in/final/rda-2010.pdf. Last accessed on March 14, 2017.
WHO Guideline: Vitamin A supplementation in infants and children 6-59 months of age. Geneva, World Health Organization, 2011.
Carol L, Wagner, Frank R. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatr. 2008;122:1142.