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Vitamin D for Growth and Rickets in Stunted Children: A Randomized Trial
Francesca L Crowe1,2, M Zulf Mughal3,2, Zabihullah Maroof4,5
1Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.
Insights
Vitamin D supplementation did not prevent rickets or improve growth in young Afghan children. However, it showed a potential benefit for growth in children with higher dietary calcium intake.
Area of Science:
- Pediatrics
- Nutritional Science
- Public Health
Background:
- Vitamin D is crucial for bone health.
- Limited data exists on vitamin D supplementation effects in stunted young children.
- Rickets and growth stunting are significant concerns in developing populations.
Purpose of the Study:
- To evaluate the impact of vitamin D supplementation on rickets risk.
- To assess the effect of vitamin D on linear growth in infants and young children.
- To investigate these effects in Afghan children.
Main Methods:
- A double-blind, placebo-controlled trial involving 3046 children aged 1-11 months.
- Random assignment to oral vitamin D3 (100,000 IU) or placebo every 3 months for 18 months.
- Rickets assessed via radiographs; growth measured by weight and length, with z-scores calculated.
Main Results:
- Vitamin D supplementation did not significantly reduce rickets prevalence (5.3% vs 5.5%).
- No significant difference in height-for-age z-scores between groups (mean difference 0.05).
- A positive effect on height-for-age z-scores was observed in children with higher dietary calcium intake (>300 mg/day).
Conclusions:
- Vitamin D supplementation showed no overall benefit for rickets or growth in this population.
- The findings suggest that vitamin D's efficacy may be influenced by concurrent dietary calcium intake.
- Further research is needed to understand the interplay between vitamin D and calcium for optimal child development.
Background And Objectives:
Vitamin D is essential for healthy development of bones, but little is known about the effects of supplementation in young stunted children. Our objective was to assess the effect of vitamin D supplementation on risk of rickets and linear growth among Afghan children.
Methods:
In this double-blind, placebo-controlled trial, 3046 children ages 1 to 11 months from inner-city Kabul were randomly assigned to receive oral vitamin D3 (100 000 IU) or placebo every 3 months for 18 months. Rickets Severity Score was calculated by using wrist and knee radiographs for 631 randomly selected infants at 18 months, and rickets was defined as a score >1.5. Weight and length were measured at baseline and 18 months by using standard techniques, and z scores were calculated.
Results:
Mean (95% confidence interval [CI]) serum 25-hydroxyvitamin D (seasonally corrected) and dietary calcium intake were insufficient at 37 (35-39) nmol/L and 372 (327-418) mg/day, respectively. Prevalence of rickets was 5.5% (placebo) and 5.3% (vitamin D): odds ratio 0.96 (95% CI: 0.48 to 1.92); P = .9. The mean difference in height-for-age z score was 0.05 (95% CI: -0.05 to 0.15), P = .3, although the effect of vitamin D was greater for those consuming >300 mg/day of dietary calcium (0.14 [95% CI: 0 to 0.29]; P = .05). There were no between-group differences in weight-for-age or weight-for-height z scores.
Conclusions:
Except in those with higher calcium intake, vitamin D supplementation had no effect on rickets or growth.
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