Apparent Efficacy of Food-Based Calcium Supplementation in Preventing Rickets in Bangladesh

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• 作者：Gerald F. Combs Jr. (1) (2)
  Nazmul Hassan (3)
  Nancie Dellagana (4)
  David Staab (4)
  Phil Fischer (5)
  Curtiss Hunt (2)
  Jennifer Watts (2)
  
• 关键词：Rickets ; Calcium ; Vitamin D ; Radiography ; Bone ; Bone age
• 刊名：Biological Trace Element Research
• 出版年：2008
• 出版时间：March 2008
• 年：2008
• 卷：121
• 期：3
• 页码：193-204
• 全文大小：301KB
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• 作者单位：Gerald F. Combs Jr. (1) (2)
  Nazmul Hassan (3)
  Nancie Dellagana (4)
  David Staab (4)
  Phil Fischer (5)
  Curtiss Hunt (2)
  Jennifer Watts (2)
  
  1. Division of Nutritional Sciences, Cornell University, Ithaca, NY, 14853, USA
  2. Grand Forks Human Nutrition Research Center, USDA-ARS, Grand Forks, ND, 58202-9034, USA
  3. Institute of Nutrition and Food Science, Dhaka University, Dhaka, 1000, Bangladesh
  4. Memorial Christian Hospital, Malumghat, Cox’s Bazar, Bangladesh
  5. Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, 55905, USA
  

文摘

To determine whether increased Ca intakes can prevent rickets in a susceptible group of children living in a rickets-endemic area of Bangladesh, we conducted a 13-month long, double-blind, clinical trial with 1-to 5-year-old children who did not present with rickets but ranked in the upper decile of plasma alkaline phosphatase (AP) activity of a screening cohort of 1,749 children. A total of 158 children were randomized to a milk-powder-based dietary supplement given daily, 6?days/week, and providing either 50, 250, or 500?mg Ca, or 500?mg Ca plus multivitamins, iron, and zinc. Upon initial screening, 194 healthy children presented with no rachitic leg signs and had serum AP in the upper decile (>260?u/dl) of the cohort. When 183 of those subjects were re-screened after a 7-month pre-trial period, 23 (12.6%) had developed rachitic leg signs, suggesting an annual risk of 21.5% in this cohort. Of those still not presenting with leg signs and completing 13?months of dietary intervention, none showed rachitic leg signs, none showed significant radiological evidence of active rickets, and all showed carpal ossification normal for age after that intervention. These results are consistent with even the lowest amount of supplemental Ca (50?mg/day) being useful in supporting normal bone development in this high-risk population.