Submitted to: Journal of Federation of American Societies for Experimental Biology
Publication Type: Abstract Only
Publication Acceptance Date: 12/1/2004
Publication Date: 3/7/2005
Citation: Combs Jr., G.F., Hassan, N., Hunt, C.D., Watts, J. 2005. Apparent efficacy of food-based calcium supplementation in preventing rickets in Bangladesh [abstract]. The Federation of American Societies for Experimental Biology Journal. 19(5):A1462.
Technical Abstract: Rickets occurs in Bangladesh, affecting as much as 4% of children in some areas. Our previous studies have found that cases showed normal serum 25-OH-vitamin D levels and consumed only 150 mg calcium (Ca)/d. Therefore, the disease may be of the Ca-deficiency type, although these children may also be low in other bone-active nutrients including boron. To determine whether increased Ca intakes can prevent rickets in this population, we conducted a randomized clinical trial in a rickets-endemic area (Chakaria). We screened 1742, 1-5 yr. old boys and girls, finding 194 healthy children with no physical leg signs of rickets but with serum alkaline phosphatase (AP) >260 u/dl. When 183 of those subjects were re-screened after a 7 mo. pre-trial period, 23 (12.6%) had developed physical leg signs of rickets, suggesting an annual risk of 21.5% in this cohort. Re-screened subjects without signs (75 boys, 80 girls) were randomized to a milk powder-based beverage given daily 6 days/wk and providing either 50 mg Ca, 250 mg Ca, 500 mg Ca, or 500 mg Ca+multivitamins/minerals. After 13 mos. of intervention, no subjects presented with physical signs of rickets and all showed carpal ossification normal for age. However, 18 (16%) showed radiographic signs (medial angle of at least one knee <168o) with no differences among treatment groups. These results suggest that even a small increase in Ca intake in a highly available food form may be useful in supporting normal bone development in this population.