Calcium Nutrition Research Articles

High prevalence of vitamin D and calcium deficiency among pregnant women and their newborns in Chengdu, China

Vitamin D and calcium deficiency is common in pregnant women and newborn infants. There are few data about the prevalence of hypovitaminosis D during pregnancy and infancy in China. We assessed vitamin D status of pregnant women and their neonates in Chengdu, Sichuan province, China. Maternal serum and cord blood levels of calcium, 25-hydroxyvitamin D [25(OH)D], alkaline phosphatase, and parathyroid hormone (PTH) were studied in 77 urban and rural mother-neonate pairs at term. The mean level of maternal serum 25(OH)D was 35.95+/-19.7 nmol/L, and that of cord blood 25(OH)D was 40.98+/-18.89 nmol/L. The intake of calcium and vitamin D was uniformly low, although it was higher in urban (1010+/-450 mg/d, 237+/-169 IU/d) than in rural (320+/-210 mg/d, 62+/-66 IU/d) women. Maternal serum 25(OH)D was correlated positively with cord blood 25(OH)D (r=0.94, P<0.01). There is a high prevalence of vitamin D and calcium insufficiency in pregnant women and neonates in Chengdu even when mothers are compliant with prenatal vitamin supplementation. Supplementation is needed to improve maternal and neonatal vitamin D and calcium nutrition.

Growth and Mineral Composition of Nickel-Stressed Plants Under Conditions of Supplementation With Excessive Amounts of Calcium and Iron

This study investigated the effectiveness of excessive calcium (Ca) and iron (Fe) supplement nutrition in spinach Markiza F1 cv. and sweet corn Zlota Karlowa cv. to alleviate nickel (Ni)-induced phytotoxicity. The following doses of the pollutant Ni were introduced: 0 (control), 40, or 60 mg Ni/kg growth medium. Two levels of calcium (Ca), 270 (basic) and 400 mg/kg (intensive), as well as two levels of iron (Fe), 10 (basic) and 20 mg/kg (intensive), respectively, were used. Intensive nutrition supplementation of Ni-stressed test plants species with Ca or Fe was beneficial as manifested by significantly increased maize shoots and roots biomass, lowered content of Ni in spinach and maize in above-ground parts, and decreased concentration of the pollutant in roots of intensive Ca-supplied maize plants grown in the environment containing 60 mg Ni/kg. Moreover there was significantly elevated Fe content in highly fertilized with iron spinach plants grown in the presence of 60 mg Ni/kg and in shoots of Ni-treated maize plants intensively supplied with Ca or Fe. Generally, high content of Ca or Fe in the growth medium significantly raised the content of free and bound Ca in shoots of Ni-stressed spinach plants. The same phenomenon was found in roots, but only in the presence of 60 mg Ni. Intensive nutrition supplementation of Ni-treated maize plants with Fe or Ca generally did not change the concentration of free Ca in plant organs, but elevated bound Ca levels in roots was observed. Increased bound Ca content was also found in leaves of maize plants intensive supplied with Ca. Thus, intensive Ca or Fe nutrition presents a promising potential for use in the conditions of Ni contamination by increasing plant growth, reducing Ni translocation from roots to shoots and raising the nutritive value of above-ground parts of spinach and maize plants.

Significance of fruit transpiration on calcium nutrition in developing apricot fruit

AbstractThe first objective of this study was to search for a possible correlation between accumulation of calcium (Ca), potassium (K), and magnesium (Mg) and fruit transpiration in developing apricot (Prunus armeniaca L.) fruit. Secondly, the work aimed to determine the significance of transpirational flux on Ca nutrition. We hypothesized that if the fruit transpiration is the determining factor of Ca accumulation (phloem‐immobile element) then the import of Ca would be suppressed by restriction of fruit water loss, while the import of phloem‐mobile nutrients (i.e., K and Mg) would not be. To test this hypothesis, the seasonal changes of transpiration and of Ca, K, and Mg concentration/accumulation were assessed in fruits left to naturally transpire or under restricted transpiration (bagged fruits). Fruit transpiration was measured on detached fruits using a portable gas‐exchange equipment (ADC‐LCA4, ADC BioScientific Ltd, Hoddesdon, England). Results demonstrated that 83% of total fruit Ca content was gained within the first 4 weeks after fruit‐set, and that Ca import ceased concomitantly to a reduction of transpiration. In spite of the limitation of fruit transpiration, Ca entered the nontranspiring fruits, and its concentration was about 45% of that in control fruits suggesting that other factor(s) operated for Ca accumulation. This study provides the evidence that fruit transpiration accounted for 55% of total Ca that entered a fruit. We conclude that optimal soil Ca availability and apportioning to the fruit during the early 4 weeks of growth are essential to sustain the fruit demand of this nutrient and that some cultural practices (e.g., summer pruning, irrigation) should be tested as possible tools to improve fruit Ca nutrition via increasing fruit transpiration.

Wood formation of trees in relation to potassium and calcium nutrition

Potassium and calcium are essential for tree metabolism and various physiological processes related to growth. In recent years, special interest was therefore accorded to the effect of both cations on cambial activity and xylem development. Various studies revealed a distinct correlation between potassium as well as calcium nutrition and wood formation. When poplar trees were grown under low K(+) or Ca²(+) regimes, the cambial activity as well as the seasonal rate of wood increment and the vessel size were significantly reduced. Molecular, biochemical and electrophysiological investigations indicate (i) a strong involvement of specific K(+) channels in the regulation of xylem cell expansion and (ii) a significant influence of Ca²(+) on the onset of cambial reactivation after winter dormancy as well as on wood structure and chemistry. These studies highlight the important role of potassium as well as calcium in xylogenesis. Based on that knowledge, further research will be directed towards a better understanding of the mechanisms governing K(+)- as well as Ca²(+)-dependent wood formation.

Effect of calcium and vitamin D supplementation on bone mineral density in women aged 65–71 years: a 3-year randomized population-based trial (OSTPRE-FPS)

The Osteoporosis Risk Factor and Prevention-Fracture Prevention Study (OSTPRE-FPS) was a randomized population-based open trial (n = 593). The supplementation group (n = 287) received daily cholecalciferol 800 IU + calcium 1,000 mg for 3 years while the control group (n = 306) received neither supplementation nor placebo. Daily vitamin D and calcium supplementation have a positive effect on the skeleton in ambulatory postmenopausal women. vitamin D deficiency is common in the elderly, and vitamin D levels are associated with low bone mineral density (BMD). The working hypothesis was that vitamin D and calcium supplementation could prevent bone loss in ambulatory postmenopausal women. the OSTPRE-FPS was a randomized population-based open trial with a 3-year follow-up in 3,432 women (aged 66 to 71 years). A randomly selected subsample of 593 subjects underwent BMD measurements. The supplementation group (n = 287) received daily cholecalciferol 800 IU + calcium 1,000 mg for 3 years while the control group (n = 306) received neither supplementation nor placebo. in the intention-to-treat analysis, total body BMD (n = 362) increased significantly more in the intervention group than in the control group (0.84% vs. 0.19%, p = 0.011). The BMD change differences at the lumbar spine (p = 0.372), femoral neck (p = 0.188), trochanter (p = 0.085), and total proximal femur (p = 0.070) were statistically nonsignificant. Analyses in compliant women (≥ 80% of use) resulted in stronger and statistically significant effects at the total body and femoral regions. daily vitamin D and calcium supplementation have a positive effect on the skeleton in ambulatory postmenopausal women with adequate nutritional calcium intake.

Effects of Nitrogen and Calcium Nutrition on Oxalate Contents, Forms, and Distribution in Spinach

ABSTRACT A hydroponic experiment was conducted to study the effects of nitrogen (N) and calcium (Ca) nutrition on oxalate contents of different forms in spinach tissues. Results showed that leaves were the main locations of oxalates in spinach. Total oxalate, soluble oxalate, and insoluble oxalate contents were highest in leaves, followed by petioles and then roots. Soluble oxalate was the dominant form of oxalate in spinach. Nitrogen and Ca2+ (calcium ion) concentrations could markedly affect oxalate contents. Soluble oxalate contents in leaves increased obviously with the increase of N concentration until 8 mmol L−1, above which oxalate content started to decrease. Supplied with the same amount of N, increasing Ca2+ concentration reduced soluble oxalate content in leaves. Total oxalate reached the lowest with 5 mmol L−1 of Ca2+ supply. Leaves and petioles had lower total oxalate and lower proportion of soluble oxalate when N and Ca2+ concentrations were 8 and 5 mmol L−1.

Calcium Nutrition of Peanut Grown in Solution Culture. I. Genetic Variation in Ca Requirements for Vegetative Growth

ABSTRACT Calcium (Ca) deficiency is an important problem in peanut (Arachis hypogaea L.) production, with lines from the sub-species A. hypogaea hypogaea (Virginia type) being considered more susceptible to Ca deficiency than those of A. hypogaea fastigata (Spanish and Valencia types). Fifteen peanut lines comprising five Virginia bunch, one Virginia runner, six Spanish, two Valencia types, and one Valencia × Spanish cross were grown for 30 d in continuously flowing solution culture at constant external Ca concentrations ranging from 9 to 2500 μM. Two lines required <9 μM Ca for near-maximum growth, whereas 5 lines required 15–20 μM, six lines required 25–50 μM, and two lines required >75 μM Ca for maximum growth. The Ca concentration in the youngest fully expanded leaves required for maximum growth also differed considerably among the lines, ranging from <5.7 g kg−1 in ‘SH-2’ to 17.3 g kg−1 in ‘Red Spanish’). The differences in solution and tissue Ca requirement for growth did not coincide with the broad botanical groupings despite that Virginia type peanut lines had consistently lower Ca concentrations in youngest fully expanded leaves than Spanish or Valencia lines at all solution Ca concentrations. Leaf magnesium (Mg), potassium (K), phosphorus (P), iron (Fe), and manganese (Mn) concentrations in the leaves decreased as the solution Ca concentration increased and it seemed probable that growth reductions observed at above-optimum Ca concentrations were due to induced deficiencies of P, Mg, or possibly Fe.

Calcium Nutrition of Peanut Grown in Solution Culture. II. Pod-zone and Tissue Calcium Requirements for Fruiting of a Virginia and a Spanish Peanut

ABSTRACT Virginia peanut types need more calcium (Ca) in the soil than Spanish types for high pod yield, but their actual soil solution and fruit tissue Ca requirements have not been well defined. A split root and pod solution culture technique was used to examine the effects of Ca concentration on fruiting of one Virginia cv. ‘Virginia Bunch 1’ and one Spanish peanut cv. ‘TMV-2’. Plants were grown in complete nutrient solution (root zone) containing 100 μM Ca, and six treatments imposed in which the pod zone solution Ca was controlled at 0 to 2500 μM. ‘TMV-2’ produced some mature seeds with no Ca added to the pod zone solution and 81% of maximum seed dry matter at 5 μM Ca, a concentration at which its pod dry matter production was close to maximum. In contrast, ‘Virginia Bunch 1’ produced no pods with no Ca added to the pod zone and only 28% of maximum pod dry matter at 5 μM Ca. ‘TMV-2’ required 6 and 21 μM Ca in the pod zone solution for 95% of maximum pod and seed production, respectively. The corresponding solution concentrations for ‘Virginia Bunch 1’ were 35 and 50 μM Ca. The seed dry matter production of ‘Virginia Bunch 1’ decreased with ≥112 μM Ca in the pod zone solution due to a decrease in individual seed mass, but there was no depression in the case of ‘TMV-2’ up to the highest pod zone solution concentration of 2500 μM Ca studied. The Ca concentration in pod walls and seeds of both cultivars increased with increase in Ca up to 500 μM in the pod zone, the effect being greater in ‘TMV-2’. However, the seed production of both cultivars was maximized at approximately the same seed Ca concentration of 0.04%. The results of this study have shown that the Spanish peanut cv. ‘TMV-2’ and the Virginia peanut cv. ‘Virginia Bunch 1’ have a similar tissue Ca requirement for seed growth despite the higher pod zone Ca requirement of ‘Virginia Bunch 1’.

Vitamin D and Calcium Insufficiency-Related Chronic Diseases: an Emerging World-Wide Public Health Problem

Vitamin D and calcium insufficiencies are risk factors for multiple chronic diseases. Data from 46 recent studies from Europe, North America, South-East Asia and the South Pacific area clearly indicate that a low vitamin D status and inadequate calcium nutrition are highly prevalent in the general population (30–80%), affecting both genders. The extent of insufficiencies is particularly high in older populations, and in some geographical areas, also in children and in young women of child-bearing age, in ethnic minorities and immigrants, as well as in people of low socio-economic status. Enrichment of cereal grain products with vitamin D and calcium would be a viable approach to increase consumption and improve health outcomes in the general population worldwide.

Vitamin D and calcium insufficiency-related chronic diseases: molecular and cellular pathophysiology

A compromised vitamin D status, characterized by low 25-hydroxyvitamin D (25-(OH)D) serum levels, and a nutritional calcium deficit are widely encountered in European and North American countries, independent of age or gender. Both conditions are linked to the pathogenesis of many degenerative, malignant, inflammatory and metabolic diseases. Studies on tissue-specific expression and activity of vitamin D metabolizing enzymes, 25-(OH)D-1 alpha-hydroxylase and 25-(OH)D-24-hydroxylase, and of the extracellular calcium-sensing receptor (CaR) have led to the understanding of how, in non-renal tissues and cellular systems, locally produced 1,25-dihydroxyvitamin D(3) (1,25-(OH)(2)D(3)) and extracellular Ca(2+) act jointly as key regulators of cellular proliferation, differentiation and function. Impairment of cooperative signalling from the 1,25-(OH)(2)D(3)-activated vitamin D receptor (VDR) and from the CaR in vitamin D and calcium insufficiency causes cellular dysfunction in many organs and biological systems, and, therefore, increases the risk of diseases, particularly of osteoporosis, colorectal and breast cancer, inflammatory bowel disease, insulin-dependent diabetes mellitus type I, metabolic syndrome, diabetes mellitus type II, hypertension and cardiovascular disease. Understanding the underlying molecular and cellular processes provides a rationale for advocating adequate intake of vitamin D and calcium in all populations, thereby preventing many chronic diseases worldwide.

Prevalence of low bone mass and endocrine disorders in hip fracture patients in Southern Germany.

Low bone mass and conditions leading to falls are considered to determine the risk of hip fracture. Bone mass is influenced by underlying diseases and risk factors such as malnutrition and life style habits. In order to evaluate the clinical significance of osteopenia and risk factors in the pathogenesis of hip fracture, we have studied 146 consecutive patients (27 males, 119 females, aged 53-95 years) undergoing rehabilitation shortly after hip fracture (4 cases of hip fracture resulting from traffic accidents had been excluded). We measured bone mineral density (BMD) at the hip (DXA, Hologic QDR 2,000+), evaluated vitamin D status (serum 25-OH-Vitamin D) and nutritional calcium intake (clinical dietician), and searched for endocrine disorders (physical examination and serum hormones). Femoral neck BMD was 0.543 +/- 0.084 g/cm2 in females and 0.635 +/- 0.087 g/cm2 in males (p < 0.01). For both sexes, the values were significantly lower compared to age-matched controls. 88% of the females and 69% of the males had T-Scores below -2.5, thus fulfilling the densitometric WHO criteria of osteoporosis. Nutritional calcium intake was similar in both sexes (804 +/- 330 mg/day in women, 738 +/- 295 mg/day in men), but lower compared to coxarthrosis patients (1080 +/- 436 mg/day). Vitamin D deficiency was prevalent in 69% of the women, and in 55%, of the men with hip fracture. In female hip fracture patients, the serum alkaline phosphatase was significantly higher (194 +/- 82 U/I) as compared to patients with surgery because of coxarthrosis (142 +/- 46 U/I), supporting the view that some degree of osteomalacia and high turnover was present. Primary hyperparathyroidism (pHPT) was newly detected in 1% and hyperthyroidism in 4.3% of the cases. Hip fracture occurs at higher BMD values in men compared to women suggesting different fracture thresholds. Vitamin D deficiency and low calcium intake are common in hip fracture patients. However, before initiation of vitamin D treatment pHPT should be excluded. Determination of TSH is recommendable in all hip fracture patients.

Regulation of The Colonic Vitamin D System for Prevention of Tumor Progression: An Update

A compromised vitamin D status and nutritional calcium deficit are linked with sporadic colorectal cancer incidence. 25(OH)D(3) serum concentration is a major determinant of 1,25-dihydroxyvitamin D3 (1,25[OH](2)D(3)) synthesis in colonic mucosa, which expresses the vitamin D receptor and both the synthesizing (CYP27B1) and catabolic (CYP24A1) hydroxylases. Receptor-bound, 1,25(OH)(2)D(3) regulates proliferation, differentiation and apoptosis in an autocrine/paracrine manner. During early malignancy 1,25(OH)(2)D(3) synthesis is often enhanced to counteract hyperproliferation. In many advanced tumors, vitamin D catabolism surpasses synthesis. In vivo, expression and activity of CYP27B1 and vitamin D receptor are stimulated by (phyto)estrogens. Conversely, low nutritional calcium and folate enhance vitamin D catabolism. These insights could explain the lower colorectal cancer incidence in females, the chemopreventive potency of vitamin D and calcium against colorectal cancer, and the benefit of nutritional folate as a methyl donor for epigenetic regulation of the vitamin D system.

Human Adult-Onset Lactase Decline: An Update

Human adult-onset lactase decline is a biologic feature characteristic of the maturing intestine in the majority of the world's population. The digestion and absorption of lactose, the major carbohydrate in milk and also the main substrate for lactase, is often variable, a consequence of lactase levels, gastric emptying rate, and colonic salvage. Although commercially available "lactase" products alleviate symptoms in many lactose-intolerant people, a greater understanding of this variability in lactose tolerance could lead to interventions that reduce the rate of gastric emptying and/or increase the proliferation of lactose-metabolizing bacteria in the colon, leading to more efficient lactose utilization. Adult-onset lactase decline appears to be a risk factor for developing osteoporosis, owing to avoidance of dairy products or interference of undigested lactose with calcium absorption. Elderly with both adult-onset lactase decline and atrophic gastritis or those undergoing anti-ulcer treatment may have an increased risk of low calcium absorption owing to the lack of gastric acid that facilitates calcium uptake. Thus, lactose-intolerant elders should monitor their calcium nutrition status carefully.

The prevalence of natural and fortified calcium food sources in the self‐selected diets of adolescent girls

Fortification of foods with calcium may provide an opportunity for improving dietary calcium intake; however, quantifying the nutritional impact of calcium fortified foods in the U.S. population remains difficult. This analysis reports on the penetration of calcium from natural and fortified food sources in the self‐selected diets of teenage girls participating in two randomized controlled trials at our research center from 2002 ‐ 2005. One‐hundred‐forty‐nine girls were randomized to either a high calcium group (HC), instructed to consume 1500 mg Ca/d from dairy and/or fortified foods (mean 1494 mg Ca/d), or to a control group instructed to consume their usual calcium (UC) diet (mean 765 mg Ca/d.) Dairy foods contributed 69% of the total calcium in the HC group and calcium fortified foods contributed the calcium equivalent of 250 g milk (300 mg Ca). Compared with the nutrient profile of milk, the calcium‐fortified food profile contributed 192% the calories, 362% the carbohydrate, and 200% the sugar of milk, with 62% less protein, 50% less phosphorus, 40% less potassium, 35% less vitamin A, and 12% less vitamin D. In the UC group, dairy foods contributed 70% of the total calcium with breakfast cereals, the top calcium fortified food, providing only 2.5% of total daily calcium. In this cohort of teenage girls following their usual diet, calcium‐fortified foods had little impact on overall calcium nutrition.

Outbreak of Egg Drop Syndrome in Bangladesh

An incident alike to egg-drop syndrome (EDS) occurred in commercial egg laying chickens in Gazipur district,Bangladesh from July to November 2005. The chickens showed decreased egg production along with production ofshell less and soft shelled eggs when they were at predicted peak production age. Nutritional status, especially crudeprotein (16.65-18.50%) and calcium (2.15-3.62%) content of the supplied feed was within the range. Virological andserological investigations on causes of decreased egg production and production of soft-shelled and shell less egg by thelaying hens revealed that the responsible causative agent is EDS virus. Total seven EDS viruses were isolated fromcloacal swab (4), soft-shelled eggs (2) and feces (1). The isolation rate 71.43% (5/7) was higher in second passage thanin first passage 28.57% (2/7) in duck embryos. None of the 7 viruses grew in chicken embryo even after second passage.All five flocks tested, were vaccinated against infectious bronchitis and Newcastle disease along with other commonvaccines generally used in Bangladesh but not against EDS. Serological investigation revealed that birds in all testedfarms (100%) had antibody against EDS virus (in 2 farms in 100% samples and in 3 farms in 80% samples). The sourceof the virus remained to be determined. To the best of our knowledge, this is the first report of EDS outbreak inBangladesh. To save poultry industry in Bangladesh from harm of this disease the biosecurity measures should bestrictly followed along with vaccination against the disease.

La vitamine D : effets « classiques », « non classiques » et évaluation du statut du patient

Knowledge about vitamin D has greatly improved during the last few years. Vitamin D cannot any more be considered as exclusively necessary to prevent ricket/osteomalacia. Its role in the prevention of some osteoporotic fractures in the elderly (in association with calcium nutrition) is now well-demonstrated and many epidemiologic and laboratory data argue for a role in the prevention of several diseases or anomalies (cancer, auto-immune diseases, cardiovascular events, sarcopenia…). A few intervention studies confirming some of these effects also exist. Vitamin D status can easily be assessed by measuring serum 25-OH vitamin D level. However, many experts have claimed that the population-based reference values for 25OHD are too low and that the cut-off value below which vitamin D insufficiency can be present is somewhere between 20 and 40 ng/mL with a clear tendency to target values above 30 ng/mL (75 nmol/L). The main consequences are that vitamin D insufficiency is highly frequent whereas the currently recommended supplementation doses are not sufficient.

Sensory analysis of calcium-biofortified lettuce.

Vegetables represent an attractive means of providing increased calcium nutrition to the public. In this study, it was demonstrated that lettuce expressing the deregulated Arabidopsis H(+)/Ca(2+) transporter sCAX1 (cation exchanger 1) contained 25%-32% more calcium than controls. These biofortified lettuce lines were fertile and demonstrated robust growth in glasshouse growth conditions. Using a panel of highly trained descriptive panellists, biofortified lettuce plants were evaluated and no significant differences were detected in flavour, bitterness or crispness when compared with controls. Sensory analysis studies are critical if claims are to be made regarding the efficacy of biofortified foods, and may be an important component in the public acceptance of genetically modified foods.

Actualité sur les effets de la vitamine D et l’évaluation du statut vitaminique D

Knowledge about vitamin D has greatly improved during the last few years. Vitamin D cannot any more be considered as exclusively necessary to prevent ricket/osteomalacia. Its role in the prevention of some osteoporotic fractures in the elderly (in association with calcium nutrition) is now well demonstrated and many epidemiologic and laboratory data argue for a role in the prevention of several diseases or anomalies (cancer, auto-immune diseases, cardiovascular events, sarcopenia…). A few intervention studies confirming some of these effects also exist. Vitamin D status can easily be assessed by measuring serum 25 hydroxy vitamin D (25OHD) level. However, many experts have claimed that the population-based reference values for 25OHD are too low and that the cut-off value below which vitamin D insufficiency can be present is somewhere between 20 and 40ng/mL with a clear tendency to target values above 30ng/mL (75nmol/L). The main consequences are that vitamin D insufficiency is highly frequent whereas the currently recommended supplementation doses are not sufficient.

Prevalence of Osteoporosis in Ambulatory Postmenopausal Women from A Semiurban Region in Southern India: Relationship to Calcium Nutrition and Vitamin D Status

To assess the prevalence of osteoporosis in healthy ambulatory postmenopausal Indian women as measured by dual-energy x-ray absorptiometry and to study the dietary calcium intake and vitamin D status and their influence on bone mineral density (BMD). We conducted a community-based cross-sectional study in a semiurban region. A randomized cluster sampling technique was used. The study cohort consisted of 150 ambulatory postmenopausal women (> or = 50 years old). Dual-energy x-ray absorptiometry for BMD was performed at the lumbar spine and femoral neck. Dietary calcium intake and biochemical variables were assessed. The prevalence of osteoporosis was 48% at the lumbar spine, 16.7% at the femoral neck, and 50% at any site. The mean dietary calcium intake was much lower than the recommended intake for this age-group. There was a significant positive correlation between body mass index and BMD at the lumbar spine and the femoral neck (r = 0.4; P = .0001). BMD at the femoral neck was significantly less (mean, 0.657 versus 0.694 g/cm(2)) in the vitamin D-insufficient study subjects in comparison with the vitamin D-sufficient women (P = .03). The high prevalence of osteoporosis and vitamin D insufficiency in this semiurban group of postmenopausal women in India is a major health concern. Measures such as adequate calcium intake and vitamin D supplementation in women of this age-group may be beneficial.

Pediatric vitamin D and calcium nutrition in developing countries

Over one billion humans have insufficient circulating levels of vitamin D, and dietary insufficiency of calcium is common in developing countries. Worldwide, nutritional rickets is considered to be the most common non-communicable disease of children. Rickets can be due either to primary deficiencies of vitamin D or calcium or to combined deficiencies of both elements. Vitamin D deficiency is also increasingly linked to non-skeletal complications. Even without laboratory and radiologic resources, the diagnosis of rickets is considered clinically when a child presents with limb deformities and has beaded ribs and widened wrists and ankles. Prevention is possible through increased sun exposure and dietary enhancement. Treatment of nutritional rickets involves provision of adequate vitamin D and calcium. Further research is needed to elucidate the precise epidemiology of vitamin D and calcium deficiencies in developing countries, to determine the roles of additional pathologic factors contributing to the development and morbidity of rickets, to improve affordable and feasible means of diagnosing rickets in resource-limited areas, to better target at-risk populations for preventive interventions, to identify accurate dosing and delivery of therapeutic interventions, and to evaluate the long-term consequences of vitamin D and calcium deficiencies in childhood.