Occurrence of infections in schoolchildren subsequent to supplementation with vitamin D-calcium or zinc: a randomized, double-blind, placebo-controlled trial.

BACKGROUND/OBJECTIVES: Vitamin D and zinc are recognized for their roles in immune-modulation, and their deficiencies are suggested to be important risk factors for childhood infections. This study, therefore, undertook to assess the occurrence of infections in rural Indian schoolchildren, subsequent to daily supplementation with vitamin D-calcium or zinc for 6 months. MATERIALS/METHODS: This was a randomized, double-blind, placebo-controlled trial in apparently healthy 6-12 year-old rural Indian children, recruited to 3 study arms: vitamin D arm (1,000 IU D3 - 500 mg calcium, n = 135), zinc arm (10 mg, n = 150) and placebo arm (n = 150). The infection status was assessed using a validated questionnaire, and the biochemical parameters of serum 25(OH)D and serum zinc were measured by ELISA and colorimetry, respectively. The primary outcome variable was occurrence of infections (upper respiratory and total infections). RESULTS: Serum 25(OH)D concentration in the vitamin D arm improved significantly by 34%, from 59.7 ± 10.9 nmol/L to 80 ± 23.3 nmol/L (P < 0.0001), but no improvement was observed for serum zinc concentration. While there was significant increase in the percentage of children reporting no or mild upper respiratory tract infections (URTI) and total infections (TI) in all three groups, improvements in the supplemented groups were similar to the placebo group. However, the vitamin D arm reported lower URTI and TI status in the vitamin D sufficient versus insufficient children. Also, URTI and TI status were found to be significantly (P < 0.0001) lower in children with improved 25(OH)D versus unchanged 25(OH)D. CONCLUSIONS: Vitamin D-calcium supplementation helped to improve the vitamin D status but exerts no effect on the occurrence of infections when compared to the placebo group. Improvement in the serum 25(OH)D concentrations and attainment of vitamin D sufficiency may exert a beneficial effect on the infection status and needs to be investigated further. To evaluate the efficacy of zinc supplementation, higher dosages need to be administered in future studies.

Effect of Antioxidant Supplementation on Total Antioxidant Status in Indian Children with Type 1 Diabetes.

Hyperglycemia results in the overproduction of free oxygen radicals that impair the endogenous antioxidant defenses. A randomized controlled trial was conducted to compare the effect of 3 months of antioxidant supplementation in the form of foods rich in micronutrients with pharmacological supplement on total antioxidant status of Indian children with type 1 diabetes. Ninety children with diabetes (mean age 11.5 ± 3.6 yrs, 37 boys) were randomly allocated to three groups: Group 1 (n = 31) = DM controls; Group 2 (n = 30) = multimicronutrient syrup; and Group 3 (n = 29) = dietary supplements (nine snack recipes rich in micronutrients). They received intervention for 3 months. Healthy controls were enrolled from local schools. Fasting blood was tested for total antioxidant status (TAS) and glycosylated hemoglobin (HbA1C). Children with diabetes had lower TAS (0.70 ± 0.2 vs. 1 ± 0.24 mmol/l, p = .0001) compared to healthy controls. Anthropometric and biochemical parameters were similar at baseline for all groups of diabetic children. Group 1 showed significant deterioration in TAS at endline (0.72 ± 0.16 vs. 0.60 ± 0.17 mmol/l, p = .008). Increase in TAS recorded in Group 2 was from 0.66 ± 0.21 to 0.70 ± 0.16 mmol/l and in Group 3 was from 0.68 to 0.73 mmol/l. There was a significant difference between Group 1 and Group 3 for percentage change in TAS (-13% vs. 16%, p = .035). Postsupplementation there was an increase in TAS values in children with diabetes, but they were still lower than in healthy controls. Indian diabetic children have compromised antioxidant status, which may be improved by incorporation of multimicronutrient-rich recipes in their diets.

Response of serum 25(OH)D to Vitamin D and calcium supplementation in school-children from a semi-rural setting in India.

The objectives of this study were to: 1) Determine the impact of varying baseline serum 25OHD on increase in vitamin D concentrations after daily supplementation with vitamin D and calcium (1000 IU + 500 mg respectively) for six months in school-children from a semi-rural setting 2) Test the efficacy of daily vitamin D-calcium supplementation on improvement in serum vitamin D concentrations to ≥75 nmol/L. Data collected from 106 subjects (58 boys, 48 girls), aged 6-12 years, included anthropometric measures like height and weight, body composition analysis, three one-day dietary recalls and sunlight exposure (by questionnaire). Blood was collected at baseline and endline and estimated for serum vitamin D by ELISA technique using standard kits. Classification of Vitamin D status was performed according to the 2011 Endocrine Society Practice Guidelines: vitamin D deficiency - <50 nmol/L; insufficiency - 50.0-74.9 nmol/L; sufficiency - ≥75 nmol/L. Statistical analysis was performed using SPSS software. Mean baseline serum vitamin D concentration was 59.7 ±â€¯11.2 nmol/L; this rose to 79.8 ±â€¯23.3 nmol/L with no significant differences between genders at the two time-points. Inverse relationship was obtained between baseline serum 25(OH)D concentrations and change in serum concentrations after supplementation, implying that with increasing baseline serum concentrations of 25(OH)D, increase in vitamin D levels post supplementation were significantly lower (r = - 0.96, p < 0.0001). Greatest benefit of change in serum vitamin D concentrations after supplementation was experienced by children with basal concentrations of <45 nmol/L. Daily vitamin D supplementation was effective in improving serum 25(OH)D to ≥75 nmol/L in 44% of children. Significantly higher percentage of children who were deficient at baseline (64%) were able to attain serum concentrations of ≥75 nmol/L as compared to children who were vitamin D insufficient (43%) (p < 0.001). Thus, daily supplementation with 1000 IU of vitamin D along with 500 mg of calcium helped in improving serum vitamin D concentrations to ≥75 nmol/L. Children who were vitamin D deficient particularly experienced these benefits.

Randomized Control Trial Assessing Impact of Increased Sunlight Exposure versus Vitamin D Supplementation on Lipid Profile in Indian Vitamin D Deficient Men.

BACKGROUND: Despite abundance of sunshine in India, Vitamin D deficiency is common and therefore there is an increasing trend toward taking Vitamin D supplements either as prescription medicine or as a nutritional supplement. Studies have suggested that duration of sun exposure may influence serum lipid profile. OBJECTIVES: To study the effect of increased sunlight exposure versus Vitamin D supplementation on Vitamin D status and lipid profile in individuals with Vitamin D deficiency (25-hydroxyvitamin-D [25OHD] <50 nmol/L). DESIGN: A prospective, randomized open-label trial was carried out in apparently healthy Indian men (40-60 years). Based on 25OHD concentrations, individuals were divided into control (>50 nmol/L, n = 50) and intervention (<50 nmol/L, n = 100) groups. Individuals from intervention group were randomly allocated to two groups; either "increased sunlight exposure group" (n = 50, received at least 20 min sunlight exposure to forearms and face between 11 a.m. and 3 p.m. over and above their current exposure) or "cholecalciferol supplement group" (n = 50, received oral cholecalciferol 1000 IU/day). RESULTS: Significant increase in 25OHD concentrations was seen in both intervention groups (P < 0.01). Significant decrease in total cholesterol (TC), high-density-lipoprotein cholesterol (HDL-C), and low-density-lipoprotein cholesterol (LDL-C) was seen in individuals with increased sunlight exposure (P < 0.05). Cholecalciferol supplement group showed a significant increase in TC and HDL-C (P < 0.05) and insignificant increase in LDL-C. CONCLUSIONS: Increase in Vitamin D concentrations through sunlight exposure significantly reduced TC, LDL-C, and HDL-C concentrations, and cholecalciferol supplementation increased TC and HDL-C concentrations.

A Cross-Sectional Study of Postpartum Changes in Bone Status in Indian Mothers.

BACKGROUND: Bone turnover is high during lactation. However, studies on bone status of Indian urban mothers are scarce. Hence, the objective was to conduct a cross-sectional study on the lactation-related changes in bone health status of Indian mothers postpartum using Dual X-ray Absorptiometry (DXA) at 3 time points: within a week of delivery, at 1- and 3-years postpartum. We also explored the association of dietary calcium intake, physical activity, serum vitamin D status, and dietary traditional food supplements (Dietary Food supplements) with bone health. METHODS: A cross-sectional study was conducted; 300 full-term, healthy primiparous women (28.6 ± 3.4 year) were randomly selected and categorized into 3 groups: 128 mothers within 7 days of delivery (Group A), 88 with 1-year-old children (B), and 84 with 3-year-old children (C). Anthropometry, lactation history, physical activity, diet, biochemical tests (vitamin D, parathyroid hormone), body composition, areal bone mineral density (a-BMD) at total body (TB), AP spine (APS), and dual neck femur (DF) were assessed by DXA (GE-Lunar DPX). RESULTS: Significantly higher APS-BMD (mean ± SD) was observed in Group C (1.107 ± 0.098 g/cm(2)) than that in A (1.045 ± 0.131 g/cm(2)) (p < 0.05). When adjusted for breastfeeding practices, mean (±standard error) APS-BMD was lowest in women in Group A (1.024 ± 0.013 g/cm(2)), but was higher at 1-year (1.079 ± 0.02 g/cm(2)) and at 3-years postpartum (1.111 ± 0.019 g/cm(2)), though differences were significant only between groups A and C (p < 0.05). Most mothers from all 3 groups consumed inadequate amount of nutrients except dietary fat and showed low physical activity. Multiple regression analysis indicated that dietary calcium, moderate physical activity, serum vitamin D, and consumption of dietary food supplements were not significant predictors of APS-BMD (p > 0.1). CONCLUSION: Prevalence of nutrient and vitamin D deficiencies, low physical activity, and poor sunlight exposure were major concerns in Indian lactating mothers; improvement in bone mass at APS was observed at 3-years which was most likely due to physiologic changes.

Changes in body composition of Indian lactating women: a longitudinal study.

BACKGROUND AND OBJECTIVES: Lactation places enormous demands on maternal bone mineral homeostasis. Indian middle class women (MSC) consume energy dense food supplements to meet these demands post-partum (PP) along with restricted physical activity (PA). Effects of these changes on body composition (BC) of PP women have not been studied. To examine longitudinal changes in: a) bone mineral density (BMD) at total body (TB), AP-spine (APS) and dual femur neck regions (DF) b) BC by body weight, lean mass, fat mass using dual energy X-ray absorptiometry (DXA) at baseline, 6-months and 1-year in urban MSC women. METHODS AND STUDY DESIGN: 76-primi-parous (28±3.2 yrs) randomly selected PP women (<7-days) were studied; 70 reassessed at 6- months and 42 1-yr PP. Data on anthropometry, BC, BMD at TB, APS and DF by DXA collected (baseline, 6- months, 1-yr PP). RESULTS: Weight, waist and body mass index (BMI) decreased both at 6-month and 1-yr PP with respect to baseline (p<0.05). BC changes showed increase in android fat % at 1-yr by 10% over baseline (p<0.05). BMD with initial decline at 6-months (-2.8%, -2.3% and -2.3% respectively) recovered partially by 1-yr (+2.5% +1.2% and +4.8% respectively) at DF and TB with complete recovery at APS (p<0.05). CONCLUSION: These urban relatively sedentary MSC women consumed fat rich food PP with higher android fat retention and partial recovery of BMD at DF and TB at 1-year. Modifications in activity and dietary nutrient intakes may be necessary to prevent cardiovascular and bone health related risks.

Influence of Vitamin D Receptor Gene Fok1 Polymorphism on Bone Mass Accrual Post Calcium and Vitamin D Supplementation.

OBJECTIVE: To examine the association of vitamin D receptor (VDR) gene polymorphisms of the Fok1 locus on bone mass accrual in Indian girls used to a low calcium intake. METHODS: An intervention trial was undertaken in 102 girls aged 8-16 y, attending a state run school in Pune city, India. All girls received 500 mg calcium daily and 30,000 IU of vitamin D3 quarterly for one year. Dietary calcium intake was evaluated. Bone mineral content (BMC), bone area (BA) and bone mineral density (BMD) were measured at total body using Dual Energy X-ray Absorptiometry (Lunar DPX-PRO). Polymorphisms of the Fok1 locus of the vitamin D Receptor (VDR) gene were detected using SYBR Green quantitative polymerase chain reaction. RESULTS: The prevalence of Fok1 polymorphism was 43.1% (Ff), 9.8% (ff) and 47.1% (FF). At baseline, FF genotype had significantly lower BMD as compared to ff and Ff genotype (p < 0.05). At baseline, majority of girls (82.4%) were hypocalcemic with low calcium intake. Post-supplementation, FF genotype had significantly lower bone mass as compared to ff and Ff genotype. Significant increase in BMC [Ff (17.9%); ff (18.1%); FF (17.4%)], and BMD [Ff (5.4 %); ff (6.3%); FF (4.8%)] was observed post supplementation (p value < 0.05), though percentage increase in BMC and BMD was similar for three Fok1 polymorphisms (p > 0.1). CONCLUSIONS: VDR gene polymorphism, as defined by Fok1 genotype had no positive influence on bone mass accrual in response to calcium supplementation.

Effect of micronutrient supplementation on height velocity of underprivileged girls in comparison with un-supplemented healthy controls.

The aim of this study was to investigate the effect of 1-year micronutrient supplementation on the height velocity of underprivileged premenarchal girls in comparison with the natural growth of apparently healthy girls from an affluent class. A 1-year cluster-randomisation intervention trial was conducted in 119 premenarchal girls (8-12 years) from two schools catering to the lower socioeconomic strata (LSES) in Pune, India. Three classes of age-matched girls were randomly allocated to any one of the three intervention groups: (i) Ca+MZn+D group (C1: zinc, 15 mg/day+multivitamins; calcium, 500 mg/day; vitamin D, 30,000 IU/3 months); (ii) Ca+D group (C2: calcium, 500 mg/day; vitamin D, 30,000 IU/3 months); and (iii) M+D group (C3: multivitamins; vitamin D, 30,000 IU/3 months). Height, weight, and Tanner stage were assessed at baseline and endline. A total of 119 age-matched, apparently healthy school girls from a higher socioeconomic group (HSES) were assessed for their growth after 1 year without any supplementation. At baseline, mean height-for-age Z-scores and weight-for-age Z-scores by Indian references were >-2 in 99% of HSES girls and 28% of LSES girls had height-for-age Z-scores <-2. Post-intervention, increase in height-for-age Z-scores adjusted for Tanner stage was significantly higher in the Ca+MZn+D group (0.32±0.06) than in the respective age-matched controls (C1 group) (-0.02±0.05) (p<0.05) as well as in both the Ca+D group (0.18±0.06) and the M+D group (0.14±0.04) (p<0.05). After adjusting for Tanner stage, height velocity was significantly higher for the Ca+MZn+D group (6.7±0.4 cm/year) than for the M+D group (6.1±0.2), Ca+D group (5.6±0.5) as well as age-matched controls (C1 group) (5.0±0.3) (p<0.05). Supplementation with calcium+vitamin D, zinc and multivitamins may be effective in improving stature in underprivileged Indian premenarchal girls.

Beneficial effect of iron pot cooking on iron status.

OBJECTIVES: To develop iron rich snacks using locally available iron rich foods and analyze their iron content when cooked in iron pots. Further, the efficacy of the developed snacks, cooked in iron pots was examined on the hemoglobin status of pre-school children through a three month randomized trial. METHODS: Four iron rich snacks (mean iron content 2.1mg/serving) were cooked in iron pots and 27 preschool children (mean age 2.9 ± 0.9 y, 12 boys) were supplemented with the snacks for 4 mo. Anthropometry and dietary intake data were collected. Hemoglobin, serum iron and transferrin saturation were assessed. RESULTS: An increase of 16.2 % in the iron content was found in the snacks cooked in iron pots than cooked in Teflon coated non-stick pots. After 4 mo of supplementation, a significant increase of 7.9 % was seen in the hemoglobin of the children. CONCLUSION: This pilot study demonstrated that iron rich recipes cooked in iron pot have a beneficial effect on iron status of children. Therefore, such food based strategies have the potential to alleviate iron deficiency anemia not only in children but also in other vulnerable sections of society like in pregnant women.

Vitamin D receptor gene polymorphisms and bone mass indices in post-menarchal Indian adolescent girls.

To study the association between vitamin D receptor (VDR) gene polymorphisms and bone mass indices in adolescent girls, a cross-sectional study was conducted in 120 post-menarchal girls aged 15-18 years in Pune city, India. Serum levels of ionised calcium, inorganic phosphorous, parathyroid hormone and 25-hydroxy vitamin-D were measured. Bone mineral content (BMC), bone area (BA) and bone mineral density (BMD) were measured at total body (TB), lumbar spine (LS) and left femoral neck (FN) using dual energy X-ray absorptiometry. Polymorphisms of the VDR gene at the Fok1 and Bsm1 loci were detected using SYBR Green quantitative polymerase chain reaction. The overall distribution of genotypes at the Bsm1 locus in this study was 33.3 % Bb, 29.2 % bb and 37.5 % BB while that for the Fok1 locus was 44.2 % Ff, 7.5 % ff and 48.3 % FF. There were no significant differences in the blood parameters when classified according to Bsm1 or Fok1 genotypes. Subjects with BB genotype have significantly higher mean TBBMC, TBBA, TBBMD and LSBMD than Bb and bb (p < 0.05) and showed a tendency for association with LSBMC and LSBA (p < 0.1). Subjects with Ff genotype showed a tendency for association with left FNBMC and FNBA (p < 0.1). Bsm1 genotype did not show an association with FN bone indices whereas Fok1 genotype did not show association with TB or LS bone indices. In conclusion, the present study demonstrates VDR gene polymorphism, defined by Bsm1 genotype, has an influence on total body and lumbar spine bone mass indices in post-menarchal Indian girls.

Enhanced effect of zinc and calcium supplementation on bone status in growth hormone-deficient children treated with growth hormone: a pilot randomized controlled trial.

Reduced bone mineral content in growth hormone-deficient children (GHD) has been reported. Calcium, zinc, and vitamin D play an important role in bone formation. Hence, the aim of this pilot randomized controlled study was to evaluate the effect of calcium, vitamin D, and zinc supplementation in prepubertal GHD children treated with GH on bone health parameters. After 1 year of treatment with GH (20 mg/m(2)/week), 31 GHD (mean age 8.7 ± 2.8 years, 18 boys) prepubertal children were randomised to receive calcium (500 mg/day) and vitamin D (60,000 IU/3 months) [Group A] or a similar supplement of calcium, vitamin D, and zinc (as per Indian Recommended Allowance) [Group B] along with GH therapy for the next 12 months. The two groups were similar in anthropometric and body composition parameters at baseline (p > 0.1). After 1 year of GH therapy, height-adjusted % gain was similar in both groups, 48 % in bone mineral content (BMC) and 45 % in bone area (BA). Height-adjusted % increase in BMC was significantly (p < 0.05) higher in the second year than in the first in both the groups. This % increase in BMC and BA was greater in Group B (51 and 36 % respectively) than in Group A (49 and 34 %), although marginally (p < 0.05). Supplementation of calcium and vitamin D along with GH therapy in GHD Indian children has the potential for enhancing bone mass accrual; this effect was further enhanced through the addition of zinc supplement.

School-based calcium-vitamin D with micronutrient supplementation enhances bone mass in underprivileged Indian premenarchal girls.

Low adult bone mass is linked to osteoporosis and fractures and is dependent on the extent of childhood and adolescent bone mineralization. The aim of the study was to investigate the effect of 1-year supplementation of calcium, multivitamin with zinc along with vitamin-D on bone mass accrual of school-going premenarchal girls from low income groups in Pune, India. Double-blind, matched-pair, cluster, randomization study was carried out in 214 premenarchal girls (8-12 years) from 2 schools in Pune, India. The two schools together formed 3 classes with 3 clusters each of age-matched girls of which one cluster was allocated to either one of the intervention groups (Ca-group:500 mg/d calcium, Ca+MZ-group:500 mg/d calcium+multivitamin tablet containing 15 mg/d zinc) or control group (C-group: multivitamin tablet without any minerals); all subjects received vitamin-D supplementation. Anthropometry, biochemical parameters, total body bone mineral content (TBBMC) and bone mineral density (TBBMD) (Dual energy X-ray absorptiometry) were assessed at baseline and endline. Post supplementation, mean percent increase in TBBMC was significantly higher in Ca-group (22.3%) and Ca+MZ-group (20.8%) compared to C-group (17.6%) (p<0.05) with no significant differences observed between Ca+MZ and Ca groups (p>0.1). Improvement in TBBMC-for-age Z-scores was higher in the two calcium supplemented groups (13.6%-22%) compared to the C-group (no improvement). Calcium supplementation, with or without multivitamins and zinc, showed a promising improvement in bone health especially with regards to improvement in bone related Z-scores in our population of underprivileged premenarchal girls.

Diet and exercise intervention, with special reference to micronutrients, reduces cardiometabolic risk in overweight children.

OBJECTIVE: To study the effect of lifestyle intervention in the presence of multivitamin-zinc supplementation in improving the cardiometabolic status of overweight children. MATERIALS AND METHODS: Data were evaluated in 74 overweight children (11.3 ± 2.9 years) randomly assigned to three groups of intervention for 4 months as follows: group A: diet-exercise counseling with multivitamin-zinc supplementation; group B: diet-exercise counseling; and group C: placebo. Anthropometric, biochemical, carotid arterial and lifestyle parameters were assessed. RESULTS: Lifestyle counseling resulted in significant reduction in inactivity, energy and fat intakes and increase in micronutrient density of diets and physical activity in groups A and B in comparison to group C. Percent decline in body fat was more in group A than in groups B and C. Percent change in triglycerides (-13.7%) was significantly higher in group A than in groups B (-5.9%) and C (5.7%). Pulse wave velocity and elasticity modulus reduced and arterial compliance improved significantly in group A than in group B. CONCLUSION: Multivitamin-zinc supplementation with lifestyle intervention has a positive effect of on the cardiometabolic status of overweight children.

Effect of zinc- and micronutrient-rich food supplements on zinc and vitamin A status of adolescent girls.

OBJECTIVES: The present study was aimed at assessing the effect of zinc- and micronutrient-rich food supplementation compared with ayurvedic zinc tablets on the blood levels of zinc and vitamin A in adolescent girls. METHODS: One hundred eighty apparently healthy schoolgirls (12.5 ± 0.85 y old) were recruited for a 10-wk intervention trial. They were randomized to three groups: one group received a food supplement that was prepared using zinc- and micronutrient-rich foods and by adopting food-processing methods that increase zinc bioavailability; the second group received ayurvedic zinc (Jasad) tablets as a natural elemental zinc supplement; and the third group served as the control without any supplementation. Diet was assessed by 24-h recall on 3 non-consecutive days. Fasting blood samples were analyzed for plasma levels of zinc, ß-carotene, retinol, vitamin C, and hemoglobin at baseline and the end of the study period. RESULTS: Food supplementation showed a significant increase in plasma levels of zinc (9.9%), ß-carotene (56.2%), and vitamin C (28.0%, P < 0.05) and a non-significant increase in hemoglobin (1.7%), although small, non-significant changes in blood micronutrient levels were observed in the control group (P > 0.1). Food supplementation decreased the prevalence of zinc deficiency (73% to 53.1%), ß-carotene deficiency (31.1% to 17.4%), and mild anemia (32.2% to 23.7%). Ayurvedic zinc supplementation significantly improved plasma zinc (61.3%) and plasma retinol (38.2%) and decreased the prevalence of zinc deficiency (73.7% to 36.2%) and vitamin A deficiency (65.4% to 20.4%, P < 0.05). CONCLUSION: Zinc- and micronutrient-rich food supplementation was effective in improving the zinc and vitamin A status of adolescent girls.

Calcium bioavailability from a fortified cereal-legume snack (laddoo).

OBJECTIVE: Calcium intakes in underprivileged Indian children are often low. Improving calcium intake fortification of indigenous foods may be a viable strategy. The aim of this study was to evaluate calcium absorption, as judged by an acute increase in serum ionized calcium concentration, after ingestion of a calcium-fortified cereal-legume snack (laddoo). METHODS: Three groups of eight children (8-12 y old) with low habitual dietary calcium intake were recruited for the study. After an overnight fast, a calcium-fortified (500 mg of calcium carbonate) cereal-legume snack (laddoo) was given to group A, a similar but non-fortified snack was given to group B, and group C received calcium carbonate (500 mg) alone. Serum concentrations of ionized calcium and intact parathyroid hormone were measured at 0, 1, 2, 3, 4, and 5 h. RESULTS: In group A, a peak of 6% above baseline was observed at 1 h in serum ionized calcium, whereas group C showed a peak of 5.5% at 4 h and group B showed a small increase of 1.8% at 1 h. The change in area under curve of groups A and C were of similar order (4.6 and 5.5, respectively), whereas that of group B was significantly lower (0.82). Serum parathyroid hormone was lowest at 2 h in groups A and B and at 3 h in group C. CONCLUSION: The fortified cereal-legume laddoo may act as a novel vehicle for increasing calcium intake in children.

Diet patterns of lactovegetarian adolescent girls: need for devising recipes with high zinc bioavailability.

OBJECTIVE: Populations subsisting on plant foods are believed to be at a high risk of mineral deficiencies. The aim of the present study was to examine the diet patterns of vegetarian adolescent girls for zinc adequacy and devise recipes to improve bioavailable zinc intakes. METHODS: A cross-sectional survey was carried out in 630 schoolgirls (10-16 y old) from Pune, India, from 2006 to 2007. Diet was assessed by a 24-h recall method on 3 random days. Diet patterns were identified by principal component analysis. Nutrient intakes were estimated using the cooked-foods database of our laboratory. Twenty recipes representing the diet patterns were formulated using foods that have a high zinc content and using methods such as sprouting/fermentation. In vitro zinc dialyzability of the recipes was determined by simulating gastrointestinal conditions and atomic absorption spectrometry. RESULTS: Five diet patterns were identified reflecting intakes of different cereals. Girls in the five diet patterns had inadequate intakes of energy, protein, and micronutrients including zinc compared with the recommended dietary intakes of India. In the new cereal-based recipes, the average contents of energy, protein, iron, calcium, zinc, beta-carotene, and vitamin C per 100g of cooked weight were 205 kcal, 6.2g, 2.5mg, 105 mg, 1.5mg, 716 microg, and 4.4 mg, respectively. Therefore, a supplement of 200 g of the recipe would fulfil 75% of the daily zinc requirement of adolescents and increase other micronutrient intake manifolds. CONCLUSION: Diets of Indian schoolgirls were deficient in zinc. Zinc-rich recipes with high bioavailability have the potential to alleviate zinc deficiency in adolescents.

Zinc supplementation improved cognitive performance and taste acuity in Indian adolescent girls.

OBJECTIVE: To test the efficacy of zinc supplementation through diet or ayurvedic zinc tablet on cognitive function and taste acuity in adolescent girls. METHODS: Using zinc-rich food items, snacks were prepared by adopting food-processing methods that enhance zinc bioavailability. Ayurvedic zinc tablet (jasad bhasma) was chosen as a natural elemental zinc supplement. Efficacy of snacks and the tablet was assessed in 180 schoolgirls (12.5 +/- 0.85 years) from Pune City, India, who were randomly allocated to any of the 3 groups: (1) ayurvedic zinc tablet-J, (2) zinc-rich snacks-D, or (3) Control-C. Supplementation was given on every school day (6 days/wk) for 10 weeks. All measurements were recorded at baseline and at the end of the study period. Food intake was recorded by 24-hour diet recall on 3 random days. Hemoglobin, serum ferritin, and plasma zinc were estimated on a fasting blood sample. Cognitive assessment was done on each participant using tests for simple reaction time (SRT), recognition reaction time (RRT), visual memory, and Raven's Progressive Matrices (RPM). Taste acuity was determined by recognition thresholds for salt (RTS) over a range of 10 different salt concentrations. RESULTS: A higher increase in plasma zinc (61.3%) was observed in the J group than in the D group (9.9%) (p < 0.01), whereas plasma zinc declined in the control group (-2.2%) over baseline (p > 0.1). Hemoglobin showed no change in all 3 groups (p > 0.1). Percent increment in scores for memory and RPM was significantly more in the D and J groups (24.5%-29.6%) than in the C group (6.5%) (p < 0.05). Mean SRT and RRT were reduced more in the D and J groups (5%-16%) than in the C group (1.6%) (p < 0.05). A significant fall in median RTS from 5 to 2.5 mmol/L was noted after both diet and zinc supplementation (p < 0.01); however, it remained the same at 5 mmol/L in the Control group after 10 weeks. CONCLUSION: Supplementation of ayurvedic zinc and zinc-rich foods are effective in improving cognitive performance and the recognition threshold for salt of adolescent girls.

GLV supplements increased plasma beta-carotene, vitamin C, zinc and hemoglobin in young healthy adults.

BACKGROUND: Green leafy vegetables (GLV) are rich sources of beta-carotene, iron and other micronutrients. Our in vitro studies have demonstrated good antioxidant potential in GLV. Moreover linkages of GLV intakes with plasma retinol and ascorbic acid were seen in apparently healthy Indians. AIM OF THE STUDY: To investigate the effect of GLV as a natural fortificant of multiple micronutrients through a prospective human trial. METHODS: Short-term (0-4 h) response (AUC) of single dose of 7.9 mg beta-carotene and 130 mg ascorbic acid through a spinach-carrot meal against the standard meal without GLV plus10 mg beta-carotene and 150 mg ascorbic acid tablets was studied in two groups of 4 young volunteers each. In the second trial of 3 weeks' supplementation, 5 groups of young adults (n = 40) were given either 100 g GLV/day alone or with tablets of vitamin E (100 mg/day), or C (100 mg/day) or more oil (5 g/day) or non-GLV meal with tablet of beta-carotene (10 mg/day). Hemoglobin (Hb), plasma beta-carotene, zinc, vitamin C, glucose, and triglycerides were measured. RESULTS: In a postprandial response, AUC were comparable in both GLV and standard meals for beta-carotene and ascorbic acid. In case of triglycerides and glucose AUC the GLV meal showed a better recovery to the baseline value after 4 hours than the standard meal. Three weeks' supplementation of GLV with more oil resulted in significant increase of plasma beta-carotene (51%) and Hb (9%). GLV with vitamin E showed a significant increase in plasma beta-carotene (40%), Hb (8%) and plasma vitamin C (6%). Supplementing beta-carotene without GLV significantly increased Hb (11%), plasma zinc (14%) in addition to beta-carotene. Multiple regression analyses weighted for energy intake indicated a significant association of percent increase in Hb with intakes of iron, riboflavin, folic acid, beta-carotene, copper, phytate and fiber (p < 0.01), percent change in plasma zinc with intakes of zinc, beta-carotene, vitamin C, riboflavin, copper, iron, and thiamin (p < 0.01), percent change in vitamin C with intakes of vitamin C, vitamin E, niacin, riboflavin, thiamin, beta-carotene, zinc, phytate and fiber (p < 0.05) and percent change in plasma beta-carotene with intakes of beta-carotene, thiamin, folic acid, zinc, phytate and tannins (p < 0.05). CONCLUSION: Using 100 g GLV/day with 10 g oil could be a single moderate strategy for supplementation of iron, beta-carotene, ascorbic acid and zinc.

Micronutrient deficiencies as predisposing factors for hypertension in lacto-vegetarian Indian adults.

OBJECTIVE: With the increasing knowledge about the antioxidant potential of many micronutrients such as zinc and vitamin C, their roles in oxidative stress related health disorders have been postulated. This study therefore investigated low micronutrient status as a predisposing factor for hypertension in a traditionally lacto-vegetarian population like Indians. METHODS: Micronutrient profile was assessed in 109 hypertensives with age-gender-socio-economic status matched 115 healthy normotensives (30-58 years of age). Food intakes were estimated through a semi-quantitative food frequency questionnaire. Nutrient intakes were then evaluated by previous estimates of cooked foods from our laboratory. Systolic and diastolic blood pressure (SBP, DBP), age, weight, height, waist and hip circumference, occupation, physical activity, smoking habits were recorded. Fasting blood samples were analyzed for hemoglobin, serum level of glucose, triglycerides, total cholesterol, HDL, ceruloplasmin, plasma level of ascorbic acid, folic acid, retinol, erythrocyte glutathione reductase activity coefficient (EGRAC) and erythrocyte membrane zinc. RESULTS: There were no significant differences between protein, fat intakes of normal and hypertensive individuals, though intakes of men were higher than those of women (p < 0.05). Intakes of omega-6 fatty acids were higher (p = 0.08) and omega-3 fatty acids were lower in hypertensive men than normotensive men (p = 0.04). Gender differences were also significant for micronutrient intakes except vitamin C and beta-carotene. Intakes of potassium, copper, folic acid and vitamin C were significantly lower in hypertensive individuals than in normotenisves. No significant association was found between occupation or activity level and hypertension (p > 0.2) in these subjects. Conditional logistic regression analysis indicated that intakes of vitamin C, folic acid and zinc were associated with 18% (OR = 1.18, 95% CI:1.08, 1.26), 51% (OR = 1.51, 95% CI 0.94, 2.1) higher odds for hypertension, and 3% lower odds for hypertension (OR = 0.97, 95% CI 0.92, 1.01), respectively. Mean plasma vitamin C and folic acid were significantly higher (p < 0.01), and serum ceruloplasmin and erythrocyte membrane zinc were marginally higher (p = 0.07) in normal than hypertensive subjects. In multivariate linear regression analyses, plasma vitamin C, serum ceruloplasmin and erythrocyte membrane zinc were negatively associated with SBP (p = 0.00001) and plasma vitamin C was negatively associated with DBP (p = 0.0001). CONCLUSION: Low dietary intakes of vitamin C, folic acid and zinc emerged as the possible risk factors for hypertension. Further, lower levels of plasma vitamin C, erythrocyte membrane zinc and ceruloplasmin were found to be the putative intermediary biomarkers in pathogenesis of hypertension.