We need sensible vitamin D and calcium supplementation recommendations!

• Calcium and vitamin D deficiency diseases constitute examples of short and long latency diseases, although, at different levels, the same fundamental physiological mechanisms operate.
• The dietary requirements of these nutrients are pegged to the prevention of the index diseases named osteoporosis and rickets/osteomalacia. (Diet <50 mg calcium/100 kcal results in osteoporosis (Nat Acad Sci).
• Normal 25(OH)D levels are important for fully normal calcium absorption efficiency in the gut.
• Low vitamin D status and low dietary calcium intake may have certain implications:
  • In the prevalence of hypovitaminosis D that may be overlooked
  • Further amplification of associated secondary hyperparathyroidism
  • Modified clinical presentation of several diseases
  • Early osteoporosis could co-exist with osteoporosis
  • Severe and complicated effect of environmental toxins like fluoride on bone mineral metabolism
  • Vitamin D and calcium supplementation for osteoporosis.
• The ICMR committee believed that the recommendations by international agencies regarding vitamin D fortification and supplementation pertain to populations in developed countries where exposure to sunlight is limited.
• Based on the clinical experience and available data, an estimated 25 million may be affected by osteoporosis.
• In India, the dietary calcium + vitamin D deficiency leads to rickets and/or osteomalacia in children and adolescents; in adults, they lead to osteomalacia.
• Strategies to improve the awareness of diet diversification for the lower socioeconomic population should include a balanced diet with cereal containing more calcium with less phytate content.
• Strengthening cereal intake and encouraging dairy products goes a long way in addressing the problem of dietary calcium deficiency in India.
• Biofortification:
  • Requires minimal intervention, is highly sustainable once it is introduced
  • Well-suited for the daily diet of the low-income populations using large staple foods
  • Can benefit a large population.