Effect of Calcium and Vitamin D Supplementation (Dairy vs. Pharmacological) on Bone Health of Underprivileged Indian Children and Youth with Type-1 Diabetes: A Randomized Controlled Trial

IF 1.7 4区医学 Q4 ENDOCRINOLOGY & METABOLISM Journal of Clinical Densitometry Pub Date : 2024-01-26 DOI:10.1016/j.jocd.2024.101468

Anuradha Khadilkar , Chirantap Oza , Misha Antani , Nikhil Shah , Nikhil Lohiya , Vaman Khadilkar , Shital Bhor , Neha Kajale , Ketan Gondhalekar , Chidvilas More , Tarun Reddy Katapally , Zulf Mughal , Jasmin Bhawra , Raja Padidela

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Abstract

Background: Bone health is affected by chronic childhood disorders including type-1 diabetes mellitus (T1DM). We conducted this randomized controlled trial with the objective of investigating the effect of 1-year supplementation of vitamin-D with milk or with pharmacological calcium on bone mass accrual in underprivileged Indian children and youth with T1DM.

Methods: 5 to 23year old (n = 203) underprivileged children and youth with T1DM were allocated to one of three groups: Milk (group A-received 200 ml milk + 1000 international unit (IU) vitamin-D3/day), Calcium supplement (group B-received 500 mg of calcium carbonate + 1000 IU of vitamin-D3/day) or standard of care/control (group C). Anthropometry, clinical details, biochemistry, diet (3-day 24-h recall), physical activity (questionnaires adapted for Indian children) and bone health parameters (using dual-energy X-ray absorptiometry and peripheral quantitative computed tomography- DXA and pQCT respectively) were evaluated at enrolment and end of 12 month intervention.

Results: Total body less head(TBLH) bone mineral content (BMC(g)) and bone mineral density (BMD(gm/cm²)) were significantly higher at end of study in girls in both supplemented groups (TBLHBMC-A-1011.8 ± 307.8, B-983.2 ± 352.9, C-792.8 ± 346.8. TBLHBMD-A-± 0.2, B-0.8 ± 0.2, C-0.6 ± 0.2, p < 0.05). Z score of lumbar spine bone mineral apparent density of supplemented participants of both sexes was significantly higher than controls (Boys- A-0.7 ± 1.1, B-0.6 ± 1.4, C- −0.7 ± 1.1; Girls- A-1.1 ± 1.1, B-0.9 ± 3.4, C- −1.7 ± 1.3, p < 0.05). A significantly higher percentage increase was found in cortical thickness in girls in both supplemented groups (A-17.9 ± 28.6, B-15.3 ± 16.5, C-7.6 ± 26.2); the differences remained after adjusting for confounders.

Conclusion: Supplementation with milk or pharmacological calcium (+vitaminD3) improved bone outcomes–particularly geometry in children with T1DM with more pronounced effect in girls. Pharmacological calcium may be more cost effective in optimising bone health in T1DM in resource limited settings.

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钙和维生素 D 补充剂（乳制品与药物）对印度贫困儿童和 1 型糖尿病青少年骨骼健康的影响：随机对照试验

背景：骨骼健康受到包括 1 型糖尿病（T1DM）在内的儿童慢性疾病的影响。我们进行了这项随机对照试验，目的是研究用牛奶或药物钙补充维生素 D 1 年对印度贫困儿童和 T1DM 患者骨量增长的影响。方法：5 至 23 岁（n=203）贫困儿童和 T1DM 患者被分配到三组中的一组：牛奶组（A 组--每天摄入 200 毫升牛奶+1000 国际单位维生素-D3）、钙补充剂组（B 组--每天摄入 500 毫克碳酸钙+1000 国际单位维生素-D3）或标准护理/对照组（C 组）。在入学时和 12 个月干预结束时，对人体测量、临床细节、生物化学、饮食（3 天 24 小时回忆）、体力活动（针对印度儿童的问卷）和骨骼健康参数（分别使用双能 X 射线吸收测量法和外周定量计算机断层扫描--DXA 和 pQCT）进行了评估：结果：在研究结束时，补充营养素组和补充营养素组女孩的全身减去头部（TBLH）骨矿物质含量（BMC(g)）和骨矿物质密度（BMD(gm/cm2)）均明显高于补充营养素组（TBLHBMC-A-1011.8 ± 307.8，B-983.2 ± 352.9，C-792.8 ± 346.80.8，TBLHBMD-A-±307.8，B-983.2 ± 352.9，C-792.8 ± 346.80.8）。TBLHBMD-A-± 0.2，B-0.8± 0.2，C-0.6± 0.2，p<0.05）。补充营养的男女参与者的腰椎骨矿物质表观密度 Z 值明显高于对照组（男生- A-0.7 ± 1.1，B-0.6 ± 1.4，C- -0.7 ± 1.1；女生- A-1.1 ± 1.1，B-0.9 ± 3.4，C-1.7 ± 1.3，p<0.05）。两组女孩皮质厚度增加的百分比明显更高（A-17.9 ± 28.6，B-15.3 ± 16.5，C-7.6 ± 26.2）；调整混杂因素后，差异依然存在：结论：补充牛奶或药剂钙（+维生素D3）可改善骨骼状况，尤其是对患有 T1DM 的儿童的几何形状，对女孩的影响更为明显。在资源有限的情况下，药物钙在优化 T1DM 患者骨骼健康方面可能更具成本效益。

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来源期刊

Journal of Clinical Densitometry 医学-内分泌学与代谢

CiteScore

4.90

自引率

8.00%

发文量

审稿时长

90 days

期刊介绍： The Journal is committed to serving ISCD''s mission - the education of heterogenous physician specialties and technologists who are involved in the clinical assessment of skeletal health. The focus of JCD is bone mass measurement, including epidemiology of bone mass, how drugs and diseases alter bone mass, new techniques and quality assurance in bone mass imaging technologies, and bone mass health/economics. Combining high quality research and review articles with sound, practice-oriented advice, JCD meets the diverse diagnostic and management needs of radiologists, endocrinologists, nephrologists, rheumatologists, gynecologists, family physicians, internists, and technologists whose patients require diagnostic clinical densitometry for therapeutic management.