Francesca L Crowe1,2, M Zulf Mughal3,2, Zabihullah Maroof4,5, Jacqueline Berry6, Musa Kaleem7, Sravya Abburu8, Gijs Walraven9, Mohammad I Masher10, Daniel Chandramohan4, Semira Manaseki-Holland11,5. 1. Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom. 2. Contributed equally as co-first authors. 3. Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, United Kingdom. 4. Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom. 5. Aga Khan Health Service, Kabul, Afghanistan. 6. Endocrinology and Diabetes Research Group, Institute of Human Development, University of Manchester, Manchester, United Kingdom. 7. Department of Radiology, Alder Hey Children's Hospital, Liverpool, United Kingdom. 8. Department of Obstetrics and Gynaecology, New Cross Hospital, Wolverhampton, United Kingdom. 9. Aga Khan Development Network, Geneva, Switzerland; and. 10. Department of Pediatrics, Kabul Medical University, Kabul, Afghanistan. 11. Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom; s.manasekiholland@bham.ac.uk.
Abstract
BACKGROUND AND OBJECTIVES:Vitamin D is essential for healthy development of bones, but little is known about the effects of supplementation in young stunted children. Our objective was to assess the effect of vitamin D supplementation on risk of rickets and linear growth among Afghan children. METHODS: In this double-blind, placebo-controlled trial, 3046 children ages 1 to 11 months from inner-city Kabul were randomly assigned to receive oral vitamin D3 (100 000 IU) or placebo every 3 months for 18 months. Rickets Severity Score was calculated by using wrist and knee radiographs for 631 randomly selected infants at 18 months, and rickets was defined as a score >1.5. Weight and length were measured at baseline and 18 months by using standard techniques, and z scores were calculated. RESULTS: Mean (95% confidence interval [CI]) serum 25-hydroxyvitamin D (seasonally corrected) and dietary calcium intake were insufficient at 37 (35-39) nmol/L and 372 (327-418) mg/day, respectively. Prevalence of rickets was 5.5% (placebo) and 5.3% (vitamin D): odds ratio 0.96 (95% CI: 0.48 to 1.92); P = .9. The mean difference in height-for-age z score was 0.05 (95% CI: -0.05 to 0.15), P = .3, although the effect of vitamin D was greater for those consuming >300 mg/day of dietary calcium (0.14 [95% CI: 0 to 0.29]; P = .05). There were no between-group differences in weight-for-age or weight-for-height z scores. CONCLUSIONS: Except in those with higher calcium intake, vitamin D supplementation had no effect on rickets or growth.
RCT Entities:
BACKGROUND AND OBJECTIVES:Vitamin D is essential for healthy development of bones, but little is known about the effects of supplementation in young stunted children. Our objective was to assess the effect of vitamin D supplementation on risk of rickets and linear growth among Afghan children. METHODS: In this double-blind, placebo-controlled trial, 3046 children ages 1 to 11 months from inner-city Kabul were randomly assigned to receive oral vitamin D3 (100 000 IU) or placebo every 3 months for 18 months. Rickets Severity Score was calculated by using wrist and knee radiographs for 631 randomly selected infants at 18 months, and rickets was defined as a score >1.5. Weight and length were measured at baseline and 18 months by using standard techniques, and z scores were calculated. RESULTS: Mean (95% confidence interval [CI]) serum 25-hydroxyvitamin D (seasonally corrected) and dietary calcium intake were insufficient at 37 (35-39) nmol/L and 372 (327-418) mg/day, respectively. Prevalence of rickets was 5.5% (placebo) and 5.3% (vitamin D): odds ratio 0.96 (95% CI: 0.48 to 1.92); P = .9. The mean difference in height-for-age z score was 0.05 (95% CI: -0.05 to 0.15), P = .3, although the effect of vitamin D was greater for those consuming >300 mg/day of dietary calcium (0.14 [95% CI: 0 to 0.29]; P = .05). There were no between-group differences in weight-for-age or weight-for-height z scores. CONCLUSIONS: Except in those with higher calcium intake, vitamin D supplementation had no effect on rickets or growth.
Authors: George Griffin; Martin Hewison; Julian Hopkin; Rose Anne Kenny; Richard Quinton; Jonathan Rhodes; Sreedhar Subramanian; David Thickett Journal: Clin Med (Lond) Date: 2021-02-16 Impact factor: 2.659
Authors: Sreedhar Subramanian; George Griffin; Martin Hewison; Julian Hopkin; Rose Anne Kenny; Eamon Laird; Richard Quinton; David Thickett; Jonathan M Rhodes Journal: J Intern Med Date: 2022-07-15 Impact factor: 13.068