Osteoporosis International

, Volume 24, Issue 8, pp 2335–2343 | Cite as

Impact of vitamin D fortified milk supplementation on vitamin D status of healthy school children aged 10–14 years

  • R. Khadgawat
  • R. K. Marwaha
  • M. K. Garg
  • R. Ramot
  • A. K. Oberoi
  • V. Sreenivas
  • M. Gahlot
  • N. Mehan
  • P. Mathur
  • N. Gupta
Original Article



Vitamin D deficiency is a major public health problem, needing immediate attention. We studied the effect of vitamin D fortification of milk in school children. Our results show that fortification of milk is safe and effective strategy to deal with widespread vitamin D deficiency.


Vitamin D deficiency among school children and adolescents is a well-documented major public health problem, needing immediate attention. To assess the effect of vitamin D fortified milk on serum 25 hydroxy vitamin D [S.25(OH)D] levels, we carried out a prospective double-blind randomized control trial in apparently healthy school children, aged 10–14 years.


Of 776 subjects recruited out of 796 who consented, 713 (boys-300; girls-413) completed the study. Subjects were randomized into three groups. Group A (n = 237) received 200 ml of unfortified milk per day while group B (n = 243) and group C (n = 233) received 200 ml of milk fortified with 600 IU (15 μg) and 1,000 IU (25 μg) of vitamin D per day for 12 weeks. Serum calcium, phosphate, alkaline phosphatase, S.25(OH)D, and urinary calcium/creatinine ratio were estimated at baseline and after supplementation.


Hypovitaminosis D [25(OH)D < 20 ng/ml] was observed in 92.3 % subjects with mean S.25(OH)D level of 11.69 ± 5.36 ng/ml. There was no significant difference in S.25(OH)D levels among the three groups at baseline. The mean percentage change in S.25(OH)D level in groups B (137.97 %) and C (177.29 %.) were significantly greater than group A (−5.25 %). The percentage of subjects having S.25(OH)D levels >20 ng/ml following supplementation were 5.9 % in group A, 69.95 % in group B, and 81.11 % in group C in comparison to 6.32 %, 4.9 % and 12 %, respectively, at baseline.


Fortification of milk with vitamin D is an effective and safe strategy in improving S.25(OH)D levels in children aged 10–14 years.


Children Milk fortification Vitamin D deficiency 



We are grateful to Mr. D H PaiPanandiker, chairman and Ms RekhaSinha, CEO, International Life Sciences Institute (India), and Wg Cdr (Dr) Anjali Gautam for their administrative and tactical support. We also acknowledge help rendered by Gopaljee Dairy Foods Pvt.Ltd., New Delhi in production of fortified milk. We are also thankful to Ms Pamela Marwaha for supervision of the project.

We highly appreciate the support of the school authorities, staff, parents, and the children for their active participation. We would like to put on record our appreciation for the help rendered by Ms Nazmeen, Mr. Anthresh Back, Ms. Anjani Bakshi, and Ms. Pinky Kaushik in successful completion of the project.

Financial support

This project was funded by DSM Nutritional Products India Pvt Ltd. Vitamin D3 for fortification was provided by them.

Conflicts of interest

The authors have nothing to disclose.


  1. 1.
    Holick MF (2012) Evidence-based D-bate on health benefits of vitamin D revisited. Dermatoendocrino l4:183–190CrossRefGoogle Scholar
  2. 2.
    Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM (2012) Guidelines for preventing and treating vitamin D deficiency and insufficiency revisited. J Clin Endocrinol Metab 97:1153–1158PubMedCrossRefGoogle Scholar
  3. 3.
    Holick MF (2012) Nutrition: D-iabetes and D-eath D-efying vitamin D. Nat Rev Endocrinol 8:388–390PubMedCrossRefGoogle Scholar
  4. 4.
    Holick MF (2008) The vitamin D deficiency pandemic and consequences for nonskeletal health: mechanisms of action. Mol Asp Med 29:361–368CrossRefGoogle Scholar
  5. 5.
    Marwaha RK, Goswami R (2010) Vitamin D deficiency and its health consequences in India. In: Holick MF (ed) Vitamin D: physiology, molecular biology, and clinical applications, 2nd edn. Humana Press, New York, pp 529–542CrossRefGoogle Scholar
  6. 6.
    Black LJ, Seamans KM, Cashman KD, Kiely M (2012) An updated systematic review and meta-analysis of the efficacy of vitamin D food fortification. J Nutr 142:1102–1108PubMedCrossRefGoogle Scholar
  7. 7.
    Marwaha RK, Tandon N, Agarwal N, Puri S, Agarwal R, Singh S, Mani K (2010) Impact of two regimens of vitamin D supplementation on calcium—vitamin D—PTH axis of schoolgirls of Delhi. Indian Pediatr 47:761–769PubMedCrossRefGoogle Scholar
  8. 8.
    Marshall WA, Tanner JM (1969) Variations in the pattern of pubertal changes in girls. Arch Dis Child 44:291–303PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Marshall WA, Tanner JM (1970) Variations in the pattern of pubertal changes in boys. Arch Dis Child 45:13–23PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Marwaha RK, Khadgawat R, Tandon N, Kanwar R, Narang A, Sastry A, Bhadra K, Kalaivani M (2010) Reference intervals of serum calcium, ionized calcium, phosphate and alkaline phosphatase in healthy Indian school children and adolescents. Clin Biochem 43:1216–1219PubMedCrossRefGoogle Scholar
  11. 11.
    Metz MP (2006) Determining urinary calcium/creatinine cut-offs for the paediatric population using published data. Ann Clin Biochem 43:398–401PubMedCrossRefGoogle Scholar
  12. 12.
    Lips P (2001) Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 22:477–501PubMedCrossRefGoogle Scholar
  13. 13.
    Puri S, Marwaha RK, Agarwal N, Tandon N, Agarwal R, Grewal K, Reddy DH, Singh S (2008) Vitamin D status of apparently healthy schoolgirls from two different socioeconomic strata in Delhi: relation to nutrition and lifestyle. Br J Nutr 99:876–882PubMedCrossRefGoogle Scholar
  14. 14.
    Andıran N, Çelik N, Akça H, Doğan G (2012) Vitamin D deficiency in children and adolescents. J Clin Res Pediatr Endocrinol 4:25–29PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Hatun S, Islam O, Cizmecioglu F, Kara B, Babaoglu K, Berk F, Gökalp AS (2005) Subclinical vitamin D deficiency is increased in adolescent girls who wear concealing clothing. J Nutr 135:218–222PubMedGoogle Scholar
  16. 16.
    Gordon CM, DePeter KC, Feldman HA, Grace E, Emans SJ (2004) Prevalence of vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med 158:531–537PubMedCrossRefGoogle Scholar
  17. 17.
    Rajakumar K, Fernstrom JD, Janosky JE, Greenspan SL (2005) Vitamin D insufficiency in preadolescent African-American children. Clin Pediatr (Phila) 44:683–692CrossRefGoogle Scholar
  18. 18.
    El-Hajj Fuleihan G, Nabulsi M, Choucair M, Salamoun M, Hajj Shahine C, Kizirian A, Tannous R (2001) Hypovitaminosis D in healthy schoolchildren. Pediatrics 107:E53PubMedCrossRefGoogle Scholar
  19. 19.
    Marwaha RK, Tandon N, Reddy DR, Aggarwal R, Singh R, Sawhney RC, Saluja B, Ganie MA, Singh S (2005) Vitamin D and bone mineral density status of healthy schoolchildren in northern India. Am J Clin Nutr 82:477–482PubMedGoogle Scholar
  20. 20.
    Ala-Houhala M, Parviainen MT, Pyykkö K, Visakorpi JK (1984) Serum 25-hydroxyvitamin D levels in Finnish children aged 2 to 17 years. Acta Paediatr Scand 73:232–236PubMedCrossRefGoogle Scholar
  21. 21.
    Du X, Greenfield H, Fraser DR, Ge K, Trube A, Wang Y (2001) Vitamin D deficiency and associated factors in adolescent girls in Beijing. Am J Clin Nutr 74:494–500PubMedGoogle Scholar
  22. 22.
    Lehtonen-Veromaa M, Möttönen T, Irjala K, Kärkkäinen M, Lamberg-Allardt C, Hakola P, Viikari J (1999) Vitamin D intake is low and hypovitaminosis D common in healthy 9- to 15-year-old Finnish girls. Eur J Clin Nutr 53:746–751PubMedCrossRefGoogle Scholar
  23. 23.
    Lamberg-Allardt C (2006) Vitamin D in foods and as supplements. Prog Biophys Mol Biol 9:33–38CrossRefGoogle Scholar
  24. 24.
    Calvo MS, Whiting SJ, Barton CN (2005) Vitamin D intake: a global perspective of current status. J Nutr 135:310–316PubMedGoogle Scholar
  25. 25.
    Maalouf J, Nabulsi M, Vieth R, Kimball S, El-Rassi R, Mahfoud Z, El-Hajj Fuleihan G (2008) Short- and long-term safety of weekly high-dose vitamin D3 supplementation in school children. J Clin Endocrinol Metab 93:2693–2701PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Viljakainen HT, Natri AM, Kärkkäinen M, Huttunen MM, Palssa A, Jakobsen J, Cashman KD, Mølgaard C, Lamberg-Allardt C (2006) A positive dose–response effect of vitamin D supplementation on site-specific bone mineral augmentation in adolescent girls: a double-blinded randomized placebo-controlled 1-year intervention. J Bone Miner Res 21:836–844PubMedCrossRefGoogle Scholar
  27. 27.
    Moore CE, Murphy MM, Holick MF (2005) Vitamin D intakes by children and adults in the United States differ among ethnic groups. J Nutr 135:2478–2485PubMedGoogle Scholar
  28. 28.
    Zhu K, Zhang Q, Foo LH, Trube A, Ma G, Hu X, Du X, Cowell CT, Fraser DR, Greenfield H (2006) Growth, bone mass, and vitamin D status of Chinese adolescent girls 3 y after withdrawal of milk supplementation. Am J Clin Nutr 83:714–721PubMedGoogle Scholar
  29. 29.
    Piirainen T, Laitinen K, Isolauri E (2007) Impact of national fortification of fluid milks and margarines with vitamin D on dietary intake and serum 25-hydroxyvitamin D concentration in 4-year-old children. Eur J Clin Nutr 61:123–128PubMedCrossRefGoogle Scholar
  30. 30.
    Lehtonen-Veromaa M, Möttönen T, Leino A, Heinonen OJ, Rautava E, Viikari J (2007) Prospective study on food fortification with vitamin D among adolescent females in Finland: minor effects. Br J Nutr 100:418–423Google Scholar
  31. 31.
    El-Hajj Fuleihan G, Nabulsi M, Tamim H, Maalouf J, Salamoun M, Khalife H, Choucair M, Arabi A, Vieth R (2006) Effect of vitamin D replacement on musculoskeletal parameters in school children: a randomized controlled trial. J Clin Endocrinol Metab 91:405–412PubMedCrossRefGoogle Scholar
  32. 32.
    O’Mahony L, Stepien M, Gibney MJ, Nugent AP, Brennan L (2011) The potential role of vitamin D enhanced foods in improving vitamin D status. Nutrients 3:1023–1041PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    IUF Dairy Industry Research – Indian Industry Research—; Accessed 22nd October, 2012

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2013

Authors and Affiliations

  • R. Khadgawat
    • 1
  • R. K. Marwaha
    • 2
  • M. K. Garg
    • 3
  • R. Ramot
    • 1
  • A. K. Oberoi
    • 1
  • V. Sreenivas
    • 4
  • M. Gahlot
    • 5
  • N. Mehan
    • 6
  • P. Mathur
    • 7
  • N. Gupta
    • 1
  1. 1.Department of Endocrinology, All India Institute of Medical SciencesNew DelhiIndia
  2. 2.International Life Sciences Institute (ILSI)Gautam NagarIndia
  3. 3.Department of EndocrinologyArmy Hospital (Research & Referral)DelhiIndia
  4. 4.Department of Biostatistics, All India Institute of Medical SciencesNew DelhiIndia
  5. 5.Department of Dietitics, All India Institute of Medical SciencesNew DelhiIndia
  6. 6.Department of Medicine, Sur Homeopathy Medical CollegeDelhiIndia
  7. 7.Department of Lab Medicine, Trauma Center, All India Institute of Medical SciencesNew DelhiIndia

Personalised recommendations