Vitamin D Supplementation in Children: Indian Perspectives

  • Anuradha V. KhadilkarEmail author
  • Shashi A. Chiplonkar
Part of the Nutrition and Health book series (NH)


The crucial role played by vitamin D in musculoskeletal development is very well recognized. In infants and toddlers poor vitamin D status may lead to rickets while in children and adolescents it affects the acquisition of peak bone mass. Maternal vitamin D status has been shown to have a significant positive effect on neonatal bone status, and this effect appears to track up to the prepubescent period [1]. There is also a growing body of evidence which links vitamin D to various nonskeletal disorders including autoimmune disorders (Crohn’s disease, multiple sclerosis, rheumatoid arthritis, and type 1 diabetes), infections, and risk of developing cancers. However, in this chapter, the discussions on vitamin D supplementation mainly focus on its role for the improvement of childhood bone health [2].


Vitamin D India Sun-rich Deficiency Supplementation 



25-Hydroxyvitamin D


Parathyroid hormone


International unit




Vitamin D receptor


  1. 1.
    Viljakainen HT, Saarnio E, Hytinantti T, et al. Maternal vitamin D status determines bone variables in the newborn. J Clin Endocrinol Metab. 2010;95:1749–57.PubMedCrossRefGoogle Scholar
  2. 2.
    Holick MF. Vitamin D, deficiency. N Engl J Med. 2007;357:266–81.PubMedCrossRefGoogle Scholar
  3. 3.
    Khadilkar A, Das G, Sayyad M, Sanwalka N, Bhandari D, Khadilkar V, et al. Low calcium intake and hypovitaminosis D in adolescent girls. Arch Dis Child. 2007;92:1045.PubMedCrossRefGoogle Scholar
  4. 4.
    Sahu M, Bhatia V, Aggarwal A, Rawat V, Saxena P, Pandey A, et al. Vitamin D deficiency in rural girls and pregnant women despite abundant sunshine in northern India. Clin Endocrinol (Oxf). 2009;70:680–4.CrossRefGoogle Scholar
  5. 5.
    Sachan A, Gupta R, Das V, Agarwal A, Awasthi PK, Bhatia V. High prevalence of vitamin D deficiency among pregnant women and their newborns in northern India. Am J Clin Nutr. 2005;81:1060–4.PubMedGoogle Scholar
  6. 6.
    Harinarayan CV, Ramalakshmi T, Prasad UV, Sudhakar D. Vitamin D status in Andhra Pradesh: a population based study. Indian J Med Res. 2008;127:211–8.PubMedGoogle Scholar
  7. 7.
    Marwaha RK, Tandon N, Agarwal N, Puri S, Agarwal R, Singh S, et al. Impact of two regimens of vitamin D supplementation on calcium—vitamin D—PTH axis of schoolgirls of Delhi. Indian Pediatr. 2010;47:761–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Ekbote VH, Khadilkar AV, Mughal MZ, Hanumante N, Sanwalka N, Khadilkar VV, et al. Role of Sunlight Exposure in Development of Rickets in Hypocalcaemic Indian Toddlers. Indian J Pediatr. 2010;77:61–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Khadilkar AV. Vitamin D, deficiency in Indian adolescents. Indian Pediatr. 2010;47:755–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Awumey EM, Mitra DA, Hollis BW, Kumar R, Bell NH. Vitamin D metabolism is altered in Asian Indians in the southern United States: a clinical research center study. J Clin Endocrinol Metab. 1998;83:169–73.PubMedCrossRefGoogle Scholar
  11. 11.
    Fu L, Yun F, Oczak M, Wong BY, Vieth R, Cole DE. Common genetic variants of the vitamin D binding protein (DBP) predict differences in response of serum 25-hydroxyvitamin D [25(OH)D] to vitamin D supplementation. Clin Biochem. 2009;42:1174–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Khadilkar A, Mughal MZ, Hanumante N, Sayyad M, Sanwalka N, Naik S, et al. Oral calcium supplementation reverses the biochemical pattern of parathyroid hormone resistance in underprivileged Indian toddlers. Arch Dis Child. 2009;94:932–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Sanwalka NJ, Khadilkar AV, Mughal MZ, Sayyad MG, Khadilkar VV, Shirole SC, et al. A study of calcium intake and sources of calcium in adolescent boys and girls from two socioeconomic strata, in Pune. Asia Pac J Clin Nutr. 2010;19:324–9.PubMedGoogle Scholar
  14. 14.
    Calvo MS, Kumar R, Heath HM. Persistently elevated parathyroid hormone secretion and action in young women after four weeks of ingesting high phosphorus low calcium diets. J Clin Endocrinol Metab. 1990;70:1334–40.PubMedCrossRefGoogle Scholar
  15. 15.
    Narasinga Rao BS, Sivakumar B. Nutrient requirements and recommended dietary allowances. In: Bamji MS, Krishnaswamy K, Brahmam GNV editors. Textbook of Human Nutrition, 3rd Edition. New Delhi: Oxford & IBH publishing Co.Pvt. Ltd.; 2009. pp. 154–78.Google Scholar
  16. 16.
    Gopalan C, Ramasastri BB, Balasubramanyam SC. Nutritive value of Indian food. Hyderabad: National Institute of Nutrition/Nutritive value of Indian Food; 1998.Google Scholar
  17. 17.
    NIN Annual Report, 1991.Google Scholar
  18. 18.
    Marwaha RK, Tandon N, Chopra S, Agarwal N, Garg MK, Sharma B, et al. Vitamin D status in pregnant Indian women across trimesters and different seasons and its correlation with neonatal serum 25-hydroxyvitamin D levels. Br J Nutr. 2011;31:1–7.Google Scholar
  19. 19.
    Hollis BW, Wagner CL. Vitamin D requirements during lactation: high-dose maternal supplementation as therapy to prevent hypovitaminosis D for both the mother and the nursing infant. Am J Clin Nutr. 2004;80(6 Suppl):1752S–8.PubMedGoogle Scholar
  20. 20.
    Balasubramanian S. Vitamin D, deficiency in breastfed infants & the need for routine vitamin D supplementation. Indian J Med Res. 2011;133:250–2.PubMedGoogle Scholar
  21. 21.
    Wagner CL, Greer FR. American Academy of Pediatrics Section on Breastfeeding; American Academy of Pediatrics Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics. 2008;122:1142–52.PubMedCrossRefGoogle Scholar
  22. 22.
    Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:1911–30.PubMedCrossRefGoogle Scholar
  23. 23.
    Wagner CL, Hulsey TC, Fanning D, Ebeling M, Hollis BW. High-dose vitamin D3 supplementation in a cohort of breastfeeding mothers and their infants: a 6-month follow-up pilot study. Breastfeed Med. 2006;1(2):59–70.PubMedCrossRefGoogle Scholar
  24. 24.
    Kim MJ, Na B, No SJ, Han HS, Jeong EH, Lee W, et al. Nutritional status of vitamin D and the effect of vitamin D supplementation in Korean breast-fed infants. J Korean Med Sci. 2010;25:83–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Madar AA, Klepp KI, Meyer HE. Effect of free vitamin D(2) drops on serum 25-hydroxyvitamin D in infants with immigrant origin: a cluster randomized controlled trial. Eur J Clin Nutr. 2009;63(4):478–84.PubMedCrossRefGoogle Scholar
  26. 26.
    Kumar GT, Sachdev HS, Chellani H, Rehman AM, Singh V, Arora H, et al. Effect of weekly vitamin D supplements on mortality, morbidity, and growth of low birthweight term infants in India up to age 6 months: randomised controlled trial. BMJ. 2011;342:d2975. doi: 10.1136/bmj.d2975.PubMedCrossRefGoogle Scholar
  27. 27.
    Ekbote VH, Khadilkar AV, Chiplonkar SA, Hanumante NM, Khadilkar VV, Mughal MZ. A pilot randomized controlled trial of oral calcium and vitamin D supplementation using fortified laddoos in underprivileged Indian toddlers. Eur J Clin Nutr. 2011;65(4):440–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Puri S, Marwaha RK, Agarwal N, Tandon N, Agarwal R, Grewal K, et al. Vitamin D status of apparently healthy schoolgirls from two different socioeconomic strata in Delhi: relation to nutrition and lifestyle. Br J Nutr. 2008;99:876–82.PubMedCrossRefGoogle Scholar
  29. 29.
    Khadilkar AV, Sayyad MG, Sanwalka NJ, Bhandari DR, Naik S, Khadilkar VV, et al. Vitamin D supplementation and bone mass accrual in underprivileged adolescent Indian girls. Asia Pac J Clin Nutr. 2010;19:465–72.PubMedGoogle Scholar
  30. 30.
    El-Hajj Fuleihan G, Nabulsi M, Tamim H, Maalouf J, Salamoun M, Khalife H, et al. Effect of vitamin D replacement on musculoskeletal parameters in school children: a randomized controlled trial. J Clin Endocrinol Metab. 2006;91:405–12.PubMedCrossRefGoogle Scholar
  31. 31.
    Mølgaard C, Larnkjaer A, Cashman KD, Lamberg-Allardt C, Jakobsen J, Michaelsen KF. Does vitamin D supplementation of healthy Danish Caucasian girls affect bone turnover and bone mineralization? Bone. 2010;46:432–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Abrams SA. Calcium and vitamin D requirements for optimal bone mass during adolescence. Curr Opin Clin Nutr Metab Care. 2011;14(6):605–9. doi: 10.1097/MCO.0b013e32834b2b01.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Growth and Endocrine DepartmentHirabai Cowasji Jehangir Medical Research Institute, Jehangir HospitalPuneIndia
  2. 2.Hirabai Cowasji Jehangir Medical Research Institute, Jehangir HospitalPuneIndia

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