When it comes to better health, calcium and vitamin D are critical for musculoskeletal health. One of the main actions of Vitamin D is for the absorption of calcium.
While both calcium and vitamin D are important during the whole life cycle, starting from infancy to old age.
Deficiency of dual nutrients during growing years can result in rickets or osteomalacia.
A diet low in calcium & high in phytates, lack of fortification with vitamin D, genetic factors such as increased 25(OH) D-24-hydroxylase (this degrades 25(OH)D to inactive metabolites) are some of the reasons proposed for vitamin D deficiency in Indian children. A change in lifestyle with reduced sunlight exposure, lack of vitamin-rich nutrients increases the tendency for vitamin D deficiency. High amounts of phytates and oxalates in the diet hinders the calcium absorption. Also, the low calcium to phosphorus ratio in the Indian diet results in poor absorption of calcium.
How much calcium and vitamin D needs to be included?
- For prevention of rickets, 400 IU of vitamin D and 150-220 mg/kg of calcium, and in neonates, 400 IU of vitamin D and 200 mg of calcium daily is recommended.
- From 1-18 years, 400 IU and 600 IU vitamin D/day and 250-500 mg/day and 600-800 mg/day of calcium, respectively.
- Larger doses of vitamin D have been prescribed from 3 months to 18 years of age as 60,000 IU/week for 6 weeks.
- Age-appropriate doses of calcium and vitamin D have been advised for maintenance post-therapy. Calcium carbonate contains the highest amount of elemental calcium (40%) compared to other forms (gluconate, citrate).
What to eat for maintaining vitamin D & calcium in the body?
- Including vitamin D fortified milk products is a good option to get both the nutrients in the required amount.
- Vitamin D3 (cholecalciferol) supplements have been reported to have greater efficacy in raising 25(OH)D concentrations.
- Natural sources of vitamin D are pasteurised eggs, certain mushrooms and seafood.
- Calcium-rich foods are paneer, curd, milk and other non-dairy sources like ragi, sesame seeds, lotus seeds.
Reference
Khadilkar, A., Khadilkar, V., Chinnappa, J., Rathi, N., Khadgawat, R., Balasubramanian, S., Parekh, B., & Jog, P. (2017). Prevention and Treatment of Vitamin D and Calcium Deficiency in Children and Adolescents: Indian Academy of Pediatrics (IAP) Guidelines. Indian pediatrics, 54(7), 567–573. https://doi.org/10.1007/s13312-017-1070-x