High prevalence of low dietary calcium and low vitamin D status in healthy south Indians

Calcium and vitamin D under nutrition can adversely affect the bone mineral metabolism. There is no population-based study from India documenting dietary habits, serum calcium and vitamin D levels. Our study investigated the dietary habits of rural and urban societies in and around Tirupati and their relationship with serum calcium, phosphorous and vitamin D [25(OH)D] levels. Four hundred and seven subjects from 5 villages around Tirupati, (rural population) and 125 asymptomatic staff of our hospital (urban population) were studied. Dietary intakes of calcium, phosphorous and phytates were documented by diet history. Serum calcium, phosphorus and 25 (OH) D levels were estimated in 191 rural subjects and 125 urban subjects. Compared to urban subjects, rural subjects had a significantly lower intake of dietary calcium (P <0.0001) and a significantly higher dietary phytate/calcium ratio and serum calcium and 25 (OH) D levels (P <0.0001). Dietary calcium intake was inadequate in both rural and urban subjects compared to the recommended daily allowances (RDA) for our country. About 31% of the population had normal vitamin D levels, 54% had vitamin D insufficiency and 15% vitamin D deficiency. About two-thirds of the population had low levels of vitamin D. Inadequate dietary calcium intake associated with high phytate/calcium ratio reduces the bioavailable calcium in the gut. Hence, there is a need to fortify food with calcium and to propose new guidelines for 25 (OH) D in Indian subjects. Multicentric studies with large sample populations are required to generate normal standards and nationally relevant guidelines.