• Ikhlaq Ahmad
  • Sadia Fatima
  • Muhammad Waqas Luqman
  • Rubina Nazli
  • Syed Hamid Habib
  • Inayat Shah Khyber Medical University




Vitamin D; Vitamin D deficiency; Lipid-Based Supplement; Placebo


Background: Under-nutrition is a major public health problem worldwide. Several studies have documented the effects of vitamin D and calcium supplements in healthy children and in children with bone abnormalities but the effects of multiple micronutrients supplementation in underweight children is limited in literature. Methods: In this randomized controlled trial 38 participants were recruited and divided into two groups of 19 subjects. On the first day of experimental trial, in fasting state 5cc blood samples were collected from all subjects followed by their anthropometric measurements, and serum levels of calcium and vitamin D. All subjects of one group were given Lipid-based nutritional supplement (LNS) and whereas the other group was given the placebo. After one month of compliance the same measurements were repeated and compared. Results: After one month of supplementation mid-upper arm circumference (p=0.005), weight (p<0.001), height (p=0.000), and BMI-Z score (p=0.002) the energy intake (P<0.001), were significantly increased in LNS as compared to Placebo. However, no improvement was observed in the plasma vitamin D (p=0.44) and calcium levels (p=0.46) of underweight children in both groups. Conclusion: Multi micronutrient supplementations are effective in improving anthropometry in the short duration of time. They also improve the energy intake of underweight children. However, no improvement is observed in levels of vitamin D and calcium in LNS group even after a one-month use.


Ahsan T, Rahman M, Ramatullah M, Ahsan M, Khan MNI, Islam SN. Multiple micronutrient (zinc, magnesium) therapy to severe malnourished children: effect on growth catch up and clinical recovery. Eur Sci J 2013;9(30):103–15.

Ingutia RA, Islam KZ, Hossain MM, Ingutia R. Analysis of the relation between rural poverty, malnutrition and hunger, and the interlinks with agricultural production growth and productivity growth with special reference to Mozambique and Bangladesh. 2009.

Park SE, Kim S, Ouma C, Loha M, Wierzba TF, Beck NS. Community management of acute malnutrition in the developing world. Pediatr Gastroenterol Hepatol Nutr 2012;15(4):210–9.

Srivastava A, Mahmood SE, Srivastava PM, Shrotriya VP, Kumar B. Nutritional status of school-age children-A scenario of urban slums in India. Arch Public Health 2012;70(1):8.

Rahman A, Chowdhury S. Determinants of chronic malnutrition among preschool children in Bangladesh. J Biosoc Sci 2007;39(2):161–73.

Gong W, Liu A, Yao Y, Ma Y, Ding C, Song C, et al. Nutrient supplement use among the Chinese population: a cross-sectional study of the 2010–2012 China nutrition and health surveillance. Nutrients 2018;10(11):1733.

Rovner AJ, Stallings VA, Schall JI, Leonard MB, Zemel BS. Vitamin D insufficiency in children, adolescents, and young adults with cystic fibrosis despite routine oral supplementation. Am J Clin Nutr 2007;86(6):1694–9.

Holick MF, Chen TC. Vitamin D deficiency: A worldwide problem with health consequences. Am J Clin Nutr 2008;87(4):1080S–6.

Dedeoglu M, Garip Y, Bodur H. Osteomalacia in Crohn’s disease. Arch Osteoporos 2014;9:177.

Holick MF. Resurrection of vitamin D deficiency and rickets. J Clin Invest 2006;116(8):2062–72.

Camargo CA, Ganmaa D, Frazier AL, Kirchberg FF, Stuart JJ, Kleinman K, et al. Randomized trial of vitamin D supplementation and risk of acute respiratory infection in Mongolia. Pediatrics 2012;130(3):e561–7.

Atiq M, Suria A, Nizami S, Ahmed I. Vitamin D status of breastfed Pakistani infants. Acta paediatr 1998;87(7):737–40.

Harinarayan C. Prevalence of vitamin D insufficiency in postmenopausal south Indian women. Osteoporos Int 2005;16(4):397–402.

Roy DK, Berry JL, Pye SR, Adams JE, Swarbrick CM, King Y, et al. Vitamin D status and bone mass in UK South Asian women. Bone 2007;40(1):200–4.

Ross AC. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab 2011;96(1):53–8.

Nicklas TA, Qu H, Hughes SO, He M, Wagner SE, Foushee HR, et al. Self-perceived lactose intolerance results in lower intakes of calcium and dairy foods and is associated with hypertension and diabetes in adults. Am J Clin Nutr 2011;94(1):191–8.

Larsson SC, Bergkvist L, Rutegård J, Giovannucci E, Wolk A. Calcium and dairy food intakes are inversely associated with colorectal cancer risk in the Cohort of Swedish Men. Am J Clin Nutr 2006;83(3):667–73.

O’Connor LM, Lentjes MA, Luben RN, Khaw KT, Wareham NJ, Forouhi NG. Dietary dairy product intake and incident type 2 diabetes: a prospective study using dietary data from a 7-day food diary. Diabetologia 2014;57(5):909–17.

Institute of Medicine (US) Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington (DC): National Academies Press (US); 1997.

Mei Z, Yip R, Grummer-Strawn LM, Trowbridge FL. Development of a research child growth reference and its comparison with the current international growth reference. Arch Pediatr Adolesc Med 1998;152(5):471–9.

Hajhir M. Diseases Induced by Malnutrition. Tehran: Andisheh Farda. 2004.

WHO. Stakeholders meeting on maternal interventions vigilance: safety monitoring and surveillance in vaccine and other research settings: Domaine de Penthes, Geneva, Switzerland, 20-21 November 2017. World Health Organization, 2018.

Bhutta ZA, Soofi SB, Zaidi SSH, Habib A. Pakistan National Nutrition Survey, 2011.

Kapil U, Pandey RM, Goswami R, Sharma B, Sharma N, Ramakrishnan L, et al. Prevalence of Vitamin D deficiency and associated risk factors among children residing at high altitude in Shimla district, Himachal Pradesh, India. Indian J Endocrinol Metab 2017;21(1):178–83.

Akkermans MD, Eussen SR, van der Horst-Graat JM, Van Elburg RM, van Goudoever JB, Brus F. A micronutrient-fortified young-child formula improves the iron and vitamin D status of healthy young European children: a randomized, double-blind controlled trial. Am J Clin Nutr 2017;105(2):391–9.

Rousseau AF, Damas P, Ledoux D, Cavalier E. Effect of cholecalciferol recommended daily allowances on vitamin D status and fibroblast growth factor-23: an observational study in acute burn patients. Burns 2014;40(5):865–70.

Rich-Edwards JW, Ganmaa D, Kleinman K, Sumberzul N, Holick MF, Lkhagvasuren T, et al. Randomized trial of fortified milk and supplements to raise 25-hydroxyvitamin D concentrations in schoolchildren in Mongolia. Am J Clin Nutr 2011;94(2):578–84.

Klein GL, Herndon DN, Chen TC, Kulp G, Holick MF. Standard multivitamin supplementation does not improve vitamin D insufficiency after burns. J Bone Miner Metab 2009;27(4):502–6.

Reddy V, Sivakumar B. Magnesium-dependent vitamin-D-resistant rickets. Lancet 1974;1(7864):963–5.

Heaney RP, Dowell MS, Hale CA, Bendich A. Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. J Am Coll Nutr 2003;22(2):142–6.

Fatima S, Gerasimidis K, Wright C, Tsiountsioura M, Arvanitidou EI, Malkova D. Response of appetite and potential appetite regulators following intake of high energy nutritional supplements. Appetite 2015;95:36–43.

Fatima S, Gerasimidis K, Wright C, Malkova D. Impact of High Energy Nutritional Supplement Drink consumed for five consecutive days on cardio metabolic risk factors in underweight females. Proc Nutr Soc 2015;74(OCE1).

Parsons EL, Stratton RJ, Cawood AL, Smith TR, Elia M. Oral nutritional supplements in a randomised trial are more effective than dietary advice at improving quality of life in malnourished care home residents. Clin Nutr 2017;36(1):134–42.

Huynh D, Devitt A, Paule C, Reddy B, Marathe P, Hegazi R, et al. Effects of oral nutritional supplementation in the management of malnutrition in hospital and post‐hospital discharged patients in I ndia: a randomised, open‐label, controlled trial. J Hum Nutr Diet 2015;28(4):331–43.

Norman K, Kirchner H, Freudenreich M, Ockenga J, Lochs H, Pirlich M. Three month intervention with protein and energy rich supplements improve muscle function and quality of life in malnourished patients with non-neoplastic gastrointestinal disease—a randomized controlled trial. Clin Nutr 2008;27(1):48–56.

Ackatia-Armah RS, McDonald CM, Doumbia S, Erhardt JG, Hamer DH, Brown KH. Malian children with moderate acute malnutrition who are treated with lipid-based dietary supplements have greater weight gains and recovery rates than those treated with locally produced cereal-legume products: a community-based, cluster-randomized trial. Am J Clin Nutr 2015;101(3):632–45.

Nackers F, Broillet F, Oumarou D, Djibo A, Gaboulaud V, Guerin PJ, et al. Effectiveness of ready-to-use therapeutic food compared to a corn/soy-blend-based pre-mix for the treatment of childhood moderate acute malnutrition in Niger. J Trop Pediatr 2010;56(6):407–13.




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