Effects of vitamin D and high dairy protein intake on bone mineralization and linear growth in 6-to 8-year-old children: the D-pro randomized trial

Background Vitamin D and dairy protein may stimulate bone mineralization and linear growth in children, but previous studies show inconsistent results and have not examined their combined effects. Objectives To investigate combined and separate effects of vitamin D supplementation and high-protein (HP) compared with normal-protein (NP) yogurt intake on children's bone mineralization and linear growth. Methods In a 2 x 2-factorial trial, 200 healthy, 6- to 8-year-old, Danish, children with light skin (55 degrees N) were randomized to 20 mu g/d vitamin D-3 or placebo and to substitute 260 g/d dairy with HP (10 g protein/100 g) or NP (3.5 g protein/100 g) yogurt for 24 weeks during an extended winter. Outcomes were total body less head (TBLH) and lumbar spine bone mineral density (BMD), bone mineral content (BMC), and bone area (BA) by dual-energy X-ray absorptiometry, height, and biomarkers of bone turnover and growth. The primary outcome was TBLH BMD. Results In total, 184 children (92%) completed the study. The baseline serum 25-hydroxyvitamin D was 80.8 +/- 17.2 nmol/L, which increased by 7.2 +/- 14.1 nmol/L and decreased by 32.3 +/- 17.5 nmol/L with vitamin D and placebo, respectively. The baseline protein intake was 15.4 +/- 2.4 energy percentage (E%), which increased to 18.3 +/- 3.4 E% with HP. There were no vitamin D-yogurt interactions and no main effects of either intervention on TBLH BMD. However, vitamin D supplementation increased lumbar spine BMD and TBLH BMC compared to placebo, whereas HP groups showed lower increments in lumbar spine BMD, TBLH BMC and BA, and plasma osteocalcin compared to NP groups. Height, growth factors, and parathyroid hormone levels were unaffected. Conclusions Although there were no effects on whole-body BMD, vitamin D increased bone mass and spinal BMD, whereas high compared with normal dairy protein intake had smaller incremental effects on these outcomes. This supports a recommended vitamin D intake of around 20 mu g/d during winter but not use of HP dairy products for improved bone mineralization among healthy, well-nourished children. This trial was registered at clinicaltrials.gov as NCT03956732.