Using food fortification to improve vitamin D bioaccessibility and intakes

Purpose Vitamin D deficiency is a well-recognised public health problem within the UK, with specific population groups more vulnerable to deficiency. Two pilot studies were used to explore awareness of vitamin D deficiency and attitudes towards food fortification. Design/methodology/approach A survey of 120 participants from five at-risk groups (South Asians, Blacks, Middle Eastern, Far Eastern and Caucasian older adults over 65 years) plus a group of British Caucasians who do not avoid sun exposure explored awareness of vitamin D, sun exposure knowledge and behaviour and attitudes towards food fortification. The latter group was included to provide a comparison group who were at a reduced risk of deficiency. χ2 was used to test associations between categorical variables and the study groups. The second study used three focus groups and two interviews, conducted on young South Asian females and examined knowledge and awareness of vitamin D and vitamin D-fortified foods. Findings A lack of knowledge and misconceptions were highlighted by both studies in relation to at-risk factors, including sunlight exposure (p = 0.037), dietary intakes (p = 0.0174) and darker skin pigmentation (p = 0.023), sources of vitamin D and the health benefits associated with optimal consumption. Attitudes to mandatory fortification of some foods varied significantly (p = 0.004) between the groups with acceptance rates for Blacks (68 per cent), those over 65 years (50 per cent), Middle Eastern (67 per cent) and Far Eastern (73 per cent), whereas the control (71 per cent) showed no acceptance, and South Asians gave a mixed response (48 per cent No). Focus group findings highlighted positive views towards fortification, although this was less for mandatory as opposed to voluntary fortification. Both pilot studies highlight the need for more research into this area, to create more effective public health policies. Originality/value The research presents novel insights into a topical area where there is limited research.

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Efficacy of vitamin D food fortification and biofortification in children and adults: a systematic review protocol

JBI Evidence Synthesis ◽

10.11124/jbisrir-d-19-00373 ◽

2020 ◽

Vol 18 (12) ◽

pp. 2694-2703

Author(s):

Eleanor Dunlop ◽

Mairead Kiely ◽

Anthony P. James ◽

Tanya Singh ◽

Lucinda J. Black

Keyword(s):

Systematic Review ◽

Vitamin D ◽

Food Fortification ◽

Systematic Review Protocol ◽

Review Protocol

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The Role of Vitamin D in Inflammatory Bowel Disease – Assessing Therapeutic and Preventive Potential of Supplementation and Food Fortification

Food Technology and Biotechnology ◽

10.17113/ftb.56.04.18.5805 ◽

2018 ◽

Vol 56 (4) ◽

Cited By ~ 1

Author(s):

Dunja Leskovar ◽

◽

Tomislav Meštrović ◽

Anja Barešić ◽

Ivana Kraljević ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Vitamin D ◽

Bowel Disease ◽

Food Fortification ◽

Inflammatory Bowel

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Geographical differences in vitamin D status, with particular reference to European countries

Proceedings of The Nutrition Society ◽

10.1079/pns2003297 ◽

2003 ◽

Vol 62 (4) ◽

pp. 813-821 ◽

Cited By ~ 133

Author(s):

Lars Ovesen ◽

Rikke Andersen ◽

Jette Jakobsen

Keyword(s):

Vitamin D ◽

Low Frequency ◽

The Elderly ◽

Food Sources ◽

Natural Food ◽

Food Fortification ◽

Vitamin D Status ◽

Geographical Differences ◽

Hydroxyvitamin D ◽

Supplement Use

Vitamin D is produced endogenously when the skin is exposed to sunlight and can be obtained exogenously from a few natural food sources, from food fortification and from supplements. Generally, vitamin D intake is low ≤2–3 μg/d in Europe. Casual exposure to sunlight is thought to provide most of the vitamin D requirement of the human population. However, skin synthesis of vitamin D may not compensate for the low nutritional intake in Europe, even in countries with high supplies from food fortification and supplements. For assessment of vitamin D nutritional status the concentration of 25-hydroxyvitamin D (25(OH)D) in serum is considered to be an accurate integrative measure reflecting an individual's dietary intake and cutaneous production. A substantial percentage of the elderly and adolescents in Europe have a low concentration of 25(OH)D; in the elderly this percentage ranges from approximately 10 in the Nordic countries to approximately 40 in France. Low vitamin D status seems to be aggravated by disease and immobility, and by a low frequency of supplement use.

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Use of Branded Food Composition Databases for the Exploitation of Food Fortification Practices: A Case Study on Vitamin D in the Slovenian Food Supply

Frontiers in Nutrition ◽

10.3389/fnut.2021.775163 ◽

2022 ◽

Vol 8 ◽

Author(s):

Sanja Krušič ◽

Maša Hribar ◽

Edvina Hafner ◽

Katja Žmitek ◽

Igor Pravst

Keyword(s):

Vitamin D ◽

Nutritional Quality ◽

Food Composition ◽

Health Concern ◽

Food Fortification ◽

Average Content ◽

Breakfast Cereals ◽

Sales Data

Vitamin D deficiency is a worldwide public health concern, which can be addressed with voluntary or mandatory food fortification. The aim of this study was to determine if branded food composition databases can be used to investigate voluntary fortification practices. A case study was conducted using two nationally representative cross-sectional datasets of branded foods in Slovenia, collected in 2017 and 2020, and yearly sales data. Using food labeling data we investigated prevalence of fortification and average vitamin D content, while nutrient profiling was used to investigate overall nutritional quality of the foods. In both datasets, the highest prevalence of vitamin D fortification was observed in meal replacements (78% in 2017; 100% in 2020) and in margarine, corresponding to high market share. Other food categories commonly fortified with vitamin D are breakfast cereals (5% in 2017; 6% in 2020), yogurts and their imitates (5% in 2017; 4% in 2020), and baby foods (18% in both years). The highest declared average content of vitamin D was observed in margarine and foods for specific dietary use (7–8 μg/100g), followed by breakfast cereals (4 μg/100g), while the average content in other foods was below 2 μg/100g. Only minor differences were observed between 2017 and 2020. Major food-category differences were also observed in comparison of the overall nutritional quality of the fortified foods; higher overall nutritional quality was only observed in fortified margarine. Our study showed that branded food composition databases are extremely useful resources for the investigation and monitoring of fortification practices, particularly if sales data can also be used. In the absence of mandatory or recommended fortification in Slovenia, very few manufacturers decide to add vitamin D, and even when this is the case, such products are commonly niche foods with lower market shares. We observed exceptions in imported foods, which can be subject to fortification policies introduced in other countries.

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Corrigendum to ‘Efficacy and safety of food fortification to improve Vitamin D intakes of older adults’ [Nutrition 75-76 (2020)]

Nutrition ◽

10.1016/j.nut.2020.110837 ◽

2020 ◽

Vol 75-76 ◽

pp. 110837

Author(s):

Aislinn McCourt ◽

Breige A. McNulty ◽

Janette Walton ◽

Aifric O’Sullivan

Keyword(s):

Older Adults ◽

Vitamin D ◽

Food Fortification ◽

Efficacy And Safety

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Food fortification and biofortification as potential strategies for prevention of vitamin D deficiency

Nutrition Bulletin ◽

10.1111/nbu.12363 ◽

2019 ◽

Vol 44 (1) ◽

pp. 36-42 ◽

Cited By ~ 3

Author(s):

J. Guo ◽

J. A. Lovegrove ◽

D. I. Givens

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Food Fortification

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Vitamin D Food Fortification and Nutritional Status in Children: A Systematic Review of Randomized Controlled Trials

Nutrients ◽

10.3390/nu11112766 ◽

2019 ◽

Vol 11 (11) ◽

pp. 2766 ◽

Cited By ~ 2

Author(s):

Paula Nascimento Brandão-Lima ◽

Beatriz da Cruz Santos ◽

Concepción Maria Aguilera ◽

Analícia Rocha Santos Freire ◽

Paulo Ricardo Saquete Martins-Filho ◽

...

Keyword(s):

Systematic Review ◽

Vitamin D ◽

Clinical Trials ◽

Nutritional Status ◽

Systematic Reviews ◽

Randomized Clinical Trials ◽

Hypovitaminosis D ◽

Food Fortification ◽

Fortified Foods ◽

Eligibility Criteria

Children are in the risk group for developing hypovitaminosis D. Several strategies are used to reduce this risk. Among these, fortification of foods with vitamin D (25(OH)D) has contributed to the achievement of nutritional needs. This systematic review aims to discuss food fortification as a strategy for maintenance or recovery of nutritional status related to vitamin D in children. The work was developed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and registered in the International prospective register of systematic reviews (PROSPERO) database (CRD42018052974). Randomized clinical trials with children up to 11 years old, who were offered vitamin D-fortified foods, and who presented 25(OH)D concentrations were used as eligibility criteria. After the selection stages, five studies were included, totaling 792 children of both sexes and aged between two and 11 years. Interventions offered 300–880 IU of vitamin D per day, for a period of 1.6–9 months, using fortified dairy products. In four of the five studies, there was an increase in the serum concentrations of 25(OH)D with the consumption of these foods; additionally, most children reached or maintained sufficiency status. Moreover, the consumption of vitamin D-fortified foods proved to be safe, with no concentrations of 25(OH)D > 250 nmol/L. Based on the above, the fortification of foods with vitamin D can help maintain or recover the nutritional status of this vitamin in children aged 2–11 years. However, it is necessary to perform additional randomized clinical trials in order to establish optimal doses of fortification, according to the peculiarities of each region.

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