Vitamin D bio-enrichment of pork may offer a food-based strategy to increase vitamin D intakes in the UK population

Abstract A multi-disciplinary expert group met to discuss vitamin D deficiency in the UK, and strategies for improving population intakes and status. Changes to UK Government advice since the 1st Rank Forum on Vitamin D (2009) were discussed, including rationale for setting a RNI (10µg/day;400IU/day) for adults and children (4+ years). Current UK data show inadequate intakes among all age groups, and high prevalence of low vitamin D status among specific groups (e.g. pregnant women and adolescent males/females). Evidence of widespread deficiency within some minority ethnic groups, resulting in nutritional rickets (particularly among Black and South Asian infants), raised particular concern. It is too early to establish whether population vitamin D status has altered since Government recommendations changed in 2016. Vitamin D food fortification was discussed as a potential strategy to increase population intakes. Data from dose-response and dietary modelling studies indicate dairy products, bread, hens’ eggs and some meats as potential fortification vehicles. Vitamin D3 appears more effective than vitamin D2 for raising serum 25-hydroxyvitamin D concentration, which has implications for choice of fortificant. Other considerations for successful fortification strategies include: i) need for ‘real-world’ cost information for use in modelling work; ii) supportive food legislation; iii) improved consumer and health professional understanding of vitamin D’s importance; iv) clinical consequences of inadequate vitamin D status; v) consistent communication of Government advice across health/social care professions, and via the food industry. These areas urgently require further research to enable universal improvement in vitamin D intakes and status in the UK population.

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Special considerations for vitamin D in the south Asian population in the UK

Therapeutic Advances in Musculoskeletal Disease ◽

10.1177/1759720x17704430 ◽

2017 ◽

Vol 9 (6) ◽

pp. 137-144 ◽

Cited By ~ 7

Author(s):

Nicola M. Lowe ◽

Issak Bhojani

Keyword(s):

Vitamin D ◽

South Asian ◽

Asian Population ◽

The South ◽

South Asian Population ◽

The Uk

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Validation of a locally derived serum calcium adjustment equation: relationship with total 25(OH) vitamin D and PTH levels

Journal of Clinical Pathology ◽

10.1136/jclinpath-2016-203663 ◽

2016 ◽

Vol 70 (1) ◽

pp. 69-74 ◽

Cited By ~ 1

Author(s):

Jonathan Joseph Scargill ◽

John Mark Guy

Keyword(s):

Vitamin D ◽

Fold Increase ◽

Reference Interval ◽

Albumin Concentration ◽

Vitamin D Levels ◽

Significant Difference ◽

25 Oh Vitamin D ◽

New Equation ◽

The Uk ◽

Adjustment Equation

AimsMany clinical laboratories in the UK use a standard equation to adjust total calcium for albumin concentration. To assess the validity of this practice, we assessed the effect of the use of a traditional and locally derived calcium adjustment equation on parathyroid hormone (PTH) and 25(OH, hydroxy) vitamin D levels.MethodsSamples requested for calcium and albumin measurement over a 6 month period that met inclusion criteria were used to derive a calcium adjustment equation (n=60 941). The traditional and locally derived calcium adjustment equations were then applied to a second cohort of adult patients that underwent calcium measurement over a 1 year period (n=275 456). Patients were classified as hypocalcaemic, normocalcaemic or hypercalcaemic using a UK Pathology Harmony adjusted calcium reference interval (2.2–2.6 mmol/L).ResultsThe local calcium adjustment equation provided a 7.1-fold reduction in the prevalence of hypocalcaemia. Patients classified as hypocalcaemic using the locally derived equation had statistically significantly lower 25(OH) vitamin D and higher PTH levels. A 2.4-fold increase in the prevalence of hypercalcaemia was also observed using the new equation, but with no significant difference in 25(OH) vitamin D or PTH levels.ConclusionsA locally derived calcium adjustment equation reclassified the calcium status of 61 278 (22%) patients. Patients classified as hypocalcaemic by the locally derived equation had significantly lower 25(OH) vitamin D and significantly higher PTH values, providing evidence that use of this adjustment equation generates adjusted calcium results of greater clinical relevance. This study provides further and novel evidence that individual laboratories should determine local equations for adjusted calcium where possible.

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MO792CONTEMPORARY MINERAL AND BONE DISORDER MARKERS AND TREATMENT AMONG HEMODIALYSIS PATIENTS IN THE EUROPEAN DIALYSIS OUTCOMES AND PRACTICE PATTERNS STUDY (DOPPS)*

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab096.001 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Brian Bieber ◽

Indranil Dasgupta ◽

Pieter Evenepoel ◽

Stefan H Jacobson ◽

Piergiorgio Messa ◽

...

Keyword(s):

Vitamin D ◽

Practice Patterns ◽

Hemodialysis Patients ◽

Serum Phosphorus ◽

Active Vitamin ◽

Mineral And Bone Disorder ◽

Bone Disorder ◽

Country Differences ◽

Dialysis Outcomes ◽

The Uk

Abstract Background and Aims Chronic kidney disease mineral and bone disorder (CKD-MBD) is characterized by abnormalities in serum calcium, phosphorus, and parathyroid hormone (PTH) and associated with morbidity and mortality. Previous publications from the Dialysis Outcomes and Practice Patterns Study (DOPPS) have demonstrated country differences in the prevalence and treatment of CKD-MBD among hemodialysis patients in participating European countries. We aim to compare the distribution of CKD-MBD related labs and treatments across countries in a contemporary population of European hemodialysis patients. Method DOPPS is an international prospective cohort study of hemodialysis patients ≥18 years of age. Patients are enrolled randomly from a representative sample of dialysis facilities within each nation at the start of each study phase. The current analysis includes n=1,701 patients from 91 facilities in the initial prevalent cross section of Europe DOPPS phase 7 (2019-present; Belgium, Germany, Italy, Spain, Sweden, UK). Results from Belgium should be considered preliminary as initial questionnaire completion is ongoing. Results The % of patients with a high PTH (>600 pg/mL) ranged from 6% in Italy to 24% in the UK, with 12-17% having high PTH in all other countries. Mean serum total calcium ranged from 8.7 in Germany to 9.1 mg/dL in the UK (Table). Mean serum phosphorus varied from 4.5 in Belgium to 5.3 mg/dL in Germany. Dialysate calcium of 2.5 mEq/L was predominant in Germany, Sweden, and the UK while 3.0 mEq/L was the most common prescription in Belgium, Italy, and Spain. Calcimimetic prescription ranged from 13% in the UK to 32% in Spain. Etelcalcetide prescription ranged from 1% in the UK to 12% in Spain and 14% in Italy. Active vitamin D prescription ranged from 27% in Belgium to 75% in Sweden. Nearly all vitamin D prescriptions were administered intravenously in Spain versus about half in Italy; in all other countries, the route of active vitamin D administration was primarily oral. Patient age and dialysis vintage varied by country, potentially contributing to some of the observed country differences in MBD marker levels and treatment practices. Conclusion CKD-MBD related abnormalities in PTH, serum phosphorus and calcium remain common in European dialysis patients, with prevalence varying considerably by country. Substantial international variation in CKD-MBD treatments was also observed in prescription of vitamin D and calcimimetics. Uptake of the relatively new calcimimetic, etelcalcetide, varied considerably by country. A detailed understanding of the effect of treatment variation on CKD-MBD marker levels and patient outcomes is needed to provide important insights for the European HD community in optimizing management of secondary hyperparathyroidism.

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Importance of calcium, vitamin D and vitamin K for osteoporosis prevention and treatment

Proceedings of The Nutrition Society ◽

10.1017/s0029665108007003 ◽

2008 ◽

Vol 67 (2) ◽

pp. 163-176 ◽

Cited By ~ 66

Author(s):

Susan A. Lanham-New

Keyword(s):

Vitamin D ◽

Bone Loss ◽

Vitamin K ◽

Hypovitaminosis D ◽

Osteoporosis Prevention ◽

Mineral Density ◽

Increased Risk ◽

Post Menopause ◽

Exogenous Factors ◽

The Uk

Throughout the life cycle the skeleton requires optimum development and maintenance of its integrity to prevent fracture. Bones break because the loads placed on them exceed the ability of the bone to absorb the energy involved. It is now estimated that one in three women and one in twelve men aged >55 years will suffer from osteoporosis in their lifetime and at a cost in the UK of >£1·7×109 per year. The pathogenesis of osteoporosis is multifactorial. Both the development of peak bone mass and the rate of bone loss are determined by key endogenous and exogenous factors. Ca supplements appear to be effective in reducing bone loss in women late post menopause (>5 years post menopause), particularly in those with low habitual Ca intake (<400 mg/d). In women early post menopause (<5 years post menopause) who are not vitamin D deficient, Ca supplementation has little effect on bone mineral density. However, supplementation with vitamin D and Ca has been shown to reduce fracture rates in the institutionalised elderly, but there remains controversy as to whether supplementation is effective in reducing fracture in free-living populations. Re-defining vitamin D requirements in the UK is needed since there is evidence of extensive hypovitaminosis D in the UK. Low vitamin D status is associated with an increased risk of falling and a variety of other health outcomes and is an area that requires urgent attention. The role of other micronutrients on bone remains to be fully defined, although there are promising data in the literature for a clear link between vitamin K nutrition and skeletal integrity, including fracture reduction.

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925Ethnic differences and determinants of vitamin D deficiency in the UK Biobank

International Journal of Epidemiology ◽

10.1093/ije/dyab168.641 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Joshua Sutherland ◽

Ang Zhou ◽

Matthew Leach ◽

Elina Hyppönen

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Asian Population ◽

European Ancestry ◽

Uk Biobank ◽

Mixed Ancestry ◽

Black African ◽

Hydroxyvitamin D ◽

The Uk ◽

Summer Time

Abstract Background While controversy remains regarding optimal vitamin D status, the public health relevance of true vitamin D deficiency is undisputed. There are few contemporary cross-ethnic studies investigating the prevalence and determinants of very low 25-hydroxyvitamin D [25(OH)D] concentrations. Methods We used data from 440,581 UK Biobank participants, of which 415,903 identified as white European, 7,880 Asian, 7,602 black African, 1,383 Chinese, and 6,473 of mixed ancestry. 25(OH)D concentrations were measured by DiaSorin Liaison XL and deficiency defined as ≤ 25 nmol/L 25(OH)D. Results The prevalence of 25(OH)D deficiency was highest among participants of Asian ancestry (57.2% in winter/spring and 50.8% in summer/autumn; followed by black African [38.47%/30.78%], mixed ancestry [36.53%/22.48%], Chinese [33.12%/20.68%] and white European [17.45%/5.90%], P < 1.0E-300). Participants with higher socioeconomic deprivation were more likely to have 25(OH)D deficiency compared to less deprived (P < 1.0E-300 for all comparisons), with the pattern being more apparent among those of white European ancestry and in summer (Pinteraction<6.4E-5 for both). In fully-adjusted analyses, regular consumption of oily fish was effective in mitigating ≤25 nmol/L 25(OH)D deficiency across all ethnicities, whilst outdoor-summer time was less effective for black Africans than white Europeans (OR: 0.89; 95% CI: 0.70, 1.12 and OR: 0.40; 95% CI: 0.38, 0.42, respectively). Conclusions Vitamin D deficiency remains an issue throughout the UK, particularly in lower socioeconomic areas and the UK Asian population, half of whom have vitamin D deficiency across seasons. Key messages The prevalence of 25(OH)D deficiency in the UK is alarming, with certain ethnic and socioeconomic groups considered particularly vulnerable.

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Vitamin D Serum Levels in the UK Population, including a Mathematical Approach to Evaluate the Impact of Vitamin D Fortified Ready-to-Eat Breakfast Cereals: Application of the NDNS Database

Nutrients ◽

10.3390/nu12061868 ◽

2020 ◽

Vol 12 (6) ◽

pp. 1868

Author(s):

Wim Calame ◽

Laura Street ◽

Toine Hulshof

Keyword(s):

Vitamin D ◽

Daily Intake ◽

Serum Levels ◽

Vitamin D Status ◽

Nutrition Survey ◽

Breakfast Cereals ◽

Vitamin D Intake ◽

The Uk ◽

The Impact ◽

The Relationship

Vitamin D status is relatively poor in the general population, potentially leading to various conditions. The present study evaluates the relationship between vitamin D status and intake in the UK population and the impact of vitamin D fortified ready-to-eat cereals (RTEC) on this status via data from the National Diet and Nutrition Survey (NDNS: 2008–2012). Four cohorts were addressed: ages 4–10 (n = 803), ages 11–18 (n = 884), ages 19–64 (n = 1655) and ages 65 and higher (n = 428). The impact of fortification by 4.2 μg vitamin D per 100 g of RTEC on vitamin D intake and status was mathematically modelled. Average vitamin D daily intake was age-dependent, ranging from ~2.6 (age range 4–18 years) to ~5.0 μg (older than 64 years). Average 25(OH)D concentration ranged from 43 to 51 nmol/L, the highest in children. The relationship between vitamin D intake and status followed an asymptotic curve with a predicted plateau concentration ranging from 52 in children to 83 nmol/L in elderly. The fortification model showed that serum concentrations increased with ~1.0 in children to ~6.5 nmol/L in the elderly. This study revealed that vitamin D intake in the UK population is low with 25(OH)D concentrations being suboptimal for general health. Fortification of breakfast cereals can contribute to improve overall vitamin D status.

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The Use of Dietary Supplements Among African and Caribbean Women Living in the UK: A Cross-Sectional Study

Nutrients ◽

10.3390/nu12030847 ◽

2020 ◽

Vol 12 (3) ◽

pp. 847

Author(s):

Amanda Rodrigues Amorim Adegboye ◽

Omorogieva Ojo ◽

Gulshanara Begum

Keyword(s):

Vitamin D ◽

Dietary Supplements ◽

Dietary Supplement ◽

High Cholesterol ◽

Black African ◽

Supplement Use ◽

Caribbean Women ◽

Black Caribbean ◽

Dietary Supplement Use ◽

The Uk

Previous studies have shown that the use of dietary supplements is associated with the prevention of birth defects, negative pregnancy outcomes and cardiovascular diseases. However, there might be some ethnic disparities in supplement usage suggesting that women who could benefit from it are not frequent users. This study aimed to characterise the use of dietary supplement among Black African and Black Caribbean women living in the United Kingdom (UK). Furthermore, it evaluated possible associations between the use of dietary supplements and health and diet awareness. A total of 262 women self-ascribed as Black African and Black Caribbean living in the UK completed a comprehensive questionnaire on socio-demographic factors, diet, use of supplements and cultural factors. The main outcome variable was the regular use of any type of dietary supplement. Use of vitamin D and/or calcium was also explored. A stepwise logistic regression analysis was applied to identify predictors of regular use of dietary supplements. A total of 33.2% of women reported regular use of any dietary supplements and 16.8% reported use of vitamin D and/or calcium. There were no significant ethnic differences in the use of dietary supplements. Reporting use of the back of food packaging label (odds ratio (OR) 2.21; 95% CI 1.07–4.55); a self-rated healthy diet (OR 2.86; 95% CI 1.19–6.91) and having cardiovascular disease (CVD), hypertension and/or high cholesterol (OR 3.81; 95% CI 1.53–9.49) increased the likelihood of using any dietary supplement. However, having poorer awareness decreased the likelihood (OR 0.94; 95% CI 0.88–0.99) of using any dietary supplement. For the use of vitamin D and/or calcium supplements, the main predictor was having CVD, hypertension and/or high cholesterol (OR 4.43; 95% CI 1.90–10.35). The prevalence of dietary supplement use was low among African and Caribbean women. Thus, awareness of potential benefits of some dietary supplements (e.g., vitamin D) among the Black population should be promoted.

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