Rachel E Allen1, Alan D Dangour2, Alison E Tedstone3, Zaid Chalabi2. 1. From the Department of Health, Wellington House, London, United Kingdom, and London School of Hygiene and Tropical Medicine, London, United Kingdom Rachel.Allen@phe.gov.uk. 2. London School of Hygiene and Tropical Medicine, London, United Kingdom. 3. From the Department of Health, Wellington House, London, United Kingdom, and.
Abstract
BACKGROUND: More than one-fifth of the United Kingdom population has poor vitamin D status (serum 25-hydroxyvitamin D [25(OH)D] concentration <25 nmol/L), particularly individuals with low sun exposure or poor dietary intake. OBJECTIVE: We identified the fortification vehicle and concentration most likely to safely increase population vitamin D intakes and vitamin D status. DESIGN: Wheat flour and milk were identified as primary fortification vehicles for their universal consumption in population groups most at risk of vitamin D deficiency including children aged 18-36 mo, females aged 15-49 y, and adults aged ≥65 y. With the use of data from the first 2 y (2008-2010) of the National Diet and Nutrition Survey Rolling Program, we simulated the effect of fortifying wheat flour and milk with vitamin D on United Kingdom food consumption. Empirically derived equations for the relation between vitamin D intake and the serum 25(OH)D concentration were used to estimate the population serum 25(OH)D concentration for each fortification scenario. RESULTS: At a simulated fortification of 10 μg vitamin D/100 g wheat flour, the proportion of at-risk groups estimated to have vitamin D intakes below United Kingdom Reference Nutrient Intakes was reduced from 93% to 50%, with no individual exceeding the United Kingdom Tolerable Upper Intake Level; the 2.5th percentile of the population winter serum 25(OH)D concentration rose from 20 to 27 nmol/L after fortification. The simulation of the fortification of wheat flour at this concentration was more effective than that of the fortification of milk (at concentrations between 0.25 and 7 mg vitamin D/100 L milk) or of the fortification of milk and flour combined. CONCLUSION: To our knowledge, this study provides new evidence that vitamin D fortification of wheat flour could be a viable option for safely improving vitamin D intakes and the status of United Kingdom population groups at risk of deficiency without increasing risk of exceeding current reference thresholds.
BACKGROUND: More than one-fifth of the United Kingdom population has poor vitamin D status (serum 25-hydroxyvitamin D [25(OH)D] concentration <25 nmol/L), particularly individuals with low sun exposure or poor dietary intake. OBJECTIVE: We identified the fortification vehicle and concentration most likely to safely increase population vitamin D intakes and vitamin D status. DESIGN:Wheat flour and milk were identified as primary fortification vehicles for their universal consumption in population groups most at risk of vitamin D deficiency including children aged 18-36 mo, females aged 15-49 y, and adults aged ≥65 y. With the use of data from the first 2 y (2008-2010) of the National Diet and Nutrition Survey Rolling Program, we simulated the effect of fortifying wheat flour and milk with vitamin D on United Kingdom food consumption. Empirically derived equations for the relation between vitamin D intake and the serum 25(OH)D concentration were used to estimate the population serum 25(OH)D concentration for each fortification scenario. RESULTS: At a simulated fortification of 10 μg vitamin D/100 g wheat flour, the proportion of at-risk groups estimated to have vitamin D intakes below United Kingdom Reference Nutrient Intakes was reduced from 93% to 50%, with no individual exceeding the United Kingdom Tolerable Upper Intake Level; the 2.5th percentile of the population winter serum 25(OH)D concentration rose from 20 to 27 nmol/L after fortification. The simulation of the fortification of wheat flour at this concentration was more effective than that of the fortification of milk (at concentrations between 0.25 and 7 mg vitamin D/100 L milk) or of the fortification of milk and flour combined. CONCLUSION: To our knowledge, this study provides new evidence that vitamin D fortification of wheat flour could be a viable option for safely improving vitamin D intakes and the status of United Kingdom population groups at risk of deficiency without increasing risk of exceeding current reference thresholds.
Authors: Kevin D Cashman; Kirsten G Dowling; Zuzana Škrabáková; Marcela Gonzalez-Gross; Jara Valtueña; Stefaan De Henauw; Luis Moreno; Camilla T Damsgaard; Kim F Michaelsen; Christian Mølgaard; Rolf Jorde; Guri Grimnes; George Moschonis; Christina Mavrogianni; Yannis Manios; Michael Thamm; Gert Bm Mensink; Martina Rabenberg; Markus A Busch; Lorna Cox; Sarah Meadows; Gail Goldberg; Ann Prentice; Jacqueline M Dekker; Giel Nijpels; Stefan Pilz; Karin M Swart; Natasja M van Schoor; Paul Lips; Gudny Eiriksdottir; Vilmundur Gudnason; Mary Frances Cotch; Seppo Koskinen; Christel Lamberg-Allardt; Ramon A Durazo-Arvizu; Christopher T Sempos; Mairead Kiely Journal: Am J Clin Nutr Date: 2016-02-10 Impact factor: 7.045
Authors: Francesca L Crowe; Kate Jolly; Christine MacArthur; Semira Manaseki-Holland; Neil Gittoes; Martin Hewison; Robert Scragg; Krishnarajah Nirantharakumar Journal: BMJ Open Date: 2019-06-04 Impact factor: 2.692