TY - JOUR

T1 - Rationale and plan for vitamin D food fortification: A review and guidance paper

AU - Pilz, Stefan

AU - März, Winfried

AU - Cashman, Kevin D.

AU - Kiely, Mairead E.

AU - Whiting, Susan J.

AU - Holick, Michael F.

AU - Grant, William B.

AU - Pludowski, Pawel

AU - Hiligsmann, Mickael

AU - Trummer, Christian

AU - Schwetz, Verena

AU - Lerchbaum, Elisabeth

AU - Pandis, Marlene

AU - Tomaschitz, Andreas

AU - Grübler, Martin R.

AU - Gaksch, Martin

AU - Verheyen, Nicolas

AU - Hollis, Bruce W.

AU - Rejnmark, Lars

AU - Karras, Spyridon N.

AU - Hahn, Andreas

AU - Bischoff-Ferrari, Heike A.

AU - Reichrath, Jörg

AU - Jorde, Rolf

AU - Elmadfa, Ibrahim

AU - Vieth, Reinhold

AU - Scragg, Robert

AU - Calvo, Mona S.

AU - van Schoor, Natasja M.

AU - Bouillon, Roger

AU - Lips, Paul

AU - Itkonen, Suvi T.

AU - Martineau, Adrian R.

AU - Lamberg-Allardt, Christel

AU - Zittermann, Armin

PY - 2018/7

Y1 - 2018/7

N2 - Vitamin D deficiency can lead to musculoskeletal diseases such as rickets and osteomalacia, but vitamin D supplementation may also prevent extraskeletal diseases such as respiratory tract infections, asthma exacerbations, pregnancy complications and premature deaths. Vitamin D has a unique metabolism as it is mainly obtained through synthesis in the skin under the influence of sunlight (i.e., ultraviolet-B radiation) whereas intake by nutrition traditionally plays a relatively minor role. Dietary guidelines for vitamin D are based on a consensus that serum 25-hydroxyvitamin D (25[OH]D) concentrations are used to assess vitamin D status, with the recommended target concentrations ranging from ≥25 to ≥50 nmol/L (≥10-≥20 ng/mL), corresponding to a daily vitamin D intake of 10 to 20 μg (400-800 international units). Most populations fail to meet these recommended dietary vitamin D requirements. In Europe, 25(OH)D concentrations < 30 nmol/L (12 ng/mL) and < 50 nmol/L (20 ng/mL) are present in 13.0 and 40.4% of the general population, respectively. This substantial gap between officially recommended dietary reference intakes for vitamin D and the high prevalence of vitamin D deficiency in the general population requires action from health authorities. Promotion of a healthier lifestyle with more outdoor activities and optimal nutrition are definitely warranted but will not erase vitamin D deficiency and must, in the case of sunlight exposure, be well balanced with regard to potential adverse effects such as skin cancer. Intake of vitamin D supplements is limited by relatively poor adherence (in particular in individuals with low-socioeconomic status) and potential for overdosing. Systematic vitamin D food fortification is, however, an effective approach to improve vitamin D status in the general population, and this has already been introduced by countries such as the US, Canada, India, and Finland. Recent advances in our knowledge on the safety of vitamin D treatment, the dose-response relationship of vitamin D intake and 25(OH)D levels, as well as data on the effectiveness of vitamin D fortification in countries such as Finland provide a solid basis to introduce and modify vitamin D food fortification in order to improve public health with this likewise cost-effective approach.

AB - Vitamin D deficiency can lead to musculoskeletal diseases such as rickets and osteomalacia, but vitamin D supplementation may also prevent extraskeletal diseases such as respiratory tract infections, asthma exacerbations, pregnancy complications and premature deaths. Vitamin D has a unique metabolism as it is mainly obtained through synthesis in the skin under the influence of sunlight (i.e., ultraviolet-B radiation) whereas intake by nutrition traditionally plays a relatively minor role. Dietary guidelines for vitamin D are based on a consensus that serum 25-hydroxyvitamin D (25[OH]D) concentrations are used to assess vitamin D status, with the recommended target concentrations ranging from ≥25 to ≥50 nmol/L (≥10-≥20 ng/mL), corresponding to a daily vitamin D intake of 10 to 20 μg (400-800 international units). Most populations fail to meet these recommended dietary vitamin D requirements. In Europe, 25(OH)D concentrations < 30 nmol/L (12 ng/mL) and < 50 nmol/L (20 ng/mL) are present in 13.0 and 40.4% of the general population, respectively. This substantial gap between officially recommended dietary reference intakes for vitamin D and the high prevalence of vitamin D deficiency in the general population requires action from health authorities. Promotion of a healthier lifestyle with more outdoor activities and optimal nutrition are definitely warranted but will not erase vitamin D deficiency and must, in the case of sunlight exposure, be well balanced with regard to potential adverse effects such as skin cancer. Intake of vitamin D supplements is limited by relatively poor adherence (in particular in individuals with low-socioeconomic status) and potential for overdosing. Systematic vitamin D food fortification is, however, an effective approach to improve vitamin D status in the general population, and this has already been introduced by countries such as the US, Canada, India, and Finland. Recent advances in our knowledge on the safety of vitamin D treatment, the dose-response relationship of vitamin D intake and 25(OH)D levels, as well as data on the effectiveness of vitamin D fortification in countries such as Finland provide a solid basis to introduce and modify vitamin D food fortification in order to improve public health with this likewise cost-effective approach.

KW - Evidence

KW - Food fortification

KW - General population

KW - Guidelines

KW - Policy

KW - Public health

KW - Recommendations

KW - Vitamin D

UR - http://www.scopus.com/inward/record.url?scp=85050089451&partnerID=8YFLogxK

U2 - 10.3389/fendo.2018.00373

DO - 10.3389/fendo.2018.00373

M3 - Article

VL - 9

JO - Frontiers in endocrinology

JF - Frontiers in endocrinology

SN - 1664-2392

M1 - 373

ER -