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

verfasst von

Stefan Pilz, Winfried März, Kevin D. Cashman, Mairead E. Kiely, Susan J. Whiting, Michael F. Holick, William B. Grant, Pawel Pludowski, Mickael Hiligsmann, Christian Trummer, Verena Schwetz, Elisabeth Lerchbaum, Marlene Pandis, Andreas Tomaschitz, Martin R. Grübler, Martin Gaksch, Nicolas Verheyen, Bruce W. Hollis, Lars Rejnmark, Spyridon N. Karras, Andreas Hahn, Heike A. Bischoff-Ferrari, Jörg Reichrath, Rolf Jorde, Ibrahim Elmadfa, Reinhold Vieth, Robert Scragg, Mona S. Calvo, Natasja M. van Schoor, Roger Bouillon, Paul Lips, Suvi T. Itkonen, Adrian R. Martineau, Christel Lamberg-Allardt, Armin Zittermann

Abstract

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.

Organisationseinheit(en)

Institut für Lebensmittelwissenschaft und Humanernährung
Abteilung Ernährungsphysiologie und Humanernährung

Externe Organisation(en)

Universität Graz
SYNLAB Holding Deutschland GmbH
University College Cork
University of Saskatchewan
Boston University (BU)
Sunlight - Nutrition and Health Research Center
Children's Memorial Health Institute
Maastricht University
Bad Gleichenberg Clinic
Inselspital - Universitätsspital Bern
Paracelsus Medizinische Privatuniversität (PMU)
Medical University of Graz
Medical University of South Carolina
Aarhus University Hospital
Aristotle University of Thessaloniki (A.U.Th.)
Universität Zürich (UZH)
Universitätsklinikum des Saarlandes
University of Tromso
Universität Wien
University of Toronto
University of Auckland
U.S. Food and Drug Administration
Amsterdam UMC - Unversity Medical Centers
KU Leuven
Universität Helsinki
Queen Mary University of London
Ruhr-Universität Bochum

Typ

Artikel

Journal

Frontiers in endocrinology

Band

9

ISSN

1664-2392

Publikationsdatum

07.2018

Publikationsstatus

Veröffentlicht

Peer-reviewed

Ja

ASJC Scopus Sachgebiete

Endokrinologie, Diabetes und Stoffwechsel

Ziele für nachhaltige Entwicklung

SDG 3 – Gute Gesundheit und Wohlergehen

Elektronische Version(en)

https://doi.org/10.3389/fendo.2018.00373 (Zugang: Offen)
https://doi.org/10.15488/3733 (Zugang: Offen)