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

Research output: Contribution to journalArticleResearchpeer review

Authors

  • 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

External Research Organisations

  • University of 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 Medical University Salzburg (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
  • University of Vienna
  • University of Toronto
  • University of Auckland
  • U.S. Food and Drug Administration
  • Amsterdam UMC - Unversity Medical Centers
  • KU Leuven
  • University of Helsinki
  • Queen Mary University of London
  • Ruhr-Universität Bochum
View graph of relations

Details

Original languageEnglish
Article number373
JournalFrontiers in endocrinology
Volume9
Early online date17 Jul 2018
Publication statusPublished - Jul 2018

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.

Keywords

    Evidence, Food fortification, General population, Guidelines, Policy, Public health, Recommendations, Vitamin D

ASJC Scopus subject areas

Sustainable Development Goals

Cite this

Rationale and plan for vitamin D food fortification: A review and guidance paper. / Pilz, Stefan; März, Winfried; Cashman, Kevin D. et al.
In: Frontiers in endocrinology, Vol. 9, 373, 07.2018.

Research output: Contribution to journalArticleResearchpeer review

Pilz, S, März, W, Cashman, KD, Kiely, ME, Whiting, SJ, Holick, MF, Grant, WB, Pludowski, P, Hiligsmann, M, Trummer, C, Schwetz, V, Lerchbaum, E, Pandis, M, Tomaschitz, A, Grübler, MR, Gaksch, M, Verheyen, N, Hollis, BW, Rejnmark, L, Karras, SN, Hahn, A, Bischoff-Ferrari, HA, Reichrath, J, Jorde, R, Elmadfa, I, Vieth, R, Scragg, R, Calvo, MS, van Schoor, NM, Bouillon, R, Lips, P, Itkonen, ST, Martineau, AR, Lamberg-Allardt, C & Zittermann, A 2018, 'Rationale and plan for vitamin D food fortification: A review and guidance paper', Frontiers in endocrinology, vol. 9, 373. https://doi.org/10.3389/fendo.2018.00373, https://doi.org/10.15488/3733
Pilz, S., März, W., Cashman, K. D., Kiely, M. E., Whiting, S. J., Holick, M. F., Grant, W. B., Pludowski, P., Hiligsmann, M., Trummer, C., Schwetz, V., Lerchbaum, E., Pandis, M., Tomaschitz, A., Grübler, M. R., Gaksch, M., Verheyen, N., Hollis, B. W., Rejnmark, L., ... Zittermann, A. (2018). Rationale and plan for vitamin D food fortification: A review and guidance paper. Frontiers in endocrinology, 9, Article 373. https://doi.org/10.3389/fendo.2018.00373, https://doi.org/10.15488/3733
Pilz S, März W, Cashman KD, Kiely ME, Whiting SJ, Holick MF et al. Rationale and plan for vitamin D food fortification: A review and guidance paper. Frontiers in endocrinology. 2018 Jul;9:373. Epub 2018 Jul 17. doi: 10.3389/fendo.2018.00373, 10.15488/3733
Pilz, Stefan ; März, Winfried ; Cashman, Kevin D. et al. / Rationale and plan for vitamin D food fortification: A review and guidance paper. In: Frontiers in endocrinology. 2018 ; Vol. 9.
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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

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