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Efficacy of food fortification for the prevention of vitamin D deficiency – results of a systematic review and meta-analysis

Published online by Cambridge University Press:  15 August 2011

L. J. Black ,
K. M. Seamans ,
K. D. Cashman  and
M. Kiely
L. J. Black
Affiliation:
Vitamin D Research Group, School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland
K. M. Seamans
Affiliation:
Vitamin D Research Group, School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland
K. D. Cashman
Affiliation:
Vitamin D Research Group, School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland
M. Kiely
Affiliation:
Vitamin D Research Group, School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland
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Abstract

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Information
Proceedings of the Nutrition Society , Volume 70 , Issue OCE3: Joint Irish Section and American Society for Nutrition Meeting, 15–17 June 2011, 70th anniversary: ‘Vitamins in early development and healthy ageing: impact on infectious and chronic disease’ , 2011 , E101
Copyright
Copyright © The Authors 2011

Food fortification with vitamin D is a potentially effective public health strategy to address vitamin D deficiency. The aim of this systematic review was to evaluate the current evidence that food fortification can improve vitamin D status in the population by increasing circulating 25-hydroxyvitamin D (25(OH)D) concentrations in excess of the cut-off levels representing deficient or desirable status.

Five medical and health databases (Medline OVID, PubMed, CINAHL, Embase, Cochrane Central Register of Controlled Trials) were searched for randomised controlled trials in free-living adults that used vitamin D-fortified foods and reported circulating 25(OH)D concentrations. A total of 440 abstracts were retrieved. Two reviewers independently screened papers for eligibility and extracted relevant data. Meta-analysis of the absolute mean change in circulating 25(OH)D concentrations was conducted using a random-effects model. Dose, latitude and baseline 25(OH)D were identified a priori as probable sources of heterogeneity. Fourteen trials were included (n 936; 483 treated and 453 controls), derived from eleven published studies(Reference Biancuzzo, Young and Bibuld1–Reference Tangpricha, Koutkia and Rieke11), all of which showed a statistically significant beneficial effect of food fortification on circulating 25(OH)D concentrations. Individual treatment effects ranged from 10.00 (95% CI −3.20, 23.20) to 36.25 (22.47, 50.03) nmol/l. There was moderate statistical heterogeneity across the fourteen trials (P=0.002, I 2=60%) which was not explained by subgroup analyses of dose, latitude and baseline 25(OH)D concentrations.

These data suggest a beneficial effect of vitamin D-fortified food on circulating 25(OH)D concentrations. However, the treatment effect is influenced by a variety of factors, such as dose, latitude, baseline 25(OH)D concentrations, sun exposure, dietary vitamin D intake and age. Investigators did not typically report the change in prevalence of individuals with 25(OH)D concentrations below cut-off levels indicating deficiency, so it was not possible to evaluate the effectiveness of fortification in preventing vitamin D deficiency. There is a need for stronger data on the effect of vitamin D-fortified food on vitamin D status using controlled intervention studies and transparent reporting.

This work was supported by European Framework VI: EURopean micronutrient RECommendations Aligned (EURRECA) 2007–2011.

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