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Content archived on 2024-05-18

Towards an optimal strategy for optimal vitamin d fortification


The OPTIFORD project included three intervention studies (WP1, WP2, and WP3) and in each WP it was shown that the specially produced tablets containing vitamin D (5, 10, or 20 microgram) had a beneficial effect on the vitamin D status when this is expressed as the concentration of serum 25-OH vitamin D. Thus, an improvement in vitamin D status (25-OH vitamin D concentration) can be obtained by means of tablets that contain vitamin D without calcium or other nutrients. The production of such tablets would enable an improved vitamin D status without negative effects. It is recommended that such vitamin D tablets become available in all countries. It is preferable that such tablets do not include gelatine or in any way are based on pork (of religious reasons)
In the OPTIFORD project food intake data were collected in Denmark, Finland, Ireland, Poland and Spain, by means of Food Frequency Questionnaires (FFQ). FFQ is a pre-coded food intake questionnaire, and for each food the question contains several kinds of information. For example for milk it is type of milk ingested, the portion size, and how often it has been drunk. The frequency is generally divided into 9 categories, from 4-5 times per day to less than once per month. The Food Frequency Questionnaires (FFQ) was not identical in the five countries. Five different languages were used, and as the food consumption pattern is different in different countries, the FFQ did not include exactly the same foods in all countries. In each country each food (each recipe) should have a unique identification. Sometimes the food is a single food, e.g. milk, which can be linked directly to a food composition database. In other instances the foods are complex, e.g. mixed dishes that has undergone some sort of preparation. The food intake data, i.e. FFQ and data on portion size and recipe information were sent by e-mail to Denmark. The calculations for the estimations of the vitamin D and calcium intake took place at DFVF, Copenhagen. By this method the food intake data from the different countries were handled in the same way, and the intake estimation could be calculated using data either from national food composition databases or from a common database developed during the Optiford project. This made it possible to avoid differences due to different national databases.
Fortification of non-fatty foods such as bread could be a feasible means to improve the vitamin D status, which is generally low in Northern countries during winter. Fortified wheat and rye bread were baked. The vitamin D preparation was water soluble powder delivered by Roche Ltd. resulting in a vitamin D content of around 12 microgram/100g baked bread. By chemical analysis it was shown that vitamin D was evenly distributed in the bread and was stable (did not disappear in the baking process). The bioavailability of vitamin D in bread was tested on four groups of healthy women receiving: 1. 85g fortified wheat bread per day 2. 85g fortified rye bread per day 3. 85g regular (unfortified) wheat bread per day 4. 85gram regular wheat bread and per day, and a daily vitamin D tablet containing 10 microgram. The study was conducted over three weeks in February-March in Finland where there is no or very little sunlight exposure. In groups 1,2 and 4 the vitamin D status (measured as the concentration of serum 25OHD) was improved significant, while no improvement was found in the control group (no 3). The study also indicated that supplementation (in bread or as tablets) was more effective on persons with a low initial level of 25-OHD. It is concluded that the added vitamin D is dispersed smoothly in the bread and is stable and bioavailable. Fortified bread is a feasible means to improve the vitamin D status equally in all population groups, and it is safe as bread is not likely to be over consumed. However, the appropriate (optimum) content of vitamin D in bread may be different in different countries. This must be studied.

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