Assessing Health Consequences of Vitamin D Fortification Utilizing a Societal Experiment Design: Methodological Lessons Learned from the D-Tect Project
Int. J. Environ. Res. Public Health 2021, 18(15), 8136; https://doi.org/10.3390/ijerph18158136
by Mina Nicole Händel 1,*,†OrcID,Ramune Jacobsen 2,†OrcID,Fanney Thorsteinsdottir 1OrcID,Amélie Cléo Keller 3,Maria Stougaard 4,Camilla Bjørn Jensen 5,Caroline Moos 1OrcID,Katrine Sidenius Duus 1OrcID,Allan Jensen 6,Ulrik Schiøler Kesmodel 7,Bo Abrahamsen 8,9,10 and Berit Lilienthal Heitmann 1,3,11OrcID
The Danish govt mandated fortifing margarine with vitamin D till 1985
Fortification works, even if food is cooked, but govts rarely fortifiy with enough
Govts, food producers, and families can fortify:
milk, yogurt, beer, bread, cereals, cooking oil, soups, jams, jellys, honey, snack bars, etc.
Some interesting fortification articles
- Vitamin D fortification of edible oils in India starting in 2017
- Vitamin D food fortification – many trials listed – Aug 2018
- International Conference of Vitamin D Fortification of Food (India) – Sept 2018
- Vitamin D fortification of milk helps (proven in Gemany this time) – RCT Dec 2013
- Improved health due to vitamin D fortification in Finland
- Fortification with Vitamin D works – 16 studies of Danish experience – July 2021
- Marks and Spencer is first UK retailer to add Vitamin D to all of its breads – Dec 2019
- Vitamin D food fortification, Belgium considers 270 IU per kcal of milk or bread– June 2019
- Best thing since sliced bread (vitamin D bread was patented and baked in 1929)
- Vitamin D2 from bread yeast is 4 times less bioaccessible than D2 in milk – April 2016
- Vitamin D3 fortified bread better than supplement – RCT April 2016
- 5000 IU of vitamin D in daily bread resulted in 50 ng and improved quality of life– May 2014
- Cooking reduces vitamin D content by about 30 percent – Oct 2013
- Germany does not fortify ANY food with vitamin D, is considering 1000 IU from bread – Nov 2013
- 5,000 IU of vitamin D (in bread) was great – should have continued forever – Oct 2013
- 5000 IU vitamin D3 added daily to bread raised blood levels to 50 ng – 2009
- Danes opposed to Vitamin D fortification, will get more COPD, diabetes, depression, lupus, leg pain, etc – Oct 2015
- Schizophrenia increased 40 percent for Spring births after Danes stopped vitamin D fortification – April 2014
- Danish study of childhood diseases vs vitamin D fortification – May 2013
By utilizing historical changes in Danish legislation related to mandatory vitamin D fortification of margarine, which was implemented in the mid 1930s and abruptly abandoned in June 1985, the studies in the D-tect project investigated the effects of vitamin D on health outcomes in individuals, who during gestation were exposed or unexposed to extra vitamin D from fortified margarine. This paper reviews and narratively summarizes the analytic approaches alongside the results of the societal fortification experiment studies from the D-tect project and addresses the challenges in designing societal experiment studies and evaluating their results. The latter are discussed as lessons learned that may be useful for designers of similar studies, expected to be extensively utilized while researching the health consequences of the COVID-19 pandemic by comparing individuals born before and after the epidemic. In the D-tect project, 16 articles based on the societal fortification experiment were published analyzing 10 different outcomes and using different statistical approaches. Lessons learned included the detail of the analysis of the historical information on the exposure, availability and validity of the outcome data, variety of analytical approaches, and specifics concerning vitamin D effect evaluation, such as consideration of the influence of sunshine or season. In conclusion, the D-tect project clearly demonstrated the cost-effectiveness and research potential of natural- or societal-experiment-based studies.
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