US children not getting enough vitamin D, recommends free milks and perhaps 3X increased fortification – Sept 2022

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Perspective: School Meal Programs Require Higher Vitamin D Fortification Levels in Milk Products and Plant-Based Alternatives—Evidence from the National Health and Nutrition Examination Surveys (NHANES 2001–2018)

Advances in Nutrition, Vol 13, # 5, Sept 2022, Pages 1440–1449,
  https://doi.org/10.1093/advances/nmac068 (view for free at DeepDive)
Mona S Calvo, Susan J Whiting

Poor vitamin D status impairs bone growth and immune defense in school-aged children and adolescents, particularly in minorities. Vitamin D insufficiency/deficiency increases the risk of acute viral respiratory infection, underscoring the need for adequate vitamin D intakes during school sessions when viral exposure may be greatest. We studied available vitamin D–related survey data and published findings based on NHANES (2001–2018) to assess the dependency of vitamin D status (25-hydroxyvitamin D [25(OH)D]; in nmol/L) on vitamin D intake (μg/d) in elementary school–aged children (4–8 y), middle school children (9–13 y), and high school adolescents (14–18 y). We sought evidence supporting the need for school programs to facilitate vitamin D adequacy. Usual vitamin D intakes from food and beverages by children/adolescents (NHANES 2015–2018) examined at the 50th percentile intake by race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic) showed all age groups consumed less than half of the Estimated Average Requirement (EAR) for vitamin D (10 μg/d), independent of race/ethnicity. NHANES (2001–2010) analyses show evidence of lower vitamin D status in school-aged children that is linked to lower intakes of fortified milk varying over race/ethnicity and age. Adolescents had lower vitamin D status and milk intake than younger children. A total of 22–44% of vitamin D intakes occurred away from home, with larger percentages of total intakes at breakfast and lunch, at times consistent with school meals. Ever-present inadequate vitamin D intakes with a large percentage consumed away from home together with well-established benefits to growth, bone, and immune defense from enriched vitamin D–fortified milk in school intervention trials provide strong justification to require enriched vitamin D–fortified foods in school meals. An easy to implement plan for improving vitamin D intakes is possible through the FDA's amendment allowing higher vitamin D fortification levels of dairy and plant-based milk alternatives that could increase vitamin D intakes beyond the EAR with just 2 daily servings.

Clipped from PDF

1. School intervention trials also provide evidence of increased milk consumption when fortified milk is offered atno cost, as well as better
   • attendance,
   • test scores,
   • bone growth and
   • resistance to viral infection.”
2. “Swedish researchers determined that children with fair skin require less vitamin D (14 ug/d or 560 lU/d) compared to darker skinned children who required 28 ug/d or 1,120 IU/d to maintain circulating 25(OH)D > 50 nmol/L in winter (63).”

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Fails to address: preschool. older children, no milk in summer, weekends, need more to get >20 ng

Might be better to fortify bread: see below

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VitaminDWiki - Fortification with Vitamin D

135 items in Fortification category

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

• Biofortification with Vitamin D - several studies
• Vitamin D fortification in Europe preventing 27,000 Cancer deaths, could prevent 129,000 – May 2022
• Vitamin D fortification could eliminate 1 in 10 Cancer deaths in the EU – May 2022
• After years of adding vitamin D, Finland now has 38 ng levels - March 2022
• Fortification with Vitamin D works – 16 studies of Danish experience – July 2021
• Vitamin D fortification of beverages – Review March 2022
• Bread fortified with Vitamin D - many studies 13+ studies
• International Conference of Vitamin D Fortification of Food (India) – Sept 2018
• 2400 IU of vitamin D needed to get most Northern adults above 20 ng – June 2020
• Vitamin D home fortification- don't wait 100 years for your govt

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VitaminDWiki - Bread Fortification (11 as of Oct 2022)

VitaminDWiki Fortification pages with BREAD in title

This list is automatically updated

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VitaminDWiki - Change of Vitamin D Fortification in Denmark

• 60 percent more life births after infertility diagnosis if Vitamin D fortification (Denmark) - Nov 2019
• Vitamin D food fortification during pregnancy reduced gestational diabetes in daughters by 13 percent – Nov 2018
• Vitamin D added to margarine reduced inflammatory bowel disease by 13 percent 30 years later – Nov 2019
• Preeclampsia of offspring cut in half if mother who smoked had vitamin D fortified margarine – Dec 2017
• Danish study of childhood diseases vs vitamin D fortification – May 2013
• 9 studies by Denmak D-Tech group (fortifiy Margarine with Vitamin D) online as of Nov 2019

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There are problems with increasing milk (Calcium) intake

• Drinking 3 glasses of milk daily associated with doubling the death rate – Oct 2014
• Most people have major problems of milk as a source of vitamin D
• Calcium from milk also causes 5+ major health problems Dr. Greger, 2015
• Calcium hazards and bioavailability
  • The problem may actually be the increasing the Ca:Mg ratio
  • Calcium to Magnesium Ratio - many studies

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See related in VitaminDWiki

• Low fat milk provides 2.5 times less vitamin D – May 2016 - and many children now drink low-fat milk
• Vitamin D levels have been crashing since 1995 (Polish Children, Elite Military, etc)
• 4,000 IU of Vitamin D is OK - 19 organizations agree - 2018
• Governments are increasing their Vitamin D recommendations about every decade.
• Deficiency of Vitamin D category listing has 462 items along with related searches
• 10 Reasons why children no longer have healthy levels of Vitamin D
• Prediction: Vitamin D levels will continue dropping for decades
• Infant-Child category has 848 items along with related searches
• Most people have major problems of milk as a source of vitamin D
• Review of vitamin D from milk products is unaware that skim milk provides little VitD – Aug 2018
  • Note: 95% of countries do not mandate any Vitamin D fortification of milk
  • Note: Some suggest Vitamin D2 fortification - ((Vitamin D2 again decreased vitamin D3 levels – RCT Nov 2012

L|D2 sometimes DECREASES vitamin D3 levels))

• Vets decided: Vitamin D2 should not be used as a Vitamin supplement for any mammal – Oct 2006

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Instead of waiting decades for more fortification, just give your child 50,000 IU of vitamin D3 once a month

50,000 IU monthly = 1600 IU daily
Third study found that Infants needed 1600 IU of vitamin D – JAMA RCT May 2013
Summary: 1600 IU vitamin D daily ==> 98% of infants >30 ng
Can get 50,000 IU Vitamin D anywhere on the globe
Vitamin D home fortification- don't wait 100 years for your govt

Alternatively: 10,000 IU every SUNday (1400 IU daily average)