Response to Vitamin D fortification varies from 1 to 10 nmol per 100 IU daily – review Aug 2023

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Fortification of Staple Foods for Household Use with Vitamin D: An Overview of Systematic Reviews

Nutrients 2023, 15(17), 3742; https://doi.org/10.3390/nu15173742
by Patrick Nyamemba Nyakundi 1,2,†ORCID ,Zsuzsanna Némethné Kontár 1,†,Attila Kovács 3,Luca Járomi 1ORCID, Afshin Z and 1 and Szimonetta Lohner 1,3,*ORCID
1 Department of Public Health Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
2 Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary
3 Cochrane Hungary, Clinical Center of the University of Pécs, Medical School, University of Pécs, 7623 Pécs, Hungary
* Author to whom correspondence should be addressed.

PDF table of contents

Vitamin D deficiency is a global public health concern with significant implications for bone health and chronic disease prevention. Our aim was to summarize the evidence from Cochrane and other systematic reviews evaluating the benefits or harms of vitamin D fortification of staple foods for household use. In April 2023, we systematically searched Ovid MEDLINE, Embase, Epistemonikos and the Cochrane Database of Systematic Reviews for systematic reviews investigating the effects of vitamin D fortification of food in general populations of any age. We used Cochrane methodology and assessed the methodological quality of included studies using AMSTAR (A MeaSurement Tool to Assess Systematic Reviews). We assessed the degree of overlap among reviews. All outcomes included in systematic reviews were assessed. The protocol is registered in PROSPERO (registration number: CRD42023420991). We included 27 systematic reviews out of 5028 records for analysis. Overall, 11 out of 12 systematic reviews calculating pooled estimates reported a significant increase in serum 25(OH)D concentrations. The mean change in serum 25(OH)D concentrations per additional 100 units of vitamin D ranged from 0.7 to 10.8 nmol/L. Fortification of food with vitamin D showed a reduction in the prevalence of vitamin D deficiency based on high-certainty evidence. Parathormone (PTH) levels were described to decrease, bone mineral density to increase, while the effects on other bone turnover markers were inconsistent. Fortification did not significantly impact most anthropometric parameters, but it seemed to positively influence lipid profiles. In summary, fortification of food with vitamin D results in a reduction of vitamin D deficiency and might increase serum 25(OH)D concentrations, to varying extents depending on the fortified vehicle and population characteristics. Additionally, fortification may have a positive impact on bone turnover and lipid metabolism but may only have a limited effect on anthropometric parameters.
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VitaminDWiki – Fortification with Vitamin D contains

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 contains

VitaminDWiki Fortification pages with BREAD in title

This list is automatically updated

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VitaminDWiki – Change of Vitamin D Fortification in Denmark contains

• 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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Many reasons for a poor response to Vitamin D fortification

1. Genes
2. Low fat content of food ( if the vitamin D is fat, rather than water soluable)
3. Note: 2.5% and 0% fat fortified milk provides far less response than 4% milk
4. Time of day (near supper is best, breakfast is worst)
5. Low on co-factors such as Magnesium and Omega-3
6. Have a current health problem that is consuming Vitamin D (surgery, diabetes, some cancers)
7. Have a current health problem that is associated with poor response (Asthma, COPD, MS, Obesity...)
8. Poor level of some B vitamins
9. Low Boron
   39% increase in vitamin D levels: low Boron diet to Boron replete diet. 3 mg of Boron/day for 49 days
10. Poor gut, fatty liver
11. People who are extremely deficient will have virtually no response until their levels start to be respored
12. Elderly have about 1/4 the absorption of Vitamin D from their intestines
13. Poor gut bacteria
    Vitamin D is aided by probiotics (review of RCTs) – Dec 2020

See also: low response to fortification, oral, UV, etc

• Response to Vitamin D - many studies
• Overview Vitamin D Dose-Response
• Reasons for low response to vitamin D
• Increased Vitamin D response if take cofactors, etc
• Vitamin D Nutrigenomics - High, Medium, and Low Responders - March 2019
• Boron improves magnesium absorption and may help vitamin D non-responders – Aug 2015

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