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Wang K, Zhao X, Yang S, Qi X, Li A, Yu W. New insights into dairy management and the prevention and treatment of osteoporosis: The shift from single nutrient to dairy matrix effects-A review. Compr Rev Food Sci Food Saf 2024; 23:e13374. [PMID: 38847750 DOI: 10.1111/1541-4337.13374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 04/23/2024] [Accepted: 05/12/2024] [Indexed: 06/13/2024]
Abstract
Dairy is recognized as a good source of calcium, which is important for preventing osteoporosis. However, the relationship between milk and bone health is more complex than just calcium supplementation. It is unwise to focus solely on observing the effects of a single nutrient. Lactose, proteins, and vitamins in milk, as well as fatty acids, oligosaccharides, and exosomes, all work together with calcium to enhance its bioavailability and utilization efficiency through various mechanisms. We evaluate the roles of dairy nutrients and active ingredients in maintaining bone homeostasis from the perspective of the dairy matrix effects. Special attention is given to threshold effects, synergistic effects, and associations with the gut-bone axis. We also summarize the associations between probiotic/prebiotic milk, low-fat/high-fat milk, lactose-free milk, and fortified milk with a reduced risk of osteoporosis and discuss the potential benefits and controversies of these dairy products. Moreover, we examine the role of dairy products in increasing peak bone mass during adolescence and reducing bone loss in old age. It provides a theoretical reference for the use of dairy products in the accurate prevention and management of osteoporosis and related chronic diseases and offers personalized dietary recommendations for bone health in different populations.
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Affiliation(s)
- Kaili Wang
- Key Laboratory of Dairy Science, College of Food Science, Ministry of Education, Northeast Agricultural University, Harbin, China
| | - Xu Zhao
- Key Laboratory of Dairy Science, College of Food Science, Ministry of Education, Northeast Agricultural University, Harbin, China
| | - Sijia Yang
- Key Laboratory of Dairy Science, College of Food Science, Ministry of Education, Northeast Agricultural University, Harbin, China
| | - Xiaoxi Qi
- Key Laboratory of Dairy Science, College of Food Science, Ministry of Education, Northeast Agricultural University, Harbin, China
| | - Aili Li
- Key Laboratory of Dairy Science, College of Food Science, Ministry of Education, Northeast Agricultural University, Harbin, China
- Dairy Processing Technology Research Centre, Heilongjiang Green Food Science Research Institute, Harbin, China
| | - Wei Yu
- Key Laboratory of Dairy Science, College of Food Science, Ministry of Education, Northeast Agricultural University, Harbin, China
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2
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Nölle N, Hörnstein A, Lambert C. Vitamin D fortification of selected edible insect species through UVB-treatment. Food Chem 2024; 444:138679. [PMID: 38341920 DOI: 10.1016/j.foodchem.2024.138679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/25/2024] [Accepted: 02/03/2024] [Indexed: 02/13/2024]
Abstract
Edible insects are attracting increased interest worldwide, because they are arguably more sustainable than more established animal foods. Apart from being rich in protein and minerals, they can also form vitamin D3 after treatment with UVB light (290-315 nm). However, only limited research, which has almost exclusively been conducted on living insects, reared under UVB lamps, has been done in this regard. As research on mushrooms has shown, that vitamin D formation is much more effective and less time consuming, when a previously sliced or ground product is treated with UVB light, it would likely be more practical to treat powdered insects with UVB light, rather than rearing them under UVB lamps. Therefore, the aim of this work was to confirm the presence of vitamin D3 in powdered UVB-treated yellow mealworms (Tenebrio molitor), migratory locusts (Locusta migratoria) and two-spotted crickets (Gryllus bimaculatus) as well as to subsequently quantify potential vitamin D content. Samples were analyzed via HPLC, and presence of vitamin D3 was verified via standard addition and spectrum analysis. UVB-treated migratory locusts and two-spotted crickets did not contain quantifiable amounts of vitamin D3. However, UVB-treated mealworms showed substantial amounts of vitamin D3 (8.95-18.24 µg/g dry matter). Thus, the UVB-treatment of powdered mealworm is an effective approach via which to enhance their vitamin D3 content and even modest serving sizes can supply the recommended daily intake of vitamin D.
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Affiliation(s)
- Nils Nölle
- Institute of Nutritional Sciences, Department of Molecular Nutritional Science, University of Hohenheim Stuttgart, Germany.
| | - Aranya Hörnstein
- Institute of Nutritional Sciences, Department of Molecular Nutritional Science, University of Hohenheim Stuttgart, Germany
| | - Christine Lambert
- Institute of Nutritional Sciences, Department of Molecular Nutritional Science, University of Hohenheim Stuttgart, Germany
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3
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Cashman KD, O'Neill CM. Strategic food vehicles for vitamin D fortification and effects on vitamin D status: A systematic review and meta-analysis of randomised controlled trials. J Steroid Biochem Mol Biol 2024; 238:106448. [PMID: 38141736 DOI: 10.1016/j.jsbmb.2023.106448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/15/2023] [Accepted: 12/17/2023] [Indexed: 12/25/2023]
Abstract
There has been growing interest in the potential of vitamin D food fortification in Europe as a means of addressing low vitamin D status. The WHO-FAO suggest that choosing a suitable food vehicle and ensuring the combination of the food vehicle and the fortificant will be efficacious and effective are of key importance to a successful food fortification programme. Our key objective was to conduct a systematic review and meta-analysis to investigate the effect of various animal- and plant-based food vehicles fortified with vitamin D (as D3 or D2) on circulating 25-hydroxyvitamin D [25(OH)D] concentrations. A list of prioritised food vehicles was established and we searched PubMed, Embase, Scopus and Web of Science for randomised controlled trials (RCTs) which used these vehicles individually, and which met prespecified criteria. The searches identified 49 papers which described suitable RCTs using vitamin D-fortified bread/savoury biscuits (n = 5), orange juice (n = 5), UV-mushrooms (n = 8), cheese (n = 3), yogurt (n = 5), fluid milk (n = 13), powdered milk (n = 5), eggs (n = 2), edible oils (n = 4), or breakfast cereal (n = 1). No suitable RCTs were identified for rice, maize flour, butter, margarine or dairy spreads, plant-based milk or yogurt alternatives. Random-effects meta-analyses of each food vehicle individually indicated weighted mean differences (WMD) in 25(OH)D in the range ∼9-35 nmol/L (3-15 RCT arms, depending on vehicle), and all statistically significant (P < 0.01-0.0001), with the exception of UV-mushrooms (P = 0.06). Heterogeneity was variable (I2 =33-99%, depending on vehicle), but subgroup analysis based on vitamer and dose reduced it in some instances. Sub-group analysis on the basis of whether the food vehicles were from plant-based or animal-based origin showed no significant difference in WMD (15.2 versus 15.9 nmol/L, respectively; P = 0.48). These results support the use of various animal- and plant-based food vehicles for vitamin D fortification to improve circulating 25(OH)D concentrations in populations. This work was registered with PROSPERO as CRD42023439883.
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Affiliation(s)
- Kevin D Cashman
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland.
| | - Colette M O'Neill
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
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4
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McCourt AF, Mulrooney SL, O’Neill GJ, O’Riordan ED, O’Sullivan AM. Serum 25-hydroxyvitamin D response to vitamin D supplementation using different lipid delivery systems in middle-aged and older adults: a randomised controlled trial. Br J Nutr 2023; 130:1548-1557. [PMID: 36912075 PMCID: PMC10551469 DOI: 10.1017/s0007114523000636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023]
Abstract
Food fortification improves vitamin D intakes but is not yet mandated in many countries. Combining vitamin D with different dietary lipids altered vitamin D absorption in in vitro and postprandial studies. This randomised, placebo-controlled trial examined the effect of the lipid composition of a vitamin D-fortified dairy drink on change in 25-hydroxyvitamin D (25(OH)D) concentrations. Sixty-three healthy adults aged 50+ years were randomised to one of the following for 4 weeks: vitamin D-fortified olive oil dairy drink, vitamin D-fortified coconut oil dairy drink, vitamin D supplement or placebo control dairy drink. All vitamin D groups received 20 µg of vitamin D3 daily. Serum was collected at baseline and post-intervention to measure 25(OH)D concentrations and biomarkers of metabolic health. Repeated-measures general linear model ANCOVA (RM GLM ANCOVA) compared changes over time. There was a significant time × treatment interaction effect on 25(OH)D concentrations for those classified as vitamin D-insufficient (P < 0·001) and -sufficient at baseline (P = 0·004). 25(OH)D concentrations increased significantly for all insufficient participants receiving vitamin D3 in any form. However, for vitamin D-sufficient participants at baseline, 25(OH)D concentrations only increased significantly with the coconut oil dairy drink and supplement. There was no effect of vitamin D on biomarkers of metabolic health. Vitamin D fortification of lipid-containing foods may be used in lieu of supplementation when supplement adherence is low or for individuals with dysphagia. These results are important given the recent recommendation to increase vitamin D intakes to 15-20 µg for older adults in Ireland.
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Affiliation(s)
- Aislinn F. McCourt
- UCD Institute of Food and Health, University College Dublin (UCD), Dublin, Republic of Ireland
| | - Steven L. Mulrooney
- UCD Institute of Food and Health, University College Dublin (UCD), Dublin, Republic of Ireland
| | - Graham J. O’Neill
- TUD School of Food Science and Environmental Health, Technological University Dublin (TUD), Dublin, Republic of Ireland
| | - E. Dolores O’Riordan
- UCD Institute of Food and Health, University College Dublin (UCD), Dublin, Republic of Ireland
| | - Aifric M. O’Sullivan
- UCD Institute of Food and Health, University College Dublin (UCD), Dublin, Republic of Ireland
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Murata H, Zhang Q, Ito T, Kawakami R, Sakamoto S, Torii S, Shibata S, Tanisawa K, Higuchi M. The combined effect of rowing exercise and the intake of functional foods containing inulin on muscle mass and bone mineral density in older Japanese women. Geriatr Gerontol Int 2023; 23:779-787. [PMID: 37721114 DOI: 10.1111/ggi.14672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 08/17/2023] [Accepted: 09/03/2023] [Indexed: 09/19/2023]
Abstract
AIM Aging decreases muscle mass and bone mineral density (BMD), especially in older women. It has been reported that rowing and inulin intake positively affect muscle and bone, respectively. We examined the synergistic effect of rowing and functional food intake, including inulin, on lean body mass, BMD, and physical function parameters in older Japanese women. METHODS Fifty women aged 65-79 years were divided into four groups with or without inulin intake and rowing. The interventions were carried out for 12 weeks in each group. We assessed lean body mass and BMD using dual-energy X-ray absorptiometry at baseline and after the intervention and examined the changes in the values in each group. RESULTS Lean body mass in all groups decreased, and the change in lean body mass in the group with rowing and inulin intake was significantly smaller than that in the group without them (-0.05 ± 0.61; -0.83 ± 0.59 kg; P = 0.030). The BMD in the three intervention groups increased after the 12-week intervention. The change in BMD in each of the three intervention groups showed significant differences compared with the control group (Rowing + Inulin: P = 0.03; Rowing + No inulin: P = 0.01; No rowing + Inulin: P < 0.01). CONCLUSIONS Rowing and the intake of functional foods, including inulin, synergistically prevented a decrease in lean body mass. These factors, individually and additively, might increase BMD in older Japanese women. Geriatr Gerontol Int 2023; 23: 779-787.
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Affiliation(s)
- Hiroko Murata
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
- Department of Health and Nutrition, Jumonji University, Niiza, Japan
| | - Qiwei Zhang
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Tomoko Ito
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
- Department of Food and Nutrition, Tokyo Kasei University, Itabashi, Japan
| | - Ryoko Kawakami
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
- Physical Fitness Research Institute, Meiji Yasuda Life Foundation of Health and Welfare, Hachioji, Japan
| | - Shizuo Sakamoto
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
- Faculty of Sport Science, Surugadai University, Hanno, Japan
| | - Suguru Torii
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | | | - Kumpei Tanisawa
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Mitsuru Higuchi
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
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Nyakundi PN, Némethné Kontár Z, Kovács A, Járomi L, Zand A, Lohner S. Fortification of Staple Foods for Household Use with Vitamin D: An Overview of Systematic Reviews. Nutrients 2023; 15:3742. [PMID: 37686773 PMCID: PMC10489979 DOI: 10.3390/nu15173742] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
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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Affiliation(s)
- Patrick Nyamemba Nyakundi
- Department of Public Health Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary
| | | | - Attila Kovács
- Cochrane Hungary, Clinical Center of the University of Pécs, Medical School, University of Pécs, 7623 Pécs, Hungary
| | - Luca Járomi
- Department of Public Health Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Afshin Zand
- Department of Public Health Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Szimonetta Lohner
- Department of Public Health Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
- Cochrane Hungary, Clinical Center of the University of Pécs, Medical School, University of Pécs, 7623 Pécs, Hungary
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7
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Using food fortification to improve vitamin D bioaccessibility and intakes. Proc Nutr Soc 2022; 81:99-107. [DOI: 10.1017/s0029665121003803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Vitamin D intakes and status are low in many countries due to seasonal UVB exposure variation and the fact that few foods are naturally vitamin D rich. Data modelling studies show that vitamin D intakes increase with food fortification, and countries with mandatory fortification policies have higher vitamin D intakes and status compared to countries without. While many foods can be vitamin D fortified, vitamin D bioavailability differs depending on fortification methods, food structure and composition. Randomised controlled trials (RCT) report that vitamin D2 bioavailability varies between foods, whereas vitamin D3 is bioavailable from many foods. In vitro studies suggest that altering the lipid composition of fortified foods increases vitamin D3 absorption. Olive oil increased vitamin D3 absorption during in vitro digestion compared to other dietary oils. Additionally, when vitamin D3 was incorporated into micelles formed from in vitro digestion of olive oil, more vitamin D3 was absorbed compared to other dietary oils. However, in a human postprandial study, a preformed vitamin D3 micelle dairy drink did not increase vitamin D3 absorption, and a vitamin D3 olive dairy drink increased vitamin D3 absorption in vitamin D insufficient participants only. Action is urgently needed to improve vitamin D intakes and status worldwide. Food fortification improves vitamin D intakes; however, fortification strategies unique to each country are needed. This review will synthesise the literature describing data modelling and intervention trials that assess the safety and efficacy of vitamin D fortification strategies, and those manipulating food composition to alter vitamin D bioavailability from fortified foods. Additionally, RCT examining the impact of vitamin D fortification strategies on vitamin D intakes and status over time are reviewed.
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Effects of vitamin D-fortified oil intake versus vitamin D supplementation on vitamin D status and bone turnover factors: A double blind randomized clinical trial. Clin Nutr ESPEN 2022; 47:28-35. [DOI: 10.1016/j.clnesp.2021.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 12/17/2021] [Accepted: 12/21/2021] [Indexed: 11/22/2022]
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An Update on Vitamin D Deficiency Status in Malaysia. Nutrients 2022; 14:nu14030567. [PMID: 35276926 PMCID: PMC8838715 DOI: 10.3390/nu14030567] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 02/04/2023] Open
Abstract
Vitamin D is essential for maintaining serum calcium levels, ensuring sufficient bone mineralization, immunomodulatory properties, and a protective effect on the cardiovascular system, renal disease, cancer, as well as in pregnancy. Vitamin D deficiency is prevalent worldwide, and it is not related to a country's development index. However, the data on vitamin D deficiencies are primarily taken from out-of-date, small-scale studies on target age groups or specific diseases, rather than from large-scale, population-based surveys. In Malaysia, for the past 16 years, studies were conducted involving adult men and women, pregnant women, postmenopausal women, adolescent, and children especially with specific diseases such as spina bifida, epilepsy, chronic liver disease, and atopic dermatitis. Only a few large surveys were conducted involving children and adolescents. Across the specific target population studied, vitamin D deficiency and insufficiency were seen particularly among females, Indians, and those of Malay ethnicity. This is related to widely known causes of vitamin D deficiency such as skin type (melanin) and sun avoidant lifestyles that include covering clothes, largely practiced by Malay Muslims in Malaysia. Other related causes or the high-risk groups are breastfed infants, the elderly, the obese, those on medications, and those characterized by fat malabsorption and geophysical factors. Vitamin D deficiency can be managed with pharmacological or non-pharmacological approaches, depending on the severity. The objective is to raise serum vitamin D to a normal level, hence, relieving the symptoms and reducing the adverse health outcomes. Despite no clear guidelines in treating vitamin D deficiency in Malaysia, this condition can be prevented with taking adequate vitamin D in food resources, sun exposure, or supplementation. Special attention should be given to high-risk groups including infants, obese patients, and the elderly.
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Niedermaier T, Gredner T, Kuznia S, Schöttker B, Mons U, Brenner H. Potential of Vitamin D Food Fortification in Prevention of Cancer Deaths-A Modeling Study. Nutrients 2021; 13:3986. [PMID: 34836241 PMCID: PMC8621821 DOI: 10.3390/nu13113986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/01/2021] [Accepted: 11/05/2021] [Indexed: 12/11/2022] Open
Abstract
Meta-analyses of randomized controlled trials (RCTs) have estimated a 13% reduction of cancer mortality by vitamin D supplementation among older adults. We evaluated if and to what extent similar effects might be expected from vitamin D fortification of foods. We reviewed the literature on RCTs assessing the impact of vitamin D supplementation on cancer mortality, on increases of vitamin D levels by either supplementation or food fortification, and on costs of supplementation or fortification. Then, we derived expected effects on total cancer mortality and related costs and savings from potential implementation of vitamin D food fortification in Germany and compared the results to those for supplementation. In RCTs with vitamin D supplementation in average doses of 820-2000 IU per day, serum concentrations of 25-hydroxy-vitamin D increased by 15-30 nmol/L, respectively. Studies on food fortification found increases by 10-42 nmol/L, thus largely in the range of increases previously demonstrated by supplementation. Fortification is estimated to be considerably less expensive than supplementation. It might be similarly effective as supplementation in reducing cancer mortality and might even achieve such reduction at substantially larger net savings. Although vitamin D overdoses are unlikely in food fortification programs, implementation should be accompanied by a study monitoring the frequency of potentially occurring adverse effects by overdoses, such as hypercalcemia. Future studies on effectiveness of vitamin D supplementation and fortification are warranted.
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Affiliation(s)
- Tobias Niedermaier
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (T.G.); (S.K.); (B.S.); (U.M.)
| | - Thomas Gredner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (T.G.); (S.K.); (B.S.); (U.M.)
- Medical Faculty Heidelberg, Heidelberg University, 69117 Heidelberg, Germany
| | - Sabine Kuznia
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (T.G.); (S.K.); (B.S.); (U.M.)
- Medical Faculty Heidelberg, Heidelberg University, 69117 Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (T.G.); (S.K.); (B.S.); (U.M.)
- Network Aging Research (NAR), Heidelberg University, 69117 Heidelberg, Germany
| | - Ute Mons
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (T.G.); (S.K.); (B.S.); (U.M.)
- Faculty of Medicine and University Hospital Cologne, University of Cologne, 50923 Cologne, Germany
- Cancer Prevention Unit, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (T.G.); (S.K.); (B.S.); (U.M.)
- Network Aging Research (NAR), Heidelberg University, 69117 Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
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11
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Dunlop E, Kiely ME, James AP, Singh T, Pham NM, Black LJ. Vitamin D Food Fortification and Biofortification Increases Serum 25-Hydroxyvitamin D Concentrations in Adults and Children: An Updated and Extended Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Nutr 2021; 151:2622-2635. [PMID: 34113994 DOI: 10.1093/jn/nxab180] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/26/2021] [Accepted: 05/12/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Low vitamin D status is a global public health issue that vitamin D food fortification and biofortification may help to alleviate. OBJECTIVES We investigated the effect of vitamin D food fortification and biofortification on circulating 25-hydroxyvitamin D (25(OH)D) concentrations. We expanded the scope of earlier reviews to include adults and children, to evaluate effects by vitamin D vitamer, and investigate linear and nonlinear dose-response relations. METHODS We conducted a systematic review and meta-analysis. We searched CINAHL, MEDLINE, PubMed, Embase, the Cochrane Library, and gray and unpublished literature sites for randomized controlled trials, including people of all ages, with the criteria: absence of illness affecting vitamin D absorption, duration ≥4 wk, equivalent placebo food control, dose quantification, dose ≥5 μg/d, baseline and endpoint or absolute change in 25(OH)D concentrations reported, random allocation, and participant blinding. Quality was assessed using the Jadad Scale. RESULTS Data from 34 publications (2398 adults: 1345 intervention, 1053 controls; 1532 children: 970 intervention, 562 controls) were included. Random-effects meta-analysis of all studies combined (mean dose 16.2 μg/d) indicated a pooled treatment effect of 21.2 nmol/L (95% CI: 16.2, 26.2), with a greater effect for studies using cholecalciferol than ergocalciferol. Heterogeneity was high (I2 > 75%). Metaregression analyses for all studies combined suggested positive effect differences for baseline circulating 25(OH)D concentrations <50 nmol/L, dose ≥10 μg/d and a negative effect difference when the intervention arm included a calcium dose ≥500 mg/d greater than the control arm. Dose-response rates were found to be nonlinear (Wald test for nonlinearity P < 0.001). For all studies combined, a threshold occurred at ∼26 nmol/L for a dose of ∼21 μg/d. CONCLUSIONS These results support use of vitamin D food fortification to improve circulating 25(OH)D circulations in populations. This work was registered with PROSPERO as CRD42020145497.
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Affiliation(s)
- Eleanor Dunlop
- Curtin School of Population Health, Curtin University, Bentley, Australia
| | - Mairead E Kiely
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Anthony P James
- Curtin School of Population Health, Curtin University, Bentley, Australia
| | - Tanya Singh
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Ngoc Minh Pham
- Curtin School of Population Health, Curtin University, Bentley, Australia.,Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam
| | - Lucinda J Black
- Curtin School of Population Health, Curtin University, Bentley, Australia
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12
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McCourt A, McNulty BA, Walton J, O'Sullivan A. Efficacy and safety of food fortification to improve vitamin D intakes of older adults. Nutrition 2020; 75-76:110767. [PMID: 32248053 DOI: 10.1016/j.nut.2020.110767] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to determine the best foods for potential vitamin D food fortification and to model the efficacy and safety of different food fortification scenarios in adults ≥50 y of age in Ireland. METHODS National Adult Nutrition Survey vitamin D data for participants ≥50 y of age were updated. Vitamin D from foods with natural and added vitamin D was estimated and daily vitamin D intake patterns were examined. Data modeling was used to estimate the effects of target food fortification scenarios. RESULTS Almost two-thirds of the mean daily vitamin D intake of adults ≥50 y of age (7 ± 7 µg) comes from foods with added vitamin D. Milk and bread are the most frequently consumed foods across all meals and were subsequently targeted for the data modeling exercise. Results from the data modeling show that vitamin D intake increased between 9 and 17 µg/d, depending on the fortification scenario. Fortifying milk or bread resulted in ∼30% or ∼55% of individuals meeting the Recommended Daily Allowance (RDA); however, fortifying both simultaneously resulted in ∼70% meeting the RDA. CONCLUSIONS Currently, the majority of Irish adults ≥50 y of age are not meeting dietary recommendations for vitamin D. Fortification of commonly consumed foods such as milk and bread could improve daily intakes such that ∼70% of the cohort would meet the minimum recommendation. Future research should examine the efficacy of different food fortification scenarios to improve vitamin D intakes for older adults.
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Affiliation(s)
- Aislinn McCourt
- UCD Institute of Food and Health, University College Dublin, Belfield, Dublin, Ireland
| | - Breige A McNulty
- UCD Institute of Food and Health, University College Dublin, Belfield, Dublin, Ireland
| | - Janette Walton
- School of Biological Sciences, Cork Institute of Technology, Cork, Ireland
| | - Aifric O'Sullivan
- UCD Institute of Food and Health, University College Dublin, Belfield, Dublin, Ireland.
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