Knowledge and attitudes towards vitamin D food fortification

Vitamin D fortification of foods - sensory, acceptability, cost, and public acceptance considerations

In terms of vitamin D food fortification, there are a number of important considerations in relation to selection of the food vehicle and fortificant. While there has been much research focus on the ability of fortified foods to improve vitamin D status, other considerations, such as sensory properties and acceptability, cost, and public attitudes around vitamin D-fortified foods, have received less attention. Thus, the present narrative review aimed to summarize the existing knowledge around these important considerations. In summary, its findings suggest that: i) vitamin D addition to various food vehicles, at levels consistent with the supply of part or all the recommended intake, does not alter their sensory characteristics or overall acceptability; ii) overall, vitamin D fortification of foods is relatively cost-effective, despite the fact that some attitudinal studies highlighted participant concerns about the potential cost/expense of vitamin D-fortified foods; iii) evidence from various attitudinal studies suggest a high level of acceptance and/or purchase intention (i.e., extent to which customers are willing and inclined to buy) of vitamin D-fortified food products by the general public; and iv) there have been repeated calls for vitamin D public health educational/information campaigns to help educate consumers about the health risks associated with vitamin D deficiency and nutritional benefits associated with consumption of vitamin D-fortified foods. Such campaigns could positively mediate attitudes and acceptance of vitamin D-fortified foods amongst the public, and could also help address misconceptions and allay fears around vitamin D for concerned individuals. Lastly, the findings of the present review also highlight the existence of between-country differences, even within Europe, in relation to attitudes and purchase intention of vitamin D-fortified foods and the perceived appropriateness of certain food vehicles for vitamin D fortification, as well as the best mix of communication channels for a vitamin D public health educational/information campaign.

Assessment of knowledge, attitudes and practice towards Vitamin D among university students in Pakistan

Background

Pakistan has one of the highest reported incidence of vitamin D deficiency in studies conducted worldwide. However, there has been very limited exploration of vitamin D related knowledge, attitudes and practices among healthy youth in Pakistan.

Methods

A cross-sectional survey was conducted among youth (aged > 16 years) from two engineering universities in Pakistan. Participants were asked questions on their concern about vitamin D levels, testing, and supplementation practices. Knowledge was examined using questions about food sources, health benefits and factors affecting vitamin D production within the human body. Of the 900 eligible students invited to participate, 505 (56%) completed the questionnaire and were included in the analysis.

Results

Only 9% participants were able to identify the correct food sources of vitamin D, 33% were aware of the bone health benefits (bone health and calcium absorption) of vitamin D and 36% identified sunlight exposure as a factor influencing vitamin D production. Knowledge about food sources and health benefits of vitamin D was not associated with gender and individuals concern about their levels. Those tested and taking supplements were more likely to identify bone related health benefits and factors affecting vitamin D production. Forty percent male and 52% female students expressed concern that their vitamin D levels were too low. However, 72% participants reported that they had never been tested for vitamin D levels. Use of supplements was significantly higher among female students (F = 52% vs M = 37%; P = 0.003). Those who had been tested for vitamin D deficiency were more likely to take supplements.

Conclusion

Despite being identified as a high-risk population, knowledge about vitamin D was limited among university students. Interventions are needed to increase awareness about the importance of vitamin D for health, including the need for exposure to sunlight and adequate dietary intake of vitamin D. Our study provides much needed baseline evidence for making health-policy recommendations for this vulnerable population group.

Vitamin D Deficiency: Defining, Prevalence, Causes, and Strategies of Addressing

There are variable definitions of vitamin D deficiency, based on different thresholds of serum 25-hydroxyvitamin D (25(OH)D); this has a major bearing on the prevalence estimates of vitamin D deficiency and consequently on the magnitude of the public health issue of low vitamin D status. Despite this, there is widespread acknowledgement of the presence of vitamin D deficiency, even using the most conservative serum 25(OH)D threshold of < 25/30 nmol/L, in both low- and high-income country setting and the pressing need to address this deficiency. While ultraviolet B-rich sunlight stimulates synthesis of vitamin D in skin, there are environmental factors and personal characteristics which prevent or impede such dermal synthesis. There are several complexities and concerns in advocating sun exposure as a public health approach for increasing vitamin D status. This places increased emphasis on addressing vitamin D deficiency through dietary means. However, naturally rich sources of vitamin D are few and infrequently consumed, and nutrition surveillance data from various countries have indicated that habitual vitamin D intakes in the population are much lower than the recommendations. There are a number of strategies that can be considered for the control of micronutrient malnutrition, these include (i) increasing the diversity of foods consumed, (ii) food fortification, and (iii) supplementation. The present narrative review will consider these strategies for addressing low dietary vitamin D intake and consequently lowering the risk of vitamin D deficiency.

Serum vitamin D concentrations are inversely related to prevalence of metabolic syndrome in Qatari women

Hypovitaminosis D has reached epidemic proportions in Qatar. Vitamin D is linked to several cardiometabolic diseases such as metabolic syndrome (MetSyn), diabetes, and atherosclerosis. It is not known if vitamin D status is linked to cardiometabolic risk factors in Qatari women. Therefore, a relationship between serum 25-hydroxyvitmain D [25(OH)D] concentrations and MetSyn was investigated in Qatari women using the Qatar Biobank database. Study sample consisted of 700 women, aged 20-80 years old. A multivariate-adjusted logistic regression was used to determine relation between serum 25(OH)D and MetSyn prevalence. Multivariate linear regression was performed to determine the association between serum 25(OH)D and markers of MetSyn. Prevalences of MetSyn in the first (≈32%), second (≈27%), and third (≈28%) serum 25(OH)D quartiles were significantly higher compared to fourth serum 25(OH)D quartile (≈17.5%) (p < .035). The likelihood of having MetSyn was significantly higher in the first serum 25(OH)D quartile (OR, 1.92; 95% CI, 1.06, 3.49) compared to the fourth serum 25(OH)D quartile (p < .001) in multivariate-adjusted analysis. No relationship was observed between serum 25(OH)D and waist circumference, blood pressure, glycated hemoglobin (HbA1C), blood glucose, HDL-cholesterol, and serum triglycerides. This study showed an inverse relationship between prevalence of MetSyn and serum 25(OH)D in Qatari women. Given the widespread prevalence of vitamin D deficiency in Qatar, consideration should be given to vitamin D fortification of some selected staple foods and through targeted supplementation of vitamin D in those who are at risk for cardiometabolic diseases.