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Szabó É, Csölle I, Felső R, Kuellenberg de Gaudry D, Nyakundi PN, Ibrahim K, Metzendorf MI, Ferenci T, Lohner S. Benefits and Harms of Edible Vegetable Oils and Fats Fortified with Vitamins A and D as a Public Health Intervention in the General Population: A Systematic Review of Interventions. Nutrients 2023; 15:5135. [PMID: 38140394 PMCID: PMC10745565 DOI: 10.3390/nu15245135] [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: 11/22/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
This systematic review aims to assess whether edible vegetable oils and fats fortified with vitamin A and/or D are effective and safe in improving vitamin intake and ameliorating deficiency states in the general population. In November 2022, we systematically searched MEDLINE, Cochrane CENTRAL, Scopus, Global Index Medicus, ClinicalTrials.gov, and WHO ICTRP (International Clinical Trials Registry Platform) for randomized controlled trials (RCT) and non-randomized studies of interventions (NRSI) investigating the fortification of edible vegetable oils and fats with either vitamin A or vitamin D or both as compared to the same vegetable oils and/or fats without vitamin A and D fortification or no interventions, in the general population, without age restriction. We assessed the methodological quality of included RCTs using Cochrane's risk of bias tool 2.0 and of NRSIs using ROBINS-I tool. We performed random-effects meta-analysis and assessed certainty of evidence using GRADE. We included eight studies. Available evidence showed no significant effect of fortification with vitamin A on serum retinol levels (RCTs: MD 0.35 µmol/L, 95% CI -0.43 to 1.12; two trials; 514 participants; low-certainty evidence; CCTs: MD 0.31 µmol/L, 95% CI -0.18 to 0.80; two trials; 205 participants; very low-certainty evidence) and on subclinical vitamin A deficiency. Low-certainty evidence showed no effect of vitamin D fortification on serum 25-hydroxy vitamin D concentration (MD 6.59 nmol/L, 95% CI -6.89 to 20.07; one trial; 62 participants). In conclusion, vitamin A-fortified vegetable oils and fats may result in little to no difference in serum retinol levels in general populations. The dose of vitamin A used in the trials may be safe but may not be sufficient to reduce subclinical vitamin A deficiency. Further, the evidence suggests that vitamin D fortification results in little to no difference in serum 25-hydroxy vitamin D concentration. Several aspects of providing fortified oils and fats to the general population as a public health intervention should be further investigated, including optimal fortification dose, effects on vitamin D deficiency and its clinical symptoms and potential adverse effects.
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Affiliation(s)
- Éva Szabó
- Cochrane Hungary, Clinical Centre of the University of Pécs, Medical School, University of Pécs, 7623 Pécs, Hungary; (É.S.); (I.C.); (R.F.); (D.K.d.G.)
- Department of Biochemistry and Medical Chemistry, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Ildikó Csölle
- Cochrane Hungary, Clinical Centre of the University of Pécs, Medical School, University of Pécs, 7623 Pécs, Hungary; (É.S.); (I.C.); (R.F.); (D.K.d.G.)
- National Laboratory for Human Reproduction, University of Pécs, 7624 Pécs, Hungary
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary;
| | - Regina Felső
- Cochrane Hungary, Clinical Centre of the University of Pécs, Medical School, University of Pécs, 7623 Pécs, Hungary; (É.S.); (I.C.); (R.F.); (D.K.d.G.)
- National Laboratory for Human Reproduction, University of Pécs, 7624 Pécs, Hungary
- Genomics and Bioinformatics Core Facility, Szentágothai Research Centre, University of Pécs, 7624 Pécs, Hungary
| | - Daniela Kuellenberg de Gaudry
- Cochrane Hungary, Clinical Centre of the University of Pécs, Medical School, University of Pécs, 7623 Pécs, Hungary; (É.S.); (I.C.); (R.F.); (D.K.d.G.)
| | - Patrick Nyamemba Nyakundi
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary;
- Department of Public Health Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
| | - Kazahyet Ibrahim
- Department of Public Health Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
| | - Maria-Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany;
| | - Tamás Ferenci
- Physiological Controls Research Center, Obuda University, 1034 Budapest, Hungary;
- Department of Statistics, Corvinus University of Budapest, 1093 Budapest, Hungary
| | - Szimonetta Lohner
- Cochrane Hungary, Clinical Centre of the University of Pécs, Medical School, University of Pécs, 7623 Pécs, Hungary; (É.S.); (I.C.); (R.F.); (D.K.d.G.)
- Department of Public Health Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
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The role of prenatal vitamin D on the development of childhood asthma and wheeze: An umbrella review of systematic reviews and meta-analyses. Clin Nutr 2022; 41:1808-1817. [PMID: 35834913 DOI: 10.1016/j.clnu.2022.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/22/2022] [Accepted: 06/26/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND & OBJECTIVE It has been suggested that prenatal vitamin D plays a role in the development of childhood asthma and wheeze. Several systematic reviews have been conducted, but the results are inconsistent, and the methodological quality has not been studied. Therefore, the objective of this umbrella review was to assess the internal validity of the evidence base and the evidence for an association between prenatal vitamin D and asthma or wheezing in the offspring. METHODS We searched the electronic databases Embase, PubMed, and Cochrane Library for studies on prenatal vitamin D using search words such as vitamin D, 25-hydroxyvitamin D, calcidiol, fetal, and neonatal. The search was conducted in June 2020, and the databases were searched from their date of establishment. We included systematic reviews and/or meta-analyses of experimental and observational studies assessing the association between prenatal vitamin D or asthma and wheeze. We excluded narrative reviews, commentaries, and other umbrella reviews. The methodological quality of systematic reviews was assessed using AMSTAR 2 tool. PROSPERO reg. no. CRD42020151329. RESULTS We identified 22 eligible systematic reviews (17 on asthma and 20 on wheeze). Using the AMSTAR 2 quality assessment tool, the methodological quality was rated as critically low in 21 out of 22 systematic reviews, suggesting that previous reviews and meta-analyses did not provide accurate and comprehensive summaries of the included studies and that conclusions reached were potentially flawed. The majority of the included reviews reported that prenatal vitamin D reduces the risk of wheeze in the offspring. CONCLUSION Prior to informing public guidelines, high-quality systematic reviews of the current evidence are greatly warranted.
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Marila A, Karvonen AM, Pekkanen J, Keski-Nisula L. Perinatal factors and high-sensitive C-reactive protein levels during adolescence. EUR J INFLAMM 2022. [DOI: 10.1177/1721727x221116744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To examine whether perinatal factors are associated with low-grade inflammation measured by high-sensitivity C-reactive protein levels during adolescence. Methods Nested case-control study of 125 teenagers who were born by Cesarean delivery and had high-sensitivity C-reactive protein levels determined at 15–17 years. Data on obstetric and perinatal factors were recorded prospectively at the time of their birth. Results Median values of high-sensitivity C-reactive protein were significantly higher in teenagers, who were born as large for gestational age or with maternal diabetes compared to others (2.54 vs 0.34 mg/L; p < 0.024), and born during spring or summer compared to those born during winter or autumn (0.48 vs 0.27 mg/L; p < 0.023). No other perinatal associations were detected (for ex. such as electivity of operation, onset of labor, rupture of fetal membranes, cervical dilatation at delivery, gestational age, Apgar scores at 5 min, umbilical blood pH value, administration of neonatal antibiotics or need of neonatal intensive care treatment) in CRP levels. Further, teenagers with current body mass index in the highest tertile, regular medication for chronic disease and girls using oral contraceptives had significantly higher high-sensitivity C-reactive protein levels than others. Conclusion Prenatal exposures such as maternal metabolic environment and seasonality may have longterm effects on the low-grade inflammation and later cardiometabolic risks. Seasonality might be partly explained by maternal vitamin D levels during pregnancy, and thus future efforts are warranted to ensure sufficient vitamin D availability during pregnancy. Surprisingly, no other significant associations were detected between perinatal characteristics and high-sensitivity C-reactive protein levels.
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Affiliation(s)
- Anna Marila
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Anne M Karvonen
- Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland
| | - Juha Pekkanen
- Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Leea Keski-Nisula
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland
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Händel MN, Jacobsen R, Thorsteinsdottir F, Keller AC, Stougaard M, Jensen CB, Moos C, Duus KS, Jensen A, Schiøler Kesmodel U, Abrahamsen B, Heitmann BL. Assessing Health Consequences of Vitamin D Fortification Utilizing a Societal Experiment Design: Methodological Lessons Learned from the D-Tect Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8136. [PMID: 34360427 PMCID: PMC8345774 DOI: 10.3390/ijerph18158136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/16/2021] [Accepted: 07/23/2021] [Indexed: 11/16/2022]
Abstract
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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Affiliation(s)
- Mina Nicole Händel
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark; (F.T.); (C.M.); (K.S.D.); (B.L.H.)
| | - Ramune Jacobsen
- Department of Pharmacy, University of Copenhagen, 2100 Copenhagen, Denmark;
| | - Fanney Thorsteinsdottir
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark; (F.T.); (C.M.); (K.S.D.); (B.L.H.)
| | - Amélie Cléo Keller
- Department of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark;
| | - Maria Stougaard
- Center for Early Intervention and Family Studies, Department of Psychology, University of Copenhagen, 1353 Copenhagen, Denmark;
| | - Camilla Bjørn Jensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark;
| | - Caroline Moos
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark; (F.T.); (C.M.); (K.S.D.); (B.L.H.)
| | - Katrine Sidenius Duus
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark; (F.T.); (C.M.); (K.S.D.); (B.L.H.)
| | - Allan Jensen
- Lifestyle, Reproduction and Cancer, Danish Cancer Society Research Center, 2100 Copenhagen, Denmark;
| | - Ulrik Schiøler Kesmodel
- Department of Obstetrics and Gynaecology, Aalborg University Hospital and Aalborg University, 9000 Aalborg, Denmark;
| | - Bo Abrahamsen
- Open Patient Explorative Network, Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark;
- Department of Medicine, Holbæk Hospital, 4300 Holbæk, Denmark
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7FY, UK
| | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark; (F.T.); (C.M.); (K.S.D.); (B.L.H.)
- Department of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark;
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, NSW 2006, Australia
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Li W, Zhou J, Liu S, Xing K, Yang L, Zhong L, Chen Q, Zhang W. The correlation between neonatal vitamin D levels and the risk of childhood asthma attacks. Transl Pediatr 2021; 10:914-920. [PMID: 34012840 PMCID: PMC8107849 DOI: 10.21037/tp-21-92] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To explore the correlation between neonatal vitamin D levels and the risk of asthma in children aged 3-9 years. METHODS A total of 1,534 subjects were selected, and clinical and laboratory test data of all subjects were collected at birth, including 25-hydroxyvitamin D3 [25(OH)D3] levels, gender, season of birth, birth weight; whether delivery was premature, cesarean section, or primipara; and parental details including maternal age, ethnicity, level of education, history of smoking, and history of maternal or paternal asthma. The level of 25(OH)D3 was used as a continuous variable to analyze its correlation with the risk of asthma using the Cox proportional regression model. In addition, subjects were divided into four groups according to their 25(OH)D3 quartiles, and the first quantile group was used as a reference to analyze the risk of asthma in the other groups. Further subgroup analysis was conducted according to the patients' gender and birth season. RESULTS Among the 1,534 subjects included, there were 107 cases in the asthma-affected group and 1,427 cases in the normal control group. Compared with the control group, the level of 25(OH)D3 in the asthma group was significantly lower (P=0.03), the mother's education level was lower (P=0.002), but the preterm birth rate, cesarean section rate, and parental asthma prevalence rate were significantly higher (all P<0.05). When the neonatal 25(OH)D3 was divided into quartiles to perform a categorical variable analysis, we found that compared with the first quantile (Q1, 0.0-25.1 mmol/L), the risk of asthma in Q4 was reduced by 50% (HR=0.50, 95% CI: 0.38-0.76). The second quantile group (Q2) and the third quantile group (Q3) showed no significant difference in the risk of disease compared with Q1 but showed a trend of decreasing risk as the quantile group increased (the trend P values were both <0.05). This correlation was still valid when a stratified analysis was made based on gender and birth season. CONCLUSIONS There is a significant correlation between a reduced vitamin D level in newborns and the subsequent risk of asthma in children aged 3-9 years. Moreover, the level of vitamin D is an independent risk factor for childhood asthma.
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Affiliation(s)
- Wenlin Li
- Department of Neonatology, Haikou Hospital of The Maternal And Child Health, Haikou, China
| | - Jin Zhou
- Department of Pediatrics, Haikou Hospital of Maternal and Child Health, Haikou, China
| | - Shen Liu
- Department of Pediatrics, Haikou Hospital of Maternal and Child Health, Haikou, China
| | - Kaihui Xing
- Department of Neonatology, Haikou Hospital of The Maternal And Child Health, Haikou, China
| | - Ling Yang
- Department of Neonatology, Haikou Hospital of The Maternal And Child Health, Haikou, China
| | - Lihua Zhong
- Department of Neonatology, Haikou Hospital of The Maternal And Child Health, Haikou, China
| | - Qiuli Chen
- Department of Pediatrics, Haikou Hospital of Maternal and Child Health, Haikou, China
| | - Wei Zhang
- Department of Neonatology, Haikou Hospital of The Maternal And Child Health, Haikou, China
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Neonatal Vitamin D Status and Risk of Asthma in Childhood: Results from the D-Tect Study. Nutrients 2020; 12:nu12030842. [PMID: 32245170 PMCID: PMC7146263 DOI: 10.3390/nu12030842] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 02/06/2023] Open
Abstract
Background: low vitamin D status in pregnancy can influence the offspring’s lung function and contribute to childhood asthma development. The objective of this study was to examine the influence of neonatal vitamin D status on the development of asthma among children age 3–9 years in a large population sample. Method: in a case-cohort study utilizing a Danish biobank and register data we examined the association between neonatal 25-hydroxyvitamin D3 (25(OH)D3) concentrations and incidence of asthma among children aged 3–9 years. Cases of asthma (n = 911) were randomly selected among all cases of asthma in the Danish National Patient Register from children born between 1992 and 2002. The sub-cohort (n = 1423) was randomly selected among all children born in the same period. We used a weighted Cox proportional hazard model assessing the hazard of first asthma diagnoses by quintiles of 25(OH)D3. Results: the median 25(OH)D3 (interquartile range) for asthma cases was 23 nmol/L (14–35) and the sub-cohort 25 nmol/L (14–40). The hazard ratio for developing asthma between ages 3 and 9 years was lower for children in the fifth quintile of neonatal 25(OH)D3 compared to children in the first quintile, both in the unadjusted (0.61 95% CI: 0.46–0.80) and adjusted (0.55 95% CI: 0.39–0.77) analyses. Conclusion: the results from our study suggest that higher neonatal vitamin D concentration may reduce the risk of developing childhood asthma at ages 3–9 years, indicating that neonatal vitamin D status as a proxy of vitamin D status during the prenatal period is important for normal immune- and lung development.
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A Critical Appraisal of Strategies to Optimize Vitamin D Status in Germany, a Population with a Western Diet. Nutrients 2019; 11:nu11112682. [PMID: 31698703 PMCID: PMC6893762 DOI: 10.3390/nu11112682] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 10/26/2019] [Accepted: 10/30/2019] [Indexed: 12/12/2022] Open
Abstract
During the last decade, our scientific knowledge of the pleiotropic biological effects of vitamin D metabolites and their relevance to human health has expanded widely. Beyond the well-known key role of vitamin D in calcium homeostasis and bone health, it has been shown that vitamin D deficiency is associated with a broad variety of independent diseases, including several types of cancer, and with increased overall mortality. Moreover, recent findings have demonstrated biological effects of the vitamin D endocrine system that are not mediated via activation of the classical nuclear vitamin D receptor (VDR) by binding with high affinity to its corresponding ligand, the biologically active vitamin D metabolite 1,25-dihydroxyvitamin D (1,25(OH)2D). In contrast, many of these new biological effects of vitamin D compounds, including regulation of the circadian clock and many metabolic functions, are mediated by other vitamin D metabolites, including 20-hydroxyvitamin D and 20,23-dihydroxyvitamin D, and involve their binding to the aryl hydrocarbon receptor (AhR) and retinoid-orphan receptor (ROR). In most populations, including the German population, UVB-induced cutaneous vitamin D production is the main source for fulfilling the human body’s requirements of vitamin D. However, this causes a dilemma because solar or artificial UVR exposure is associated with skin cancer risk. In addition to UVB-induced vitamin D production in skin, in humans, there are two other possible sources of vitamin D: from diet and supplements. However, only a few natural foods contain substantial amounts of vitamin D, and in most populations, the dietary source of vitamin D cannot fulfill the body´s requirements. Because an increasing body of evidence has convincingly demonstrated that vitamin D deficiency is very common worldwide, it is the aim of this paper to (i) give an update of the vitamin D status in a population with a western diet, namely, the German population, and to (ii) develop strategies to optimize the vitamin D supply that consider both the advantages as well as the disadvantages/risks of different approaches, including increasing vitamin D status by dietary intake, by supplements, or by UVB-induced cutaneous synthesis of vitamin D.
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