The role of fortified foods and nutritional supplements in increasing vitamin D intake in Irish preschool children

Purpose There are limited data on the contribution of fortified foods and nutritional supplements to intakes of vitamin D in young children. Our objective was to examine the intake, adequacy, risk of excessive intake and sources of dietary vitamin D. Methods The nationally representative cross-sectional dietary survey of young children (aged 1-4 years) (n 500) was used to evaluate vitamin D intake and quantify the contribution of the base diet, fortified foods and nutritional supplements to total intake. Results Median (IQR) intakes of vitamin D were generally low in this young population, ranging from 2.0 (1.9) to 2.5 (4.9) mu g/day. Ninety-three and 78 % of children had intakes below 10 and 5 mu g/day, respectively. While vitamin D supplement users (17 %) had the highest intakes [6.7 (6.4) mu g/day] (P < 0.001), 74 % had intakes below 10 mu g/day. Vitamin D-fortified foods, consumed by 77 % of children [2.2 (2.0) mu g/day], made nutritionally significant contributions to intake [0.8 (1.6) mu g/day], particularly in younger children [1.5 (4.6) mu g/day]. Children who did not use nutritional supplements or fortified foods had significantly (P < 0.001) lower intakes of vitamin D than the other groups [1.0 (0.8) mu g/day]. Our analyses show the importance of milk and yoghurt, meat and fortified ready-to-eat cereals as sources of vitamin D in this age group. The use of nutritional supplements or fortified foods at current levels does not represent a risk of intakes exceeding the European Food Safety Authority (EFSA) tolerable upper intake level (UL) (50 mu g/day), as intakes did not exceed or even approach the UL (P95: 22 % of UL). Conclusion Intakes of vitamin D in preschool children in Ireland are generally low. Nutritional supplements and fortified foods make significant contributions to intakes of vitamin D, without risk of unacceptably high intakes. Though supplements are effective in raising intakes of vitamin D in users, uptake is low (17 %). Food fortification may represent a suitable public health approach to increasing vitamin D intakes. The national food consumption data of Irish preschool children provide the ideal starting point for modelling of fortification scenarios to identify which foods and levels of addition will ensure effective and safe increases in vitamin D intake.