Journal
JOURNAL OF NUTRITION
Volume 151, Issue 9, Pages 2622-2635Publisher
ELSEVIER SCIENCE INC
DOI: 10.1093/jn/nxab180
Keywords
25-hydroxyvitamin D; biofortification; food; fortification; vitamin D
Categories
Funding
- Australian Government Research Training Program Scholarship
- Multiple Sclerosis Research Australia Postdoctoral Fellowship
- Curtin University Research Fellowship
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The study reviewed the impact of vitamin D food fortification and biofortification on circulating 25-hydroxyvitamin D concentrations, suggesting that vitamin D food fortification can improve 25-hydroxyvitamin D levels in populations.
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 We searched CINAHL, MEDLINE, PubMed, Embase, the Cochrane Library, and gray and unpublished literature sites for randomized controlled trials, including people of all ages, with the criteria: absence of illness affecting vitamin D absorption, duration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 mu g/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 mu g/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 (I-2 > 75%). Metaregression analyses for all studies combined suggested positive effect differences for baseline circulating 25(OH)D concentrations <50 nmol/L, dose >= 10 mu g/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 similar to 26 nmol/L for a dose of similar to 21 mu g/d. Conclusions: These results support use of vitamin D food fortification to improve circulating 25(OH)D circulations in populations.
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