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The positive impact of general vitamin D food fortification policy on vitamin D status in a representative adult Finnish population: evidence from an 11-y follow-up based on standardized 25-hydroxyvitamin D data.
Am J Clin Nutr. 2017 06; 105(6):1512-1520.AJ

Abstract

Background:

A systematic vitamin D fortification of fluid milk products and fat spreads was started in 2003 in Finland to improve vitamin D status.

Objective:

We investigated the effects of the vitamin D fortification policy on vitamin D status in Finland between 2000 and 2011.

Design:

Serum 25-hydroxyvitamin D [S-25(OH)D] concentrations of a nationally representative sample comprising 6134 and 4051 adults aged ≥30 y from the Health 2000 and Health 2011 surveys, respectively, were standardized according to the Vitamin D Standardization Program with the use of liquid chromatography-tandem mass spectrometry. Linear and logistic regression models were used to assess the change in S-25(OH)D concentrations.

Results:

Between 2000 and 2011, the mean S-25(OH)D increased from 48 nmol/L (95% CI: 47, 48 nmol/L) to 65 nmol/L (95% CI: 65, 66 nmol/L) (P < 0.001). The prevalence of vitamin D supplement users increased from 11% to 41% (P < 0.001). When analyzing the effect of fortification of fluid milk products, we focused on supplement nonusers. The mean increase in S-25(OH)D in daily fluid milk consumers (n = 1017) among supplement nonusers was 20 nmol/L (95% CI: 19, 21 nmol/L), which was 6 nmol/L higher than nonconsumers (n = 229) (14 nmol/L; 95% CI: 12, 16 nmol/L) (P < 0.001). In total, 91% of nonusers who consumed fluid milk products, fat spreads, and fish based on Finnish nutrition recommendations reached S-25(OH)D concentrations >50 nmol/L in 2011.

Conclusions:

The vitamin D status of the Finnish adult population has improved considerably during the time period studied. The increase is mainly explained by food fortification, especially of fluid milk products, and augmented vitamin D supplement use. Other factors, such as the difference in the ultraviolet radiation index between 2000 and 2011, may partly explain the results. When consuming vitamin D sources based on the nutritional recommendations, vitamin D status is sufficient [S-25(OH)D ≥50 nmol/L], and supplementation is generally not needed.

Authors+Show Affiliations

Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland.Calcium Research Unit, Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland.Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland.Calcium Research Unit, Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland.Finnish Meteorological Institute, Helsinki, Finland.Finnish Meteorological Institute, Helsinki, Finland.Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, and.Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, and.Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital and Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Joensuu, Finland.Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; and. Finnish Institute of Occupational Health, Oulu, Finland.Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; and.Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland.Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, and. Department of Medicine, University College Cork, Cork, Ireland.Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland.Calcium Research Unit, Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland; christel.lamberg-allardt@helsinki.fi.

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

28490516

Citation

Jääskeläinen, Tuija, et al. "The Positive Impact of General Vitamin D Food Fortification Policy On Vitamin D Status in a Representative Adult Finnish Population: Evidence From an 11-y Follow-up Based On Standardized 25-hydroxyvitamin D Data." The American Journal of Clinical Nutrition, vol. 105, no. 6, 2017, pp. 1512-1520.
Jääskeläinen T, Itkonen ST, Lundqvist A, et al. The positive impact of general vitamin D food fortification policy on vitamin D status in a representative adult Finnish population: evidence from an 11-y follow-up based on standardized 25-hydroxyvitamin D data. Am J Clin Nutr. 2017;105(6):1512-1520.
Jääskeläinen, T., Itkonen, S. T., Lundqvist, A., Erkkola, M., Koskela, T., Lakkala, K., Dowling, K. G., Hull, G. L., Kröger, H., Karppinen, J., Kyllönen, E., Härkänen, T., Cashman, K. D., Männistö, S., & Lamberg-Allardt, C. (2017). The positive impact of general vitamin D food fortification policy on vitamin D status in a representative adult Finnish population: evidence from an 11-y follow-up based on standardized 25-hydroxyvitamin D data. The American Journal of Clinical Nutrition, 105(6), 1512-1520. https://doi.org/10.3945/ajcn.116.151415
Jääskeläinen T, et al. The Positive Impact of General Vitamin D Food Fortification Policy On Vitamin D Status in a Representative Adult Finnish Population: Evidence From an 11-y Follow-up Based On Standardized 25-hydroxyvitamin D Data. Am J Clin Nutr. 2017;105(6):1512-1520. PubMed PMID: 28490516.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The positive impact of general vitamin D food fortification policy on vitamin D status in a representative adult Finnish population: evidence from an 11-y follow-up based on standardized 25-hydroxyvitamin D data. AU - Jääskeläinen,Tuija, AU - Itkonen,Suvi T, AU - Lundqvist,Annamari, AU - Erkkola,Maijaliisa, AU - Koskela,Tapani, AU - Lakkala,Kaisa, AU - Dowling,Kirsten G, AU - Hull,George Lj, AU - Kröger,Heikki, AU - Karppinen,Jaro, AU - Kyllönen,Eero, AU - Härkänen,Tommi, AU - Cashman,Kevin D, AU - Männistö,Satu, AU - Lamberg-Allardt,Christel, Y1 - 2017/05/10/ PY - 2016/12/27/received PY - 2017/04/06/accepted PY - 2017/5/12/pubmed PY - 2017/8/2/medline PY - 2017/5/12/entrez KW - 25-hydroxyvitamin D KW - general fortification KW - population survey KW - standardization KW - vitamin D SP - 1512 EP - 1520 JF - The American journal of clinical nutrition JO - Am. J. Clin. Nutr. VL - 105 IS - 6 N2 - Background: A systematic vitamin D fortification of fluid milk products and fat spreads was started in 2003 in Finland to improve vitamin D status. Objective: We investigated the effects of the vitamin D fortification policy on vitamin D status in Finland between 2000 and 2011.Design: Serum 25-hydroxyvitamin D [S-25(OH)D] concentrations of a nationally representative sample comprising 6134 and 4051 adults aged ≥30 y from the Health 2000 and Health 2011 surveys, respectively, were standardized according to the Vitamin D Standardization Program with the use of liquid chromatography-tandem mass spectrometry. Linear and logistic regression models were used to assess the change in S-25(OH)D concentrations.Results: Between 2000 and 2011, the mean S-25(OH)D increased from 48 nmol/L (95% CI: 47, 48 nmol/L) to 65 nmol/L (95% CI: 65, 66 nmol/L) (P < 0.001). The prevalence of vitamin D supplement users increased from 11% to 41% (P < 0.001). When analyzing the effect of fortification of fluid milk products, we focused on supplement nonusers. The mean increase in S-25(OH)D in daily fluid milk consumers (n = 1017) among supplement nonusers was 20 nmol/L (95% CI: 19, 21 nmol/L), which was 6 nmol/L higher than nonconsumers (n = 229) (14 nmol/L; 95% CI: 12, 16 nmol/L) (P < 0.001). In total, 91% of nonusers who consumed fluid milk products, fat spreads, and fish based on Finnish nutrition recommendations reached S-25(OH)D concentrations >50 nmol/L in 2011.Conclusions: The vitamin D status of the Finnish adult population has improved considerably during the time period studied. The increase is mainly explained by food fortification, especially of fluid milk products, and augmented vitamin D supplement use. Other factors, such as the difference in the ultraviolet radiation index between 2000 and 2011, may partly explain the results. When consuming vitamin D sources based on the nutritional recommendations, vitamin D status is sufficient [S-25(OH)D ≥50 nmol/L], and supplementation is generally not needed. SN - 1938-3207 UR - https://www.unboundmedicine.com/medline/citation/28490516/The_positive_impact_of_general_vitamin_D_food_fortification_policy_on_vitamin_D_status_in_a_representative_adult_Finnish_population:_evidence_from_an_11_y_follow_up_based_on_standardized_25_hydroxyvitamin_D_data_ L2 - https://academic.oup.com/ajcn/article-lookup/doi/10.3945/ajcn.116.151415 DB - PRIME DP - Unbound Medicine ER -