Abstract
OBJECTIVES: Despite mandatory fortification of milk and margarine, most Canadians have inadequate vitamin D intake and consequently poor vitamin D status, especially in the winter. Increasing vitamin D fortification is one possible strategy to address this inadequacy. The purpose of our study was to examine the modelled effect of increased vitamin D fortification on the prevalence of inadequacy and the percentage of intakes greater than the Tolerable Upper Intake Level (UL) using different fortification scenarios.
METHODS: Dietary intakes (24-h recall) from the 2004 Canadian Community Health Survey 2.2 (n=34,381) were used to model increased vitamin D levels in milk and the addition of vitamin D to cheese and yogurt at various levels to meet label claims of an “excellent source” based on the recommended dietary intakes. The Software for Intake Distribution Evaluation was used to estimate the prevalence of inadequacy and intakes >UL
RESULTS: Fortification of milk, yogurt and cheese at 6.75 µg (270 IU)/serving led to more than doubling of vitamin D intakes across all sex/age groups and a drop in the prevalence of dietary inadequacy from >80% to <50% in all groups. Furthermore, no intakes approached the UL under any fortification scenario in any sex/age group.
CONCLUSION: There is a pressing need to improve vitamin D status among Canadians.
Increasing vitamin D fortification of dairy products, consistent with their positioning in Canada’s Food Guide, can lead to increased intake without a risk of excess. This is a population-wide public health strategy that should be given consideration in Canada.
Keywords: Vitamin D, fortification, dietary inadequacy, Tolerable Upper Intake Level, dairy products
Résumé
OBJECTIFS: Malgré l’enrichissement obligatoire du lait et de la margarine, la plupart des Canadiens ont un apport insuffisant en vitamine D — et donc un statut médiocre en vitamine D, surtout l’hiver. Accroître l’enrichissement en vitamine D est une stratégie possible pour combler cette carence. Nous avons cherché à examiner l’effet modélisé d’un accroissement de l’enrichissement en vitamine D sur la prévalence des carences et sur le pourcentage d’apports supérieurs à l’apport maximal tolérable (AM) selon divers scénarios d’enrichissement.
MÉTHODE: Les apports alimentaires (rappel 24 heures) tirés de l’Enquête sur la santé dans les collectivités canadiennes 2.2 de 2004 (n=34 381) ont servi à modéliser des niveaux accrus de vitamine D dans le lait et l’ajout de divers niveaux de vitamine D au fromage et au yogourt pour respecter les allégations d’ «excellente source de vitamine D» sur les étiquettes en fonction des apports alimentaires recommandés. L’outil Software for Intake Distribution Estimation a servi à estimer la prévalence des carences et les apports >AM.
RÉSULTATS: L’enrichissement du lait, du yogourt et du fromage à 6,75 µg (270 UI)/portion ferait plus que doubler les apports en vitamine D chez les deux sexes et dans tous les groupes d’âge et abaisserait la prévalence des carences nutritionnelles de >80 % à <50 % dans tous les groupes. Au demeurant, aucun apport ne s’approche de l’AM, peu importe le scénario d’enrichissement, dans aucun groupe d’âge ou de sexe.
CONCLUSION: Il existe un besoin pressant d’améliorer le statut en vitamine D de la population canadienne. Accroître l’enrichissement en vitamine D des produits laitiers, en respectant les niveaux recommandés dans le Guide alimentaire canadien, peut mener à des apports accrus sans risque d’excès. C’est une stratégie de santé publique à l’échelle de la population qui devrait être envisagée au Canada.
Mots clés: vitamine D, enrichissement, carences nutritionnelles, apport maximal tolérable, produits laitiers
Footnotes
Acknowledgements: This study was funded by a grant from Dairy Farmers of Canada. Dairy Farmers of Canada had no role in the implementation, analysis or interpretation of the data. Yaseer Shakur also received funding from a Comprehensive Research Experience for Medical Students scholarship from the Faculty of Medicine, University of Toronto.
Conflict of Interest: None to declare.
References
- 1.FoodNutrition Board, Institute of Medicine. Dietary Reference Intakes: Guiding Principles for Nutrition Labeling and Fortification. Washington, DC: National Academies Press; 2003. [PubMed] [Google Scholar]
- 2.Bodnar LM, Catov JM, Simhan HN, Holick MF, Powers RW, Roberts JM. Maternal vitamin D deficiency increases the risk of preeclampsia. J Clin Endocrinol Metab. 2007;92:3517–22. doi: 10.1210/jc.2007-0718. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Holick MR Vitamin D deficiency. N Engl J Med. 2007;357:266–81. doi: 10.1056/NEJMra070553. [DOI] [PubMed] [Google Scholar]
- 4.FoodNutrition Board, Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. 2011. [Google Scholar]
- 5.Shakur YA, Tarasuk V, Corey P, O’Connor DL. A comparison of micronutrient inadequacy and risk of high micronutrient intakes among vitamin and mineral supplement users and nonusers in Canada. J Nutr. 2012;142:534–40. doi: 10.3945/jn.111.149450. [DOI] [PubMed] [Google Scholar]
- 6.Whiting SJ, Langlois KA, Vatanparast H, Greene-Finestone LS. The vitamin D status of Canadians relative to the 2011 Dietary Reference Intakes: An examination in children and adults with and without supplement use. Am J Clin Nutr. 2011;94:128–35. doi: 10.3945/ajcn.111.013268. [DOI] [PubMed] [Google Scholar]
- 7.Langlois K, Greene-Finestone L, Little J, Hidiroglou N, Whiting S. Vitamin D status of Canadians as measured in the 2007 to 2009 Canadian Health Measures Survey. Health Rep. 2010;21:47–55. [PubMed] [Google Scholar]
- 8.Vieth R. Why the minimum desirable serum 25-hydroxyvitamin D level should be 75 nmol/L (30 ng/ml) Best Pract Res Clin Endocrinol Metab. 2011;25:681–91. doi: 10.1016/j.beem.2011.06.009. [DOI] [PubMed] [Google Scholar]
- 9.Grant WB, Schwalfenberg GK, Genuis SJ, Whiting SJ. An estimate of the economic burden and premature deaths due to vitamin D deficiency in Canada. Mol Nutr Food Res. 2010;54:1172–81. doi: 10.1002/mnfr.200900420. [DOI] [PubMed] [Google Scholar]
- 10.Calvo MS, Whiting SJ, Barton CN. Vitamin D fortification in the United States and Canada: Current status and data needs. Am J Clin Nutr. 2004;80:1710S–6S. doi: 10.1093/ajcn/80.6.1710S. [DOI] [PubMed] [Google Scholar]
- 11.Health Canada. Food & Drug Act. 1985. [Google Scholar]
- 12.Health Canada. Interim Marketing Authorization (IMA) to permit the optional addition of vitamin D2-yeast to yeast-leavened bakery products at a level of 2.22 ug per 100 g. Ottawa: Canada Gazette; 2011. [Google Scholar]
- 13.Health Canada. Eating Well with Canada’s Food Guide. 2007. [Google Scholar]
- 14.Health Canada. Eating Well with Canada’s Food Guide — A Resource for Educators and Communicators. 2011. [Google Scholar]
- 15.Garriguet D. Beverage consumption of Canadian adults. Health Rep. 2008;19:23–29. [PubMed] [Google Scholar]
- 16.Garriguet D. Beverage consumption of children and teens. Health Rep. 2008;19:17–22. [PubMed] [Google Scholar]
- 17.Health Canada. Canadian Community Health Survey, Cycle 2.2, Nutrition (2004) — A Guide to Accessing and Interpreting the Data. 2006. [Google Scholar]
- 18.FoodNutrition Board, Institute of Medicine. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: National Academies Press; 2000. [Google Scholar]
- 19.Health Canada, The Canadian Nutrient File. Available at: http://www.hc-sc.gc.ca/fn-an/nutrition/fiche-nutri-data/cnf_aboutus-aproposdenous_fcen-en g.php (Accessed November 10, 2009).
- 20.USDA Agricultural Research Service. USDA National Nutrient Database for Standard Reference Release 19. 2007. [Google Scholar]
- 21.Canadian Food Inspection Agency. Food Labelling for Industry. February 21,2012. 2012. [Google Scholar]
- 22.Canadian Food Inspection Agency. Nutrient content claims. In: CFIA Guide to Food Labelling and Advertising. Chapter 7.
- 23.Codex Alimentarius Commission. Guidelines on Nutrition Labelling (CAC/GL 2-1985) 2011. [Google Scholar]
- 24.Health Canada. Addition of Vitamins and Minerals to Foods, 2005: Health Canada’s Proposed Policy and Implementation Plans. 2005. [Google Scholar]
- 25.Carriquiry AL, Camano-Garcia G. Evaluation of dietary intake data using the tolerable upper intake levels. J Nutr. 2006;136:507S–5013S. doi: 10.1093/jn/136.2.507S. [DOI] [PubMed] [Google Scholar]
- 26.Dodd KW, Guenther PM, Freedman LS, Subar AF, Kipnis V, Midthune D, et al. Statistical methods for estimating usual intake of nutrients and foods: A review of the theory. J Am Diet Assoc. 2006;106:1640–50. doi: 10.1016/j.jada.2006.07.011. [DOI] [PubMed] [Google Scholar]
- 27.Kalergis M, Lefebvre MA, Hovius J, MacDonald A. Consumer perceptions regarding the vitamin D content of milk products. Can J Diet Pract Res. 2010;71:e57. doi: 10.3148/71.3.2010.e57. [DOI] [Google Scholar]
- 28.Tylavsky FA, Cheng S, Lyytikainen A, Viljakainen H, Lamberg-Allardt C. Strategies to improve vitamin D status in northern European children: Exploring the merits of vitamin D fortification and supplementation. J Nutr. 2006;136:1130–34. doi: 10.1093/jn/136.4.1130. [DOI] [PubMed] [Google Scholar]
- 29.Hanson AL, Metzger LE. Evaluation of increased vitamin D fortification in high-temperature, short-time-processed 2% milk, UHT-processed 2% fat chocolate milk, and low-fat strawberry yogurt. J Dairy Sci. 2010;93:801–7. doi: 10.3168/jds.2009-2694. [DOI] [PubMed] [Google Scholar]
- 30.Wagner D, Rousseau D, Sidhom G, Pouliot M, Audet P, Vieth R. Vitamin D3 fortification, quantification, and long-term stability in cheddar and low-fat cheeses. J Agric Food Chem. 2008;56:7964–69. doi: 10.1021/jf801316q. [DOI] [PubMed] [Google Scholar]
- 31.Guo X, Willows N, Kuhle S, Jhangri G, Veugelers PJ. Use of vitamin and mineral supplements among Canadian adults. Can J Public Health. 2009;100:357–60. doi: 10.1007/BF03405270. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32.Goltzman D, Atkinson S, Forest P, Gray-Donald K, Hanley D, Patel M, et al. Responses to Questions from Health Canada on Implementation of Dietary Reference Intakes for Calcium and Vitamin D. 2012. Expert Advisory Committee of the Canadian Academy of Health Sciences. [Google Scholar]