Development of a model for optimal food fortification: vitamin D among adults in Finland

Background Average vitamin D intake is low in Finland. Even though almost all retail milk and margarine are fortified with vitamin D, the vitamin D intake is inadequate for a significant proportion of the population. Consequently, expanded food fortification with vitamin D would be motivated. However, there is a risk of unacceptably high intakes due to the rather narrow range of the adequate and safe intake. Therefore, a safe and efficient food fortification practice should be found for vitamin D. Aim of the study To develop a model for optimal food fortification and apply it to vitamin D. Method The FINDIET 2002 Study (48-h recall and data on supplement use (n = 2007), and 3 + 3 days’ food records, n = 247) was used as the test data. The proportion of the population whose vitamin D intake is between the recommended intake (RI) and the upper tolerable intake level (UL) was plotted against the fortification level per energy for selected foods. The fortification level that maximized the proportion of the population falling between RI and UL was considered the optimal fortification level. Results If only milk, butter milk, yoghurt and margarine were fortified, it would be impossible to find a fortification level by which the intake of the whole population would lie within the RI-UL range. However, if all potentially fortifiable foods were fortified with vitamin D at level 1.2–1.5 μg/100 kcal, the intake of the whole adult population would be between the currently recommended intake of 7.5 μg/d and the current tolerable upper intake level of 50 μg/day (model 1). If the RI was set to 40 μg/day and UL to 250 μg/day, the optimal fortification level would be 9.2 μg/100 kcal in the scenario where all potentially fortifiable foods were fortified (model 2). Also in this model the whole population would fall between the RI-UL range. Conclusions Our model of adding a specific level of vitamin D/100 kcal to all potentially fortifiable foods (1.2–1.5 μg/100 kcal in model 1 and 9.2 μg/100 kcal in model 2) seems to be an efficient and safe food fortification practise.     

An updated systematic review and meta-analysis of the efficacy of vitamin D food fortification

Food fortification is a potentially effective public health strategy to increase vitamin D intakes and circulating 25-hydroxyvitamin D [25(OH)D] concentrations. We updated a previous systematic review to evaluate current evidence from randomized controlled intervention studies in community-dwelling adults of the effect of fortified foods on 25(OH)D concentrations. Ovid MEDLINE, PubMed, CINAHL, Embase, and Cochrane Central Register of Controlled Trials were searched for randomized controlled intervention studies with vitamin D-fortified foods in free-living adults and data on circulating 25(OH)D. Two reviewers independently screened 441 papers for eligibility and extracted the relevant data. A meta-analysis of the absolute mean change in circulating 25(OH)D concentrations was conducted using a random effects model. Sixteen studies from 15 publications were included, of which 14 showed a significant effect of fortified foods on 25(OH)D concentrations. Heterogeneity was high (P = <0.0001, I(2) = 89%) and was partly explained by dose, latitude (range, 3-60°), and baseline 25(OH)D (range, 24.0-83.6 nmol/L). When combined in a random effects analysis (n = 1513; 767 treated, 746 controls), a mean individual intake of ~11 μg/d (440 IU/d) from fortified foods (range, 3-25 μg/d) increased 25(OH)D by 19.4 nmol/L (95% CI: 13.9, 24.9), corresponding to a 1.2 nmol/L (95% CI: 0.72, 1.68) increase in 25(OH)D for each 1 μg ingested. Vitamin D food fortification increases circulating 25(OH)D concentrations in community-dwelling adults. Safe and effective food-based strategies could increase 25(OH)D across the population distribution and prevent vitamin D deficiency with potential benefit for public health.     

Effect of food fortification with iron on childhood anemia: a review study

A systematic review was conducted to identify studies assessing the effect of food fortification with iron on childhood anemia. The MEDLINE, LILACS, and PubMed databases and WHO and PAHO sites were searched with no time limitation, including articles published in Portuguese, English, or Spanish, using the following key words and their combination: food fortification, iron, effectiveness, efficacy, anemia, flour, staple foods, interventions, and children. Of 21 studies reviewed, only one failed to report a positive, favorable effect of iron fortification, indicating the possibility of publication bias. The studies showed important methodological limitations. The two studies with the best methodological scores showed opposite results, highlighting the need for larger trials with better planning to explore this hypothesis.     

Alcohol-related problems among adolescent suicides in Finland.

We studied 106 adolescent suicides out of a total nationwide population of 1397 suicides. Forty-four (42%) of these 13-22-year-old victims were classified as having suffered either a DSM-III-R alcohol use disorder or diagnostically subthreshold alcohol misuse according to retrospective evaluation using the Michigan Alcoholism Screening Test (MAST). These victims were found to differ from the other adolescent suicides in several characteristics: they were more likely to have comorbid categorical DSM-III-R disorders, antisocial behaviour, disturbed family backgrounds, precipitating life-events as stressors and severe psychosocial impairment. In addition, they also had a greater tendency to be alcohol-intoxicated at the time of the suicidal act, which tended to occur during weekends, suggesting that drinking in itself, and its weekly pattern, each contributed to the completion of their suicides.     

Self-esteem,emotional distress and sexual behavior among adolescent females: Inter-relationships and temporal effects

PurposeThe current analyses attempt to clarify the relationship between psychological factors and sexual behavior. We test a model examining relationships between sexual history (e.g., age at initiation, partner history) and self-esteem and emotional distress (e.g., depression, anxiety, stress, hostility) and their impact on future sexual risk behavior (e.g., unprotected sex, multiple sexual partners).MethodsThe current analyses included 155 sexually active adolescent females, aged 14–19 years, who participated in the first two waves of a longitudinal study of human immunodeficiency virus (HIV)/sexually transmitted disease (STD) and pregnancy risk. The Rosenberg Self-esteem scale, the Perceived Stress Scale, and three subscales of the Brief Symptom Inventory (depression, anxiety, hostility) and a variety of self-report measures of sexual history and sexual behavior were administered. Structural equation modeling using LISREL 8.51 was used to assess the proposed model.ResultsOur model exhibited adequate fit and demonstrated that sexual history reported retrospectively at baseline was related to self-esteem and emotional distress also measured at baseline. These variables predicted sexual risk behavior measured 6 months later. Adolescents who had lower self-esteem at baseline reported initiating sex earlier and having had risky partners. Alternatively, adolescents with more emotional distress at baseline were less likely to have had a previous STD, had more partners per year of sexual activity and a history of risky partners. Self-esteem influenced subsequent unprotected sex and emotional distress influenced subsequent multiple partners.ConclusionsThis model suggests that self-esteem and emotional distress have contrasting relationships with sexual behavior and demonstrates the importance of the temporal nature of these variables. Implications for intervention are discussed.     

预包装食品中维生素D强化情况调查

摘要:目的　了解预包装食品中维生素D强化的情况。方法　根据GB14880-2012的规定,在南京5家大型超市进行调查。结果　有36个品牌、共110种食品进行了维生素D的强化,65.5%的食品属于调制乳粉、调制乳、豆粉类;食品维生素D强化剂量均符合食品营养强化剂使用标准,人造黄油的添加量最高,最低的为糊状食品;九大知名品牌产品数约占所有维生素D强化食品的58.2%;76.4%的维生素D强化食品未明确标注维生素D2或维生素D3。结论　结果显示维生素D强化食品种类仍然不多且关于维生素D的标示信息不全。应增加维生素D的强化食品种类,并考虑强制性对一些食品进行维生素D强化。     

Strategies to improve vitamin D status in northern European children: exploring the merits of vitamin D fortification and supplementation

Adequacy of vitamin D in children in Europe has been the focus of a number of investigations. The results of measuring serum levels of 25-hydroxyvitamin D show high prevalence of vitamin D deficiency during the winter with lower prevalence during the summer. National policies on food fortification or individual supplementation with vitamin D have been recently revisited by the individual countries and the European Union as a whole. Optiford is a project managed by a coalition of scientists formed to optimize vitamin D fortification in the northern European Countries, was given the task to decide if food fortification with vitamin D is feasible and to provide a scientific basis for setting the vitamin D fortification level in Europe. This article presents the results of these investigations to date, with particular attention to potential corrective strategies to allow children and adolescents living in countries at high latitudes to maintain healthy circulating 25-hydroxyvitamin D levels year around, even in the absence of adequate sun exposure during a significant part of the year.     

Liberal fortification of foods: the risks. A study relating to Finland

STUDY OBJECTIVE: The free circulation of goods in the European Union (EU) has increased the number of fortified foods available to consumers in Finland. Fortification of foodstuffs with calcium is currently widespread. To assist decision making relating to fortification, the object of this study was to determine whether there might be a risk of excessive levels of calcium. The study was done using the dietary data of adult population by sex and calcium intake deciles, taking account of intakes of calcium from normal diets and from fortified foods. STUDY DESIGN: Calcium intakes for deciles were calculated from dietary data of the population involved in the 1992 FINDIET survey. Calcium fortification was evaluated by considering foodstuffs to which calcium has already been added or which producers might wish to fortify and market in Finland. Situations in which a fortified product replaced its unfortified equivalent were envisaged. Daily calcium intakes (mg) from particular foodstuffs were calculated based on known amounts of calcium (mg) per 100 g of each foodstuff and amounts of each product consumed per day. Total calcium intakes of people in different deciles were calculated by adding amounts of calcium contributed by each fortified product to normal dietary intakes. Calcium intakes were also calculated for consumption by persons of all foodstuffs that are or intended to be fortified with calcium. STUDY PARTICIPANTS: Adults aged 25 to 64 representing populations in four regions of Finland, who recorded food consumption over three day periods in spring 1992. STUDY SETTING: North Karelia, Kuopio Province, Turku-Loimaa, and the capital area Helsinki-Vantaa, Finland. MAIN STUDY RESULTS: The results indicate that the highest 10% of Finnish adult men receive on average 2315 mg calcium per day from diets that do not include fortified foodstuffs. These people whose energy consumption was high consumed substantial amounts of dairy products. Consumption of fortified foods would increase the calcium intake further to levels exceeding the tolerable upper intake level (2500 mg/d). CONCLUSIONS: Liberal addition of calcium to various groups of foodstuffs could increase the calcium intake in the highest decile to levels with potentially untoward health effects. In assessing benefits and possible disadvantages of fortification of foodstuffs, the dietary habits of the population concerned, probable consumption of fortified products and nutritional intakes, especially at extremes, need to be taken into account, by total risk assessment.     

Rice and sushi cravings: a preliminary study of food craving among Japanese females

The aim of the present study was to develop a preliminary version of the Food Craving Inventory for Japanese (FCI-J) and to investigate the phenomenon of food craving among Japanese females. One hundred and eighty-five female college students completed newly developed FCI-J. Factor analysis yielded conceptual factors that were interpreted as sweets, snacks, western foods, sushi, and rice. Test-retest and internal consistency analyses indicated a good reliability for both total score and score of subscales. In addition, results showed that the FCI-J has a good content, concurrent, construct, and discriminant validity. It is noteworthy that "rice craving" may be characteristic among Asian rice consuming countries, and that there are considerable "sushi cravers" in Japan. These findings suggested that the craving for some kind of food is influenced by the tradition of food products and cultures.     

Vitamin D fortification as public health policy: significant improvement in vitamin D status in young Finnish men

BACKGROUND: Vitamin D insufficiency is common in northern countries during wintertime. In Finland, after the recommendation by the Ministry of Social Affairs and Health, vitamin D has been added to liquid milk products and margarines from February 2003. OBJECTIVE: We determined the effects of national policy on vitamin D fortification on vitamin D status among young Finnish men. DESIGN: A comparison before and after intervention with study population of 196 young Finnish men (18-28 years) was carried out. Serum 25-hydroxyvitamin D3 (25-OHD3) concentrations were determined with the OCTEIA enzymeimmunoassay by IDS (Immunodiagnostic Systems Limited, Bolden, UK) in January 2003 (n = 96) and in January 2004 (n = 100), nearly 1 year after national vitamin D fortification had started. RESULTS: The mean serum 25-OHD3 concentrations during the wintertime increased by 50% after implementation of the vitamin D fortification of dairy products. Correspondingly, the prevalence of vitamin D insufficiency (serum 25-OHD3 < 40 nmol/l) was decreased by 50% from 78% in January 2003 to 35% in January 2004. CONCLUSIONS: Our results demonstrate that national vitamin D fortification substantially improved the vitamin D status of young Finnish men. Still, a third remained vitamin D insufficient.     

Perspectives on obesity and sweeteners, folic acid fortification and vitamin D requirements

This review summarizes three controversial areas of clinical practice that were discussed in many articles that appeared in the American Journal of Clinical Nutrition during the author's tenure as editor in chief. Controversy 1-obesity and high-fructose corn syrup. The increased frequency of obesity in the US is paralleled by increasing annual consumption of high-fructose corn syrup, an extracted sweetener that is routinely added to soft drinks and to many processed foods in the US diet. Metabolic studies implicate increased fructose consumption in increased body fat and obesity and with increased circulating triglyceride levels and hypercholesterolaemia in children. Controversy 2-folic acid fortification and supplements. Together with widespread use of supplemental multivitamins, fortification of the US diet with folic acid has resulted in high serum folate levels in much of the population, which may be associated with increased risk of cognitive decline in ageing people with low vitamin B12 status, decreased natural killer T-cell immune function and increased risk of recurrent advanced precancerous colorectal adenomas and breast cancer. Controversy 3-recommended intakes of vitamin D. Levels of serum 25(OH)D sufficient for fracture prevention are at least 75 nmol/l (30 ng/ml) but cannot be achieved by the current recommended dietary intakes in the US. A recent fracture risk prevention trial showed that the 4-year incidence of all cancers was reduced in US women who received high supplemental doses of both calcium and vitamin D.     

Short-term sexual health effects of relationships with significantly older females on adolescent boys

PurposeTo examine the short-term effects on the sexual health of adolescent boys in age discordant relationships.MethodsWeighted logistic regression analyses were conducted using data from waves 1 and 2 of the National Survey of Adolescent Health to determine the health effects of entry into an age discordant relationship on adolescent boys.ResultsResults indicate that boys involved in an age discordant relationship, in comparison with boys in a similar age relationship, had higher odds of having had sexual intercourse (OR = 2.92), having got a partner pregnant (OR = 1.89), having been diagnosed with STD (OR = 4.41), and having lost one's virginity (OR = 3.39). Analyses on the sexually active subset reveal no significant relationship between involvement in an age discordant relationship and birth control use broadly, or condom use specifically, at their most recent sexual intercourse.ConclusionIn general, entering into an age discordant relationship as a younger partner is associated with some adverse sexual health effects for adolescent boys. Thus, some outcomes that were demonstrated in previous research to be problematic for adolescent girls dating significantly older males are similarly problematic for adolescent boys dating older females.     

Effect of vitamin D supplementation on bone and vitamin D status among Pakistani immigrants in Denmark: a randomised double-blinded placebo-controlled intervention study

Severe vitamin D deficiency is common among Muslim immigrants. The dose necessary to correct the deficiency and its consequence for bone health are not known for immigrants. The aim was to assess the effect of relatively low dosages of supplemental vitamin D on vitamin D and bone status in Pakistani immigrants. This 1-year-long randomised double-blinded placebo-controlled intervention with vitamin D3 (10 and 20 microg/d) included girls (10.1-14.7 years), women (18.1-52.7 years) and men (17.9-63.5 years) of Pakistani origin living in Denmark. The main endpoints were serum 25-hydroxyvitamin D (S-25OHD), parathyroid hormone, bone turnover markers and bone mass. The study showed that supplementation with 10 and 20 microg vitamin D3 per d increased S-25OHD concentrations similarly in vitamin D-deficient Pakistani women (4-fold), and that 10 microg increased S-25OHD concentrations 2-fold and 20 microg 3-fold in Pakistani men. S-25OHD concentrations increased at 6 months and were stable thereafter. Baseline S-25OHD concentrations tended to be lower in girls and women than in men; females achieved about 46 nmol/l and men 55 nmol/l after supplementation. Serum intact parathyroid hormone concentrations decreased at 6 months, but there was no significant effect of the intervention on bone turnover markers and dual-energy X-ray absorptiometry measurements of the whole body and lumbar spine.     

Glucose tolerance and vitamin D: effects of treating vitamin D deficiency

OBJECTIVE: We investigated the effects of vitamin D treatment on plasma glucose, serum insulin, and insulin sensitivity in vitamin D-deficient individuals without diabetes mellitus. METHODS: Thirty-three adults with vitamin D insufficiency (serum 25-hydroxyvitamin D concentration 相似文献   

Vitamin D food fortification in European countries: the underused potential to prevent cancer deaths

European Journal of Epidemiology - Background: Meta-analyses of randomized controlled trials have shown that vitamin D supplementation reduces cancer mortality by 13%. Vitamin D fortification of...     

603名青春期儿童维生素D水平状况相关研究

目的 了解青春期儿童维生素D(VD)水平状况及其影响因素,分析导致VD不足的原因,为后续研究和防治提供科学依据。方法 2015-2016年随机抽取哈尔滨市某城区某中学603名6~8年级11~17岁青春期儿童进行体格检查、问卷调查及实验室检测血清25(OH)D、甲状旁腺素(PTH)、钙(Ca)、磷(P)和碱性磷酸酶(ALP)的水平。结果 603名青春期儿童血清25(OH)D的中位数和四分间距位数为14.16 (10.68, 18.46)ng/ml,VD不足和缺乏占81.1%。血清PTH、Ca、P、ALP水平分别为42.7(31.90, 60.70)pg/ml、(2.47±0.13) mmol/L、(1.57±0.21) mmol/L、(275.23±127.60) U/L。血清25(OH)D与PTH水平和ALP水平之间呈负相关(r=-0.039、-0.141,P<0.001),与Ca呈正相关(r=0.312,P<0.001),与P无明显相关性。PTH和25(OH)D为对数关系,当PTH达到最大抑制状态时无25(OH)D拐点值。户外活动时间、补充VD制剂与血清25(OH)D水平呈正相关(P_趋势<0.001),户外活动时间、VD制剂的补充是青春期儿童VD水平的重要影响因素。结论 11~17岁青春期儿童VD缺乏情况普遍存在。血清PTH、ALP和Ca,这些指标的测定有助于评价青春期儿童VD水平状况,建议通过鼓励青春期儿童增加户外活动,补充VD制剂等手段,可以提高血清25(OH)D水平。