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.     

食品中钙的强化水平上限研究

目的探讨确定食品中微量营养素强化上限水平的方法;以钙为例,提出食品中钙的强化水平上限建议值。方法基于风险评估基本原则,利用2002年中国居民营养与健康状况调查数据,探讨应用强化水平上限计算模型,按不同经济发展水平、年龄、性别分层分析,得出不同经济发展水平下不同年龄及性别人群的食品中钙强化水平上限,将其中的最低值作为强化水平上限的初步建议值。结果大城市、一类农村及中小城市各年龄组居民食品中钙强化水平上限(MSFL)均低于全人群相应年龄组水平。一类农村18岁以上年龄组的MSFL是相应年龄组的最低值,2～7岁、11～18岁的MSFL的最低值来自大城市。各年龄组中,18～50岁年龄组的食品中钙强化水平上限最低,为262mg/1000kJ。结论通过模型计算结果与食品强化标准某些指标值的比较分析,认为该模型可用于提出有UL值的一类营养素的强化水平上限建议值。     

食品中锌的安全强化水平研究

目的研究提出食品中锌的强化水平上限建议值,为评估和修订食品营养强化剂标准提供参考。方法基于风险评估基本原则,利用2002年中国居民营养与健康状况调查数据,探讨应用强化水平上限计算模型,按不同经济发展水平、年龄、性别分层分析,得出不同组别人群的食品中锌强化水平上限,将其中的最低值作为强化水平上限的初步建议值。结果大城市、一类农村及中小城市中的大部分组别居民食品中锌强化水平上限(MSFL)低于全人群相应组别水平。最低的MSFL出现在大城市孕妇和4~7岁学龄前儿童组,分别为9.01mg/1 000kJ和10.43mg/1 000kJ。结论通过模型计算结果与食品强化标准相应指标值的比较分析,认为现有规定可以保证食用安全,该模型是评估和审议营养强化剂安全强化水平的可选方法。建议在今后的全国居民营养与健康状况调查中增加强化食品以及营养素补充剂的摄入情况调查。     

Comparison of Micronutrient Intervention Strategies in Ghana and Benin to Cover Micronutrient Needs: Simulation of Bene-Fits and Risks in Women of Reproductive Age

Overlapping micronutrient interventions might increase the risk of excessive micronutrient intake, with potentially adverse health effects. To evaluate how strategies currently implemented in Benin and Ghana contribute to micronutrient intake in women of reproductive age (WRA), and to assess the risk for excess intakes, scenarios of basic rural and urban diets were built, and different on-going interventions were added. We estimated micronutrient intakes for all different scenarios. Four types of intervention were included in the scenarios: fortification, biofortification, supplementation and use of locally available nutrient-rich foods. Basic diets contributed poorly to daily micronutrient intake in WRA. Fortification of oil and salt were essential to reach daily requirements for vitamin A and iodine, while fortified flour contributed less. Biofortified products could make an important contribution to the coverage of vitamin A needs, while they were not sufficient to cover the needs of WRA. Iron and folic acid supplementation was a major contributor in the intake of iron and folate, but only in pregnant and lactating women. Risk of excess were found for three micronutrients (vitamin A, folic acid and niacin) in specific contexts, with excess only coming from voluntary fortified food, supplementation and the simultaneous overlap of several interventions. Better regulation and control of fortification and targeting of supplementation could avoid excess intakes.     

The Key Role of Government in Addressing the Pandemic of Micronutrient Deficiency Conditions in Southeast Asia

Micronutrient deficiency conditions are a major global public health problem. While the private sector has an important role in addressing this problem, the main responsibility lies with national governments, in cooperation with international agencies and donors. Mandatory fortification of basic foods provides a basic necessary intake for the majority and needs to be supported by provision of essential vitamin and mineral supplements for mothers and children and other high risk groups. Fortification by government mandate and regulation is essential with cooperation by private sector food manufacturers, and in the context of broader policies for poverty reduction, education and agricultural reform. Iron, iodine, vitamin A, vitamin B complex, folic acid, zinc, vitamin D and vitamin B12 are prime examples of international fortification experience achieved by proactive governmental nutrition policies. These are vital to achieve the Millennium Development Goals and their follow-up sustainable global health targets. National governmental policies for nutritional security and initiatives are essential to implement both food fortification and targeted supplementation policies to reduce the huge burden of micronutrient deficiency conditions in Southeast Asia and other parts of the world.     

Effect of a voluntary food fortification policy on folate, related B vitamin status, and homocysteine in healthy adults

BACKGROUND: Mandatory folic acid fortification of food is effective in reducing neural tube defects and may even reduce stroke-related mortality, but it remains controversial because of concerns about potential adverse effects. Thus, it is virtually nonexistent in Europe, albeit many countries allow food fortification on a voluntary basis. OBJECTIVE: The objective of the study was to examine the effect of a voluntary but liberal food fortification policy on dietary intake and biomarker status of folate and other homocysteine-related B vitamins in a healthy population. DESIGN: The study was a cross-sectional study. From a convenience sample of 662 adults in Northern Ireland, those who provided a fasting blood sample and dietary intake data were examined (n = 441, aged 18-92 y). Intakes of both natural food folate and folic acid from fortified foods were estimated; we used the latter to categorize participants by fortified food intake. RESULTS: Fortified foods were associated with significantly higher dietary intakes and biomarker status of folate, vitamin B-12, vitamin B-6, and riboflavin than were unfortified foods. There was no difference in natural food folate intake (range: 179-197 microg/d) between the fortified food categories. Red blood cell folate concentrations were 387 nmol/L higher and plasma total homocysteine concentrations were 2 micromol/L lower in the group with the highest fortified food intake (median intake: 208 microg/d folic acid) than in the nonconsumers of fortified foods (0 microg/d folic acid). CONCLUSIONS: These results show that voluntary food fortification is associated with a substantial increase in dietary intake and biomarker status of folate and metabolically related B vitamins with potential beneficial effects on health. However, those who do not consume fortified foods regularly may have insufficient B vitamin status to achieve the known and potential health benefits.     

Fortification of Foods with Vitamin D in India

Vitamin D deficiency is widely prevalent in India, despite abundant sunshine. Fortification of staple foods with vitamin D is a viable strategy to target an entire population. Vitamin D fortification programs implemented in the United States and Canada have improved the vitamin D status in these countries, but a significant proportion of the population is still vitamin D deficient. Before fortification programs are designed and implemented in India, it is necessary to study the efficacy of the American and Canadian vitamin D fortification programs and then improve upon them to suit the Indian scenario. This review explores potential strategies that could be used for the fortification of foods in the Indian context. These strategies have been proposed considering the diverse dietary practices necessitated by social, economic, cultural and religious practices and the diverse climatic conditions in India. Fortification of staple foods, such as chapati flour, maida, rice flour and rice, may be more viable strategies. Targeted fortification strategies to meet the special nutritional needs of children in India are discussed separately in a review entitled, “Fortification of foods with vitamin D in India: Strategies targeted at children”.     

Vitamin D: An overview of vitamin D status and intake in Europe

In recent years, there have been reports suggesting a high prevalence of low vitamin D intakes and vitamin D deficiency or inadequate vitamin D status in Europe. Coupled with growing concern about the health risks associated with low vitamin D status, this has resulted in increased interest in the topic of vitamin D from healthcare professionals, the media and the public. Adequate vitamin D status has a key role in skeletal health. Prevention of the well‐described vitamin D deficiency disorders of rickets and osteomalacia are clearly important, but there may also be an implication of low vitamin D status in bone loss, muscle weakness and falls and fragility fractures in older people, and these are highly significant public health issues in terms of morbidity, quality of life and costs to health services in Europe. Although there is no agreement on optimal plasma levels of vitamin D, it is apparent that blood 25‐hydroxyvitamin D [25(OH)D] levels are often below recommended ranges for the general population and are particularly low in some subgroups of the population, such as those in institutions or who are housebound and non‐Western immigrants. Reported estimates of vitamin D status within different European countries show large variation. However, comparison of studies across Europe is limited by their use of different methodologies. The prevalence of vitamin D deficiency [often defined as plasma 25(OH)D <25 nmol/l] may be more common in populations with a higher proportion of at‐risk groups, and/or that have low consumption of foods rich in vitamin D (naturally rich or fortified) and low use of vitamin D supplements. The definition of an adequate or optimal vitamin D status is key in determining recommendations for a vitamin D intake that will enable satisfactory status to be maintained all year round, including the winter months. In most European countries, there seems to be a shortfall in achieving current vitamin D recommendations. An exception is Finland, where dietary survey data indicate that recent national policies that include fortification and supplementation, coupled with a high habitual intake of oil‐rich fish, have resulted in an increase in vitamin D intakes, but this may not be a suitable strategy for all European populations. The ongoing standardisation of measurements in vitamin D research will facilitate a stronger evidence base on which policies can be determined. These policies may include promotion of dietary recommendations, food fortification, vitamin D supplementation and judicious sun exposure, but should take into account national, cultural and dietary habits. For European nations with supplementation policies, it is important that relevant parties ensure satisfactory uptake of these particularly in the most vulnerable groups of the population.     

Vitamins and minerals: A model for safe addition to foods

BACKGROUND: Significant subgroups in most European populations have intakes below nationally recommended levels for several vitamins, minerals and trace elements, placing individuals at risk of suboptimal intake of important vitamins and minerals. The voluntary addition of micronutrients to the appropriate foods may help address the risks associated with low micronutrient intakes. However, concerns need to be addressed regarding the potential for unacceptably high intakes, particularly for those people consuming very large amounts of food. AIM OF THE STUDY: To develop a model to estimate the level of each micronutrient that can be added safely to foods. METHODS: A theoretical model was developed based on the critical factors which determine the risk of unacceptably high intake for each micronutrient at high levels of food/energy intakes. These included 1) Tolerable Upper Intake Levels (UL), 2) high micronutrient intakes in Europe at the 95(th) percentile intake for each nutrient, 3) the proportion of fortified foods in the diets of individuals at the 95(th) percentile for energy intakes, 4) the proportion of foods to which micronutrients could practically be added, and 5) a range of estimates for the fractions of foods which might be actually fortified for each nutrient. A maximum level was set up for each micronutrient per typical serving or 100 kcal portion. The outputs of the model were then compared against a recent model developed by AFSSA, based on the food intake data in France. RESULTS: Three categories of micronutrients were identified, in which micronutrients could be added safely to foods at levels (per serving, e. g., 100 kcal) 1) greater than 1 European Commission Recommended Daily Intake (EC RDA): vitamin B12, vitamin C, vitamin E, riboflavin, panthothenic acid, niacin and thiamine; 2) between 50 and 100 % of the EC RDA: vitamin B6, vitamin D, folic acid, biotin, copper, iodine and selenium; 3) between 10 and 40 % of the EC RDA: iron, zinc, calcium, phosphorus and magnesium. A fourth category consisting of retinol, for which high end intake levels are close to UL for some population subgroups in Europe and thus requires further consideration. CONCLUSIONS: A wide range of vitamins and minerals can be added safely to foods at nutritionally important levels in the current diets of Europeans.     

Potential of Vitamin D Food Fortification in Prevention of Cancer Deaths—A Modeling Study

Meta-analyses of randomized controlled trials (RCTs) have estimated a 13% reduction of cancer mortality by vitamin D supplementation among older adults. We evaluated if and to what extent similar effects might be expected from vitamin D fortification of foods. We reviewed the literature on RCTs assessing the impact of vitamin D supplementation on cancer mortality, on increases of vitamin D levels by either supplementation or food fortification, and on costs of supplementation or fortification. Then, we derived expected effects on total cancer mortality and related costs and savings from potential implementation of vitamin D food fortification in Germany and compared the results to those for supplementation. In RCTs with vitamin D supplementation in average doses of 820–2000 IU per day, serum concentrations of 25-hydroxy-vitamin D increased by 15–30 nmol/L, respectively. Studies on food fortification found increases by 10–42 nmol/L, thus largely in the range of increases previously demonstrated by supplementation. Fortification is estimated to be considerably less expensive than supplementation. It might be similarly effective as supplementation in reducing cancer mortality and might even achieve such reduction at substantially larger net savings. Although vitamin D overdoses are unlikely in food fortification programs, implementation should be accompanied by a study monitoring the frequency of potentially occurring adverse effects by overdoses, such as hypercalcemia. Future studies on effectiveness of vitamin D supplementation and fortification are warranted.     

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。     

Vitamin intake in Japanese women college students

The Standard Food Tables of Japanese Foods was newly revised in 2000, and contains information on all of the vitamins except biotin. Thus, we carried out a survey of vitamin intake in Japanese women who were university seniors majoring a dietitian course. The subjects (n = 33) consumed self-selected foods, and food intake was recorded by the weight method. We calculated the vitamin intake except for biotin from the food records using the Standard Food Tables of Japanese Foods. In terms of daily intake, vitamin A was 705+/-435 microg (mean+/-SD), vitamin D 6+/-8 microg, vitamin E 7.7+/-3.0 mg, vitamin K 191+/-156 microg, vitamin B1 0.7+/-0.3 mg (0.43+/-0.15 mg/1,000 kcal), vitamin B2 1.1+/-0.4 mg (0.65+/-0.18 mg/1,000 kcal), vitamin B6 0.9+/-0.4 mg (0.017+/-0.005 mg/g protein), vitamin B12 4.4+/-4.1 microg, niacin equivalent 23+/-7 mg (14.4+/-4.9 mg/1,000 kcal), pantothenic acid 4.6+/-1.4 mg, folic acid 267+/-115 microg, and vitamin C 73+/-38 mg. All of these averages were around the Japanese Recommended Dietary Allowance (RDA) for level "III (preferable)" of physical activity. Major vitamin A resources were vegetables; vitamin D resources, fish; vitamin E resources, fats and oils and vegetables; vitamin K resources, vegetables; vitamin B1 resources, cereals and animal meats; vitamin B2 resources, various foods; vitamin B6 resources, cereals, vegetables, fish, and animal meats; vitamin B12 resources, fish; niacin equivalent resources, fish, animal meats, and cereals; pantothenic acid resources, various foods; folic acid resources, vegetables; and vitamin C resources, vegetables and potatoes. From this survey, it was found that Japanese women college students consumed many kinds of food, and therefore, their vitamin nutrition was good as compared to the RDA values for level III of physical activity; however, their energy intake (1,622+/-377 kcal) was lower than the RDA for level III (2,050 kcal/d). Their strength of physical activity would be level I. Therefore, in consideration of their lifestyle, their energy intakes is considered adequate. In conclusion, a problem for student lifestyle is a shortage of food intake due to lack of exercise.     

Folate fortification: potential impact on folate intake in an older population

OBJECTIVE: To examine the potential impact of different models of folate fortification of Australian foods on the folate intakes of older Australians. DESIGN: Dietary data were collected using a food frequency questionnaire from people attending a population-based health study. SETTING: Two postcode areas west of Sydney, Australia. SUBJECTS: A total of 2895 people aged over 49 y, obtained from a door knock census (79% of 3654 subjects examined). MAIN OUTCOME MEASURES: The folate intake in this population was estimated using four different models: (1) pre-fortification folate values; (2) current voluntary folate fortification in Australia; (3) universal fortification of all foods permitted to add folate, at 25% recommended dietary intake (RDI) per reference serve; and (4) universal fortification of all foods permitted to add folate, at 50% RDI per reference serve. The increased bioavailability of synthetic folic acid (SFA) was included in the analysis. RESULTS: At current voluntary folate fortification, approximately 65% of this population consume 320 microg dietary folate equivalents (DFE) or more per day from diet and supplements, and 0.4% (n=10) consume greater than the recommended upper safety level of 1000 microg from SFA. More than 95% of this older population would be expected to consume more than 320 microg DFE from diet and supplements with universal fortification at 50% of the RDI, and 0.5% (n=14) may consume greater than 1000 microg/day of SFA. CONCLUSIONS: There is unlikely to be a large increase in the proportion of older persons who are likely to consume more than the upper safety level of intake with universal folate fortification. As most of those who currently or are predicted to consume over 1000 microg SFA take supplements containing folic acid, it is highly recommended that vitamin B12 be included in any vitamin supplements containing folate. SPONSORSHIP: This study was supported by the Australian National Health and Medical Research Council (NHMRC).     

Folate and vitamin B12: friendly or enemy nutrients for the elderly

In the UK vitamin B12 deficiency occurs in approximately 20% of adults aged >65 years. This incidence is significantly higher than that among the general population. The reported incidence invariably depends on the criteria of deficiency used, and in fact estimates rise to 24% and 46% among free-living and institutionalised elderly respectively when methylmalonic acid is used as a marker of vitamin B12 status. The incidence of, and the criteria for diagnosis of, deficiency have drawn much attention recently in the wake of the implementation of folic acid fortification of flour in the USA. This fortification strategy has proved to be extremely successful in increasing folic acid intakes pre-conceptually and thereby reducing the incidence of neural-tube defects among babies born in the USA since 1998. However, in successfully delivering additional folic acid to pregnant women fortification also increases the consumption of folic acid of everyone who consumes products containing flour, including the elderly. It is argued that consuming additional folic acid (as 'synthetic' pteroylglutamic acid) from fortified foods increases the risk of 'masking' megaloblastic anaemia caused by vitamin B12 deficiency. Thus, a number of issues arise for discussion. Are clinicians forced to rely on megaloblastic anaemia as the only sign of possible vitamin B12 deficiency? Is serum vitamin B12 alone adequate to confirm vitamin B12 deficiency or should other diagnostic markers be used routinely in clinical practice? Is the level of intake of folic acid among the elderly (post-fortification) likely to be so high as to cure or 'mask' the anaemia associated with vitamin B12 deficiency?     

If high folic acid aggravates vitamin B12 deficiency what should be done about it?

The most common cause of vitamin B12 deficiency in older people is malabsorption of food-bound vitamin B12. Thus, it is suggested that the recommended daily allowance of 2.4 microg/d be met primarily with crystalline vitamin B12, which is believed to be well absorbed in individuals who have food-bound malabsorption. There is concern that high intakes of folic acid from fortified food and dietary supplements might mask the macrocytic anemia of vitamin B12 deficiency, thereby eliminating an important diagnostic sign. One recent study indicates that high serum folate levels during vitamin B12 deficiency exacerbate (rather than mask) anemia and worsen cognitive symptoms. Another study suggests that once vitamin B12 deficiency is established in subjects with food-bound malabsorption, 40 microg/d to 80 microg/d of oral crystalline vitamin B12 for 30 d does not reverse the biochemical signs of deficiency. Together, these studies provide further evidence that public health strategies are needed to improve vitamin B12 status in order to decrease the risk of deficiency and any potentially adverse interactions with folic acid.     

Are low tolerable upper intake levels for vitamin A undermining effective food fortification efforts?

Vitamin A deficiency (VAD) is a major health problem, particularly in low-resource countries, putting an estimated 125–130 million preschool-aged children at increased risk of morbidity and mortality from infectious diseases. Vitamin A supplementation reduces VAD and increases child survival; it is complemented by fortifying foods with vitamin A. Concern over increased risk of bone fracture associated with vitamin A intakes below the tolerable upper intake level (UL) among populations in affluent countries conflicts with the need to increase intakes in less developed countries, where populations are at greater risk of VAD and intakes are unlikely to reach the UL as diets include fewer foods containing retinol while vitamin A from carotenoids poses no risk of overdose. With the implementation of recently developed risk management tools, vitamin A can be used safely in food fortification, including point-of-use fortification in the context of supplementation among specific target groups in low-resource countries.     

Promotion of folate for the prevention of neural tube defects: who benefits?

Since the publication of randomised trials showing firm evidence of prevention of neural tube defects with periconceptional folic acid, there have been population health promotion programmes to encourage women to take folic acid supplements, and the introduction of voluntary fortification of some foods with folic acid in Australia. In order to evaluate these two strategies, we collected data by self-administered questionnaire from a random sample of recently pregnant women in Western Australia between September 1997 and March 2000. Response to health promotion was measured in three ways: (1) knowledge of the association between periconceptional folate and prevention of spina bifida (the 'correct message'); (2) use of periconceptional vitamin supplements of folic acid daily in the periconceptional period; and (3) daily folate intake from fortified foods in the 6 months before pregnancy. We examined the relationship of maternal demographic and behavioural characteristics with these three measures. Overall, 62.3% of women were aware of the correct message before pregnancy, 28.5% reported taking 200 microg or more of folic acid from supplements daily in the periconceptional period and 56.6% of women obtained 100 microg or more of folic acid from fortified foods. Women who first became aware of the correct message during pregnancy or who were unaware of the correct message before or during pregnancy were more likely than women aware before pregnancy to be younger, having their first pregnancy, be single or in a de facto relationship, have no tertiary education, and be a public patient. Similar associations were seen for women taking either no folic acid or < 200 microg of folic acid in supplements daily in the periconceptional period. There were no significant associations between these demographic variables and amount of folate obtained from fortified foods. Women who were unaware of the correct message and did not take folic acid supplements were more likely to have smoked, not to have engaged in exercise, and not to have planned their pregnancy, whereas there was no association with these behavioural characteristics and intake of folate from fortified foods. These results indicate that health promotion strategies have not reached all segments of the target population equally, but there is no such disparity with folate-fortified foods, and they suggest that mandatory fortification of a staple food is likely to reach all women regardless of demographic and behavioural characteristics, and hence provide improved opportunity for prevention of neural tube defects in Australia.     

Folate during reproduction: the Canadian experience with folic acid fortification

Folate has received international attention regarding its role in the risk-reduction of birth defects, specifically neural tube defects (NTDs). In 1998, health officials in Canada, like the United States, mandated the addition of folic acid to white flour and select grain products to increase the folate intake of reproductive-aged women. Subsequent to this initiative there has been an increase in blood folate concentrations in Canada and a 50% reduction in NTDs. Many countries, including Korea, have not mandated folic acid fortification of their food supply. Reasons vary but often include concern over the masking of vitamin B₁₂ deficiency, a belief that folate intakes among womenare adequate, low priority relative to other domestic issues, and the philosophy that individuals have the right not to consume supplemental folic acid if they so choose. Prior to folic acid fortification of the food supply in Canada, the folate intakes of women were low, and their blood folate concentrations while not sufficiently low to produce overt signs of folate deficiency (eg. anemia) were inconsistent with a level known to reduce the risk of an NTD-affected pregnancy. The purpose of this article is to describe the role of folate during the periconceptional period, pregnancy, and during lactation. The rationale for, and history of recommending folic acid-containing supplements during the periconceptional period and pregnancy is described as is folic acid fortification of the food supply. The impact of folic acid fortification in Canada is discussed, and unresolved issues associated with this policy described. While the incidence of NTDs in Canada pre-folic acid fortification were seemingly higherthan that of Korea today, blood folate levels of Korean women are strikingly similar. We will briefly explore these parallels in an attempt to understand whether folic acid fortification of the food supply in Korea might be worth consideration     

An analysis of the development of Canadian food fortification policies: the case of vitamin B

The concept of fortification, or the deliberate addition of synthetic vitamins to food, arose for the first time in Canada during the 1930s. The availability of new technology introduced a debate over the merits of food fortification as a tool to improve the nutritional health of the population. Through the use of two case studies, vitamin B(1) (thiamin) in the 1930s and vitamin B(9) (folic acid) in the 1990s, this paper examines the development of Canadian policies on food fortification. It presents early ideas about the use of food fortification to improve the health of the population, discusses shifts in attitudes toward fortification, and examines the intersections between scientific knowledge, trade considerations, and public health concerns.     

Estimation of Vitamin D Intake Based on a Scenario for Fortification of Dairy Products with Vitamin D in a Tehranian Population,Iran

Objective: The aim of this study was to evaluate possible effects of food fortification practices on vitamin D intake in adults.

Design and setting: This was designed as a cross-sectional, population-based study.

Subjects: We investigated vitamin D intake in a population-based sample of 5224 adults, using a validated food frequency questionnaire. A theoretical model was conducted to evaluate the hypothetical effects of dairy product fortification.

Results: Dairy had the highest mean of vitamin D intake among food groups. If all types of milk were fortified by vitamin D (42 IU/100 grams of milk), the mean intake of vitamin D would reach 132 ± 148 (92(180)) IU/day. If both milk and yogurt were fortified to 42 IU/100 g and 89 IU/100 g, respectively, the average mean vitamin D intake from foods in this population would increase from 84 ± 88 IU/day to 308 ± 240 IU/day. As the fortification level increased, the proportions of young people with more than the recommended daily allowance (RDA) of vitamin D increased from 1.1% to 77.4% in men and from 1.4% to 80% in women, but none of them achieved the tolerable upper intake level (UL) of vitamin D.

Conclusion: The proposed fortification scenario would provide enough vitamin D intakes by RDA in a population aged between 18 and 50 years (about 80% of the population), with none of them achieving ULs.