title: Does fortification of staple foods improve vitamin D intakes and status of groups at risk of deficiency? A United Kingdom modeling study.
abstract: BACKGROUND
  More than one-fifth of the United Kingdom population has poor vitamin D status (serum 25-hydroxyvitamin D [25(OH)D] concentration <25 nmol/L), particularly individuals with low sun exposure or poor dietary intake.
  
  
  OBJECTIVE
  We identified the fortification vehicle and concentration most likely to safely increase population vitamin D intakes and vitamin D status.
  
  
  METHODS
  Wheat flour and milk were identified as primary fortification vehicles for their universal consumption in population groups most at risk of vitamin D deficiency including children aged 18-36 mo, females aged 15-49 y, and adults aged ≥65 y. With the use of data from the first 2 y (2008-2010) of the National Diet and Nutrition Survey Rolling Program, we simulated the effect of fortifying wheat flour and milk with vitamin D on United Kingdom food consumption. Empirically derived equations for the relation between vitamin D intake and the serum 25(OH)D concentration were used to estimate the population serum 25(OH)D concentration for each fortification scenario.
  
  
  RESULTS
  At a simulated fortification of 10 μg vitamin D/100 g wheat flour, the proportion of at-risk groups estimated to have vitamin D intakes below United Kingdom Reference Nutrient Intakes was reduced from 93% to 50%, with no individual exceeding the United Kingdom Tolerable Upper Intake Level; the 2.5th percentile of the population winter serum 25(OH)D concentration rose from 20 to 27 nmol/L after fortification. The simulation of the fortification of wheat flour at this concentration was more effective than that of the fortification of milk (at concentrations between 0.25 and 7 mg vitamin D/100 L milk) or of the fortification of milk and flour combined.
  
  
  CONCLUSIONS
  To our knowledge, this study provides new evidence that vitamin D fortification of wheat flour could be a viable option for safely improving vitamin D intakes and the status of United Kingdom population groups at risk of deficiency without increasing risk of exceeding current reference thresholds.
authors.affiliation: From the Department of Health, Wellington House, London, United Kingdom, and London School of Hygiene and Tropical Medicine, London, United Kingdom Rachel.Allen@phe.gov.uk.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Allen
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Alan D
authors.initials: AD
authors.lastname: Dangour
authors.affiliation: From the Department of Health, Wellington House, London, United Kingdom, and.
authors.forename: Alison E
authors.initials: AE
authors.lastname: Tedstone
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Zaid
authors.initials: Z
authors.lastname: Chalabi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D002648:Child; D003198:Computer Simulation; D005260:Female; D005433:Flour / Q000009:adverse effects / Q000032:analysis; D005527:Food, Fortified / Q000009:adverse effects; D006801:Humans; D007223:Infant; D008297:Male; D008892:Milk / Q000009:adverse effects / Q000737:chemistry; D008954:Models, Biological; D018673:Nutrition Policy; D009749:Nutrition Surveys; D009752:Nutritional Status; D012621:Seasons; D006113:United Kingdom / Q000453:epidemiology; D014807:Vitamin D / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives / Q000097:blood / Q000627:therapeutic use*; D014808:Vitamin D Deficiency / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D
keywords: 25-hydroxyvitamin D; National Diet and Nutrition Survey; fortification; model; vitamin D