The economic case for prevention of population vitamin D deficiency: a modelling study using data from England and Wales

Aguiar, Magda; Andronis, Lazaros; Pallan, Miranda; Högler, Wolfgang; Frew, Emma

doi:10.1038/s41430-019-0486-x

Cited by 35 publications

(29 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Overall, it would be helpful if vitamin D deficiency, as currently defined for skeletal health, could be abolished in humans at the population level by measures independent of individual effort, such as the highly effective food fortification + self-supplementation programme in Finland ( 111 ). Fortification of flour plus free supplementation of high-risk groups, for example, has been proposed as a cost-effective way to abolish deficiency in the United Kingdom ( 112 ). With effective programmes to reduce skeletal health risks in place, future research could focus on other aspects of vitamin D’s role in human health such as establishing what further contributions improved vitamin D status may make to non-skeletal health, the correction of undesirable epigenetic effects of deficiency (especially in pregnancy where it may increase later health risks in offspring), the identification and correction of disadvantageous nutrient interactions and dealing with new problems that emerge as our understanding of the complexities of the vitamin D system increases.…”

Section: Overviewmentioning

confidence: 99%

Why do so many trials of vitamin D supplementation fail?

Boucher

2020

Endocrine Connections

View full text Add to dashboard Cite

Abstract. Our knowledge of vitamin D has come a long way since the 100 years it took for doctors to accept, between 1860-1890, that both sunlight and cod liver oil [a well-known folk remedy] cured and prevented rickets.1]Vitamins D2/3 were discovered exactly a hundred years ago and over the last 50 years vitamin D has been found to have many effects on virtually all human tissues and not just on bone health, while mechanisms effecting the actions of vitamin D at the cellular level are increasingly understood, but deficiency persists globally.2 Observational studies in humans have shown that better provision of vitamin D is strongly associated, dose-wise, with reductions in current and future health risks in line with the known actions of vitamin D. Randomised controlled trials, commonly accepted as providing a ‘gold standard’ for assessing the efficacy of new forms of treatment, have frequently failed to provide supportive evidence for the expected health benefits of supplementation. Such RCTs, however, have used designs evolved for testing drugs while vitamin D is a nutrient; the appreciation of this difference is critical to identifying health benefits from existing RCT data and for improving future RCT design. This report aims, therefore, to provide a brief overview of the evidence for a range of non-bony health benefits of vitamin D repletion; to discuss specific aspects of vitamin D biology that can confound RCT design and how to allow for them

show abstract

Section: Overviewmentioning

confidence: 99%

Why do so many trials of vitamin D supplementation fail?

Boucher

2020

Endocrine Connections

View full text Add to dashboard Cite

show abstract

“…Recognition of low vitamin D status has promoted research into safe and feasible vehicles for vitamin D fortification, including bread (Natri et al 2006). It has been estimated that fortification of wheat flour would be cost effective by preventing cases of vitamin D deficiency (Aguiar et al 2019) and there is some evidence that cholecalciferol (vitamin D3)‐fortified bread (made by adding a fortificant to dough) can improve vitamin D status (Natri et al 2006; Mocanu et al 2009; Nikooyeh et al 2016). Bread fortified with vitamin D made using irradiated baker’s yeast [an ingredient approved for safety as a novel food by EFSA (EFSA NDA Panel 2014b)] is available in the UK.…”

Section: Future Trendsmentioning

confidence: 99%

The role of bread in the UK diet: An update

Lockyer

Spiro

2020

Nutrition Bulletin

View full text Add to dashboard Cite

Bread has been a widely consumed traditional staple food in the UK for centuries, although there has been a decrease in consumption over the past 50 years. This may reflect the increased availability and popularity of other starchy foods such as pasta and rice and potentially negative misconceptions around bread and health (e.g. weight gain and gastrointestinal symptoms). On average, in the UK, bread provides 11-12% of energy, 16-20% of carbohydrate, 10-12% of protein and 17-21% of fibre intakes across all age groups and is a key contributor to micronutrient intakes (9-14% of folate, 15-17% of iron, 12-17% of calcium, 12-13% of magnesium and 10-11% of zinc). White bread is the largest contributor to salt intakes in the UK, though average salt content has been declining, largely as a result of the government reformulation programme with the food industry, including the setting of salt reduction targets. The mandatory fortification of flour with folic acid, a strategy used successfully in >60 other countries as a means of reducing neural tube defects (NTDs), is currently being considered and may be an important public health initiative. The variety of fibre types in bread such as arabinoxylan, oligosaccharides and resistant starch, as well as other bioactives including polyphenols, are an area of emerging interest in relation to nutrition and health. This paper gives an overview of the current contribution of bread to nutrient intakes and considers trends which may change the role of bread in our diet going forward.

show abstract

“…During the preparation of this paper, a cost–benefit analysis was published for vitamin D fortification of wheat flour, plus elective vitamin D supplementation for reducing vitamin D deficiency in England and Wales [156]. That analysis recommended fortifying wheat flour at 400 IU of vitamin D 3 per 100 g with an additional role for supplementing with 400 IU/day for the general population and at 800 IU/day for the elderly, on the basis of the recommendations for reducing falls and fragility fractures.…”

Section: Discussionmentioning

confidence: 99%

A Review of the Potential Benefits of Increasing Vitamin D Status in Mongolian Adults through Food Fortification and Vitamin D Supplementation

Grant

Boucher

2019

Nutrients

View full text Add to dashboard Cite

Serum 25-hydroxyvitamin D (25(OH)D) concentrations are low in Mongolia, averaging 22 ng/mL in summer and only 8 ng/mL in winter. Mongolians have high incidence and/or prevalence of several diseases linked to low 25(OH)D concentrations, including ischemic heart disease, malignant neoplasms, cirrhosis of the liver, ischemic stroke, lower respiratory tract infections, preterm birth complications, and diabetes mellitus. Fortifying regularly consumed foods such as flour, milk, and edible oils with vitamin D3 could raise 25(OH)D concentrations by about 10 ng/mL. However, to achieve 25(OH)D concentrations of 30–40 ng/mL in adults, vitamin D intakes of 1000 to 4000 IU/day would be required, making personal supplement use necessary. On the basis of prospective observational studies and clinical trials of disease incidence or known mortality rates and adverse pregnancy and birth outcomes, raising mean serum 25(OH)D concentrations to 40 ng/mL would likely reduce incidence and mortality rates for those and other diseases, reduce the rate of adverse pregnancy and birth outcomes, and increase mean life expectancy by one year or more.

show abstract

The economic case for prevention of population vitamin D deficiency: a modelling study using data from England and Wales

Abstract: Please refer to published version for the most recent bibliographic citation information. If a published version is known of, the repository item page linked to above, will contain details on accessing it.

Cited by 35 publications

References 48 publications

Why do so many trials of vitamin D supplementation fail?

Why do so many trials of vitamin D supplementation fail?

The role of bread in the UK diet: An update

A Review of the Potential Benefits of Increasing Vitamin D Status in Mongolian Adults through Food Fortification and Vitamin D Supplementation

Contact Info

Product

Resources

About