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

Abstract

Background: Meta-analyses of randomized controlled trials have shown that vitamin D supplementation reduces cancer mortality by 13%. Vitamin D fortification of foods may increase vitamin D levels in a similar manner as vitamin D supplementation and could achieve similar reductions in cancer mortality. Whereas some European countries already implemented widespread fortification of foods with vitamin D, in other countries only few or no foods are fortified. In this study, we estimated the reduction in cancer mortality presumably already achieved by current fortification policies in 2017 and the potential for further reductions if all countries had effective fortification. Methods: We reviewed scientific literature, publicly available information, and contacted health authorities to obtain information on current vitamin D food fortification policies in 34 European countries. Together with country-specific cancer death statistics from Eurostat, information on life expectancy, and country-specific fortification policies, we used data from studies on supplementation and serum 25(OH)D increases and cancer mortality to estimate numbers of probably already prevented cancer deaths and numbers of potentially further preventable deaths and years of life lost. Results: Current vitamin D fortification is estimated to prevent approximately 11,000 in the European Union and 27,000 cancer deaths in all European countries considered per year. If all countries considered here would implement adequate vitamin D fortification of foods, an estimated additional 129,000 cancer deaths (113,000 in the European Union) could be prevented, corresponding to almost 1.2 million prevented years of life lost (1.0 million in the EU) or approximately 9% of cancer deaths (10% in the EU). Interpretation: Systematic fortification of foods might considerably reduce the burden of cancer deaths in Europe.

An Appraisal to Address Health Consequences of Vitamin D Deficiency With Food Fortification and Supplements: Time to Act!

“…New findings convincingly show the importance of an optimal vitamin D status to prevent development and progression of cancer (1-4, 10,13,16,18,22,[28][29][30][31][32][33][34]. As an example, three meta-analyses of clinical investigations concluded in recent years, that vitamin D supplementation is associated with reduced all-cause and cancer mortality rates (30,31,35).…”

Dietary behaviour and physical activity policies in Europe: learnings from the Policy Evaluation Network (PEN)

“…32 Finally, we simulated the effect of vitamin D food fortification and/or supplementation on cancer mortality in Europe. 33 …”

Fortification by design: A rational approach to designing vitamin D delivery systems for foods and beverages

“…Furthermore, studies suggest that vitamin D may have additional health benefits beyond its classical function in skeletal health and calcium and phosphorus absorption. A deficiency of vitamin D has been reported to cause several health disorders, including cancers (Niedermaier et al., 2022), cardiovascular diseases (Driggin et al., 2022), diabetes (Johnson et al., 2022), infertility (Cito et al., 2020), immunological disorders (Charoenngam & Holick, 2020), liver disorders (Keane et al., 2018), renal and respiratory neurological disorders (Bivona et al., 2019; Jean et al., 2017), cancer (lung, skin, bone, breast, colorectal) (de La Puente‐Yagüe et al., 2018; Ferrer‐Mayorga et al., 2019; Welsh, 2018), hypertension, stroke, inflammatory bowel disease (Battistini et al., 2020), multiple sclerosis (Scazzone et al., 2021), periodontal disease (Botelho et al., 2021), rheumatoid arthritis (Espinoza et al., 2022), macular degeneration (Chan et al., 2022), and mental illness (Geng et al., 2019). As well as its key role in the prevention of these disorders, vitamin D has also been found to exhibit an array of other biological functions, including bone formation, muscle development, mineral homeostasis, calcium–phosphate balance, gene regulation, cellular differentiation (Fernández‐Barral et al., 2020), cellular growth, and embryonic development (H. Zhang et al., 2017).…”

“…Supplementation and food fortification are the most common strategies used to mitigate vitamin D deficiency (Niedermaier et al., 2022). Supplementation usually relies on the consumption of capsules or pills containing appropriate levels of vitamin D. It demands a high level of consumer compliance, expensive packaging, and an efficient distribution network.…”

“…The World Health Organization (WHO) recognizes food fortification as the most effective way to address micronutrient deficiencies due to its cost‐effectiveness and ability to target large segments of the population (WHO, 2006). Several reports advocate food fortification rather than supplementation to address vitamin D deficiency and its associated disorders (Cashman, 2020; Niedermaier et al., 2022; Whiting & Calvo, 2018). For these reasons, there has been great interest in incorporating vitamin D into food and beverage products to enhance their health benefits (Figure 1) (Browning & Cowieson, 2014; Buttriss & Lanham‐New, 2020; Cashman, 2015; Cashman & Kiely, 2016; A. Gupta, 2014a; Kazmi et al., 2007; Maurya, Bashir et al., 2020; Pilz et al., 2018; Z. Yang et al., 2013).…”