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Vitamin D Food Fortification and Biofortification Increases Serum 25-Hydroxyvitamin D Concentrations in Adults and Children: An Updated and Extended Systematic Review and Meta-Analysis of Randomized Controlled Trials
journal contribution
posted on 2023-04-19, 02:56 authored by E Dunlop, ME Kiely, AP James, T Singh, NM Pham, LJ BlackBackground: Low vitamin D status is a global public health issue that vitamin D food fortification and biofortification may help to alleviate. Objectives: We investigated the effect of vitamin D food fortification and biofortification on circulating 25-hydroxyvitamin D (25(OH)D) concentrations. We expanded the scope of earlier reviews to include adults and children, to evaluate effects by vitamin D vitamer, and investigate linear and nonlinear dose-response relations. Methods: We conducted a systematic review and meta-analysis. We searched CINAHL, MEDLINE, PubMed, Embase, the Cochrane Library, and gray and unpublished literature sites for randomized controlled trials, including people of all ages, with the criteria: absence of illness affecting vitamin D absorption, duration ≥4 wk, equivalent placebo food control, dose quantification, dose ≥5 μg/d, baseline and endpoint or absolute change in 25(OH)D concentrations reported, random allocation, and participant blinding. Quality was assessed using the Jadad Scale. Results: Data from 34 publications (2398 adults: 1345 intervention, 1053 controls; 1532 children: 970 intervention, 562 controls) were included. Random-effects meta-analysis of all studies combined (mean dose 16.2 μg/d) indicated a pooled treatment effect of 21.2 nmol/L (95% CI: 16.2, 26.2), with a greater effect for studies using cholecalciferol than ergocalciferol. Heterogeneity was high (I2 > 75%). Metaregression analyses for all studies combined suggested positive effect differences for baseline circulating 25(OH)D concentrations <50 nmol/L, dose ≥10 μg/d and a negative effect difference when the intervention arm included a calcium dose ≥500 mg/d greater than the control arm. Dose-response rates were found to be nonlinear (Wald test for nonlinearity P < 0.001). For all studies combined, a threshold occurred at ∼26 nmol/L for a dose of ∼21 μg/d. Conclusions: These results support use of vitamin D food fortification to improve circulating 25(OH)D circulations in populations. This work was registered with PROSPERO as CRD42020145497.
History
Journal
Journal of NutritionVolume
151Pagination
2622-2635Location
United StatesPublisher DOI
ISSN
0022-3166eISSN
1541-6100Language
enIssue
9Publisher
Elsevier BVUsage metrics
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Keywords
25-hydroxyvitamin Dbiofortificationfoodfortificationvitamin DAdultBiofortificationChildDietary SupplementsFood, FortifiedHumansRandomized Controlled Trials as TopicVitamin DVitamin D DeficiencyComplementary and Integrative HealthNutritionClinical ResearchClinical Trials and Supportive Activities3.1 Primary prevention interventions to modify behaviours or promote wellbeing6.1 Pharmaceuticals3.3 Nutrition and chemoprevention6 Evaluation of treatments and therapeutic interventions3 Prevention of disease and conditions, and promotion of well-being2 Zero HungerFood Sciences not elsewhere classifiedAnimal Production not elsewhere classifiedNutrition and Dietetics not elsewhere classified
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