Researchers make case for fortifying wheat flour with vitamin D

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Fortifying wheat flour with vitamin D would prevent 10 million new cases of vitamin D deficiency in England and Wales over the next ninety years, researchers say.

The researchers from the University of Birmingham say overhauling existing public health policy to introduce the mandatory fortification of vitamin D in wheat flour would not only be cost saving but would significantly reduce the burden on the NHS by preventing 25% of the estimated 40 million new cases of vitamin D deficiency over the coming 90 years.

Furthermore, offering free vitamin D supplements to targeted groups of the population would prevent an additional 8% of new cases of vitamin D deficiency over the next 90 years.

Therefore, the combination of wheat flour fortification and targeted supplementation would in total prevent 33% (13.2 million) of cases of vitamin D deficiency, the researchers said.

Boosting vitamin D intake

Dietary sources of vitamin D are limited, leading most countries to adopt policies to increase their population’s intake of vitamin D.

In the UK, multivitamin supplements containing vitamin D are recommended to all children aged up to four, pregnant women and breastfeeding mothers and are provided free-of-charge to those in low-income households.

In addition, infant formulas and spreadable fats are fortified with vitamin D. Other foods, including breakfast cereals and milk substitutes, are commonly fortified.

Despite that, the average daily vitamin D intake in the UK is below the Reference Nutritional Intake of 400 IU per day, and 20% of adults and 16% of children aged between 11 and 18 years are estimated to be deficient in Vitamin D.

“While both supplements and fortified foods are important sources of vitamin D for the UK population, evidence suggests current UK supplementation polices are not working,” said Dr Magda Aguiar, who carried out the research at the University of Birmingham.

“Addressing vitamin D deficiency in the UK requires a multi-disciplinary approach and preventing conditions that are the consequence of deficiency would save the NHS money to the extent that it would more than compensate for the money needed to implement flour fortification at a national level.”

Dr Aguiar, now at the University of British Columbia, added: “We now hope that UK policy makers will consider a new national policy to fortify foods such as wheat flour with vitamin D to address this serious health issue.

“This will lead to significant benefits for the population, particularly the most vulnerable groups.”

She said that a similar national food fortification policy in Finland has reduced vitamin D deficiency from 13% to 0.6% in the population.

Meanwhile, the Birmingham researchers’ latest analysis showed that the optimal way to prevent vitamin D deficiency would be to combine flour fortification with offering vitamin D supplements to key groups.

They proposed a new UK strategy to add 400IU of vitamin D per 100g of flour, while also offering free vitamin D supplements at a dose of 400IU for children aged up to 18, as well as doses of 800IU for all those aged over 65. This, they estimated, would cost £250 million over 90 years – equivalent to 38p per person.

Published in European Journal of Clinical Nutrition, the research was funded and led by the University of Birmingham’s Institute of Applied Health Research and Institute of Metabolism and Systems Research.