Vitamin D Food Fortification and Nutritional Status in Children: A Systematic Review of Randomized Controlled Trials.

Concepción Maria Aguilera,Paula Nascimento Brandão-Lima,Beatriz Da Cruz Santos,Liliane Viana Pires,Paulo Ricardo Saquete Martins-Filho,Analícia Rocha Santos Freire

doi:10.3390/nu11112766

Abstract

Children are in the risk group for developing hypovitaminosis D. Several strategies are used to reduce this risk. Among these, fortification of foods with vitamin D (25(OH)D) has contributed to the achievement of nutritional needs. This systematic review aims to discuss food fortification as a strategy for maintenance or recovery of nutritional status related to vitamin D in children. The work was developed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and registered in the International prospective register of systematic reviews (PROSPERO) database (CRD42018052974). Randomized clinical trials with children up to 11 years old, who were offered vitamin D-fortified foods, and who presented 25(OH)D concentrations were used as eligibility criteria. After the selection stages, five studies were included, totaling 792 children of both sexes and aged between two and 11 years. Interventions offered 300–880 IU of vitamin D per day, for a period of 1.6–9 months, using fortified dairy products. In four of the five studies, there was an increase in the serum concentrations of 25(OH)D with the consumption of these foods; additionally, most children reached or maintained sufficiency status. Moreover, the consumption of vitamin D-fortified foods proved to be safe, with no concentrations of 25(OH)D > 250 nmol/L. Based on the above, the fortification of foods with vitamin D can help maintain or recover the nutritional status of this vitamin in children aged 2–11 years. However, it is necessary to perform additional randomized clinical trials in order to establish optimal doses of fortification, according to the peculiarities of each region.

Highlights

Vitamin D (25(OH)D) is an important nutrient during childhood because of its involvement in bone formation, as well as in the immune system, which can result in higher body needs for this vitamin [1,2,3]
The main way of obtaining vitamin D is endogenously from sun exposure: ultraviolet B (UVB) rays are absorbed by 7-dehydrocholesterol, producing a thermally unstable compound that is converted in the liver to 25(OH)D, and subsequently converted to the active form
The objective of this study is to evaluate the available evidence of dairy food fortification as a strategy for maintenance or recovery of nutritional status related to vitamin D in children

Summary

Introduction

Vitamin D (25(OH)D) is an important nutrient during childhood because of its involvement in bone formation, as well as in the immune system, which can result in higher body needs for this vitamin [1,2,3]. The main way of obtaining vitamin D is endogenously from sun exposure: ultraviolet B (UVB) rays are absorbed by 7-dehydrocholesterol, producing a thermally unstable compound that is converted in the liver to 25(OH)D, and subsequently converted to the active form. Vitamin D deficiency is observed in different population groups [10,11,12,13]. Considering the issue raised, the fortification of foods with vitamin D is an alternative for wide population coverage for reducing the risk of vitamin D deficiency, and its adoption is increasing worldwide [14,15]. In some countries with high prevalence of vitamin D deficiency and ineffective sun exposure, fortification of foods with vitamin D is compulsory or voluntary, with dairy products being the most frequently fortified foods [16,17,18]

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