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Examining the effects of increased vitamin D fortification on dietary inadequacy in Canada


OBJECTIVES: Despite mandatory fortification of milk and margarine, most Canadians have inadequate vitamin D intake and consequently poor vitamin D status, especially in the winter. Increasing vitamin D fortification is one possible strategy to address this inadequacy. The purpose of our study was to examine the modelled effect of increased vitamin D fortification on the prevalence of inadequacy and the percentage of intakes greater than the Tolerable Upper Intake Level (UL) using different fortification scenarios.

METHODS: Dietary intakes (24-h recall) from the 2004 Canadian Community Health Survey 2.2 (n=34,381) were used to model increased vitamin D levels in milk and the addition of vitamin D to cheese and yogurt at various levels to meet label claims of an “excellent source” based on the recommended dietary intakes. The Software for Intake Distribution Evaluation was used to estimate the prevalence of inadequacy and intakes >UL

RESULTS: Fortification of milk, yogurt and cheese at 6.75 µg (270 IU)/serving led to more than doubling of vitamin D intakes across all sex/age groups and a drop in the prevalence of dietary inadequacy from >80% to <50% in all groups. Furthermore, no intakes approached the UL under any fortification scenario in any sex/age group.

CONCLUSION: There is a pressing need to improve vitamin D status among Canadians.

Increasing vitamin D fortification of dairy products, consistent with their positioning in Canada’s Food Guide, can lead to increased intake without a risk of excess. This is a population-wide public health strategy that should be given consideration in Canada.


OBJECTIFS: Malgré l’enrichissement obligatoire du lait et de la margarine, la plupart des Canadiens ont un apport insuffisant en vitamine D — et donc un statut médiocre en vitamine D, surtout l’hiver. Accroître l’enrichissement en vitamine D est une stratégie possible pour combler cette carence. Nous avons cherché à examiner l’effet modélisé d’un accroissement de l’enrichissement en vitamine D sur la prévalence des carences et sur le pourcentage d’apports supérieurs à l’apport maximal tolérable (AM) selon divers scénarios d’enrichissement.

MÉTHODE: Les apports alimentaires (rappel 24 heures) tirés de l’Enquête sur la santé dans les collectivités canadiennes 2.2 de 2004 (n=34 381) ont servi à modéliser des niveaux accrus de vitamine D dans le lait et l’ajout de divers niveaux de vitamine D au fromage et au yogourt pour respecter les allégations d’ «excellente source de vitamine D» sur les étiquettes en fonction des apports alimentaires recommandés. L’outil Software for Intake Distribution Estimation a servi à estimer la prévalence des carences et les apports >AM.

RÉSULTATS: L’enrichissement du lait, du yogourt et du fromage à 6,75 µg (270 UI)/portion ferait plus que doubler les apports en vitamine D chez les deux sexes et dans tous les groupes d’âge et abaisserait la prévalence des carences nutritionnelles de >80 % à <50 % dans tous les groupes. Au demeurant, aucun apport ne s’approche de l’AM, peu importe le scénario d’enrichissement, dans aucun groupe d’âge ou de sexe.

CONCLUSION: Il existe un besoin pressant d’améliorer le statut en vitamine D de la population canadienne. Accroître l’enrichissement en vitamine D des produits laitiers, en respectant les niveaux recommandés dans le Guide alimentaire canadien, peut mener à des apports accrus sans risque d’excès. C’est une stratégie de santé publique à l’échelle de la population qui devrait être envisagée au Canada.

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Correspondence to Mary R. L’Abbe PhD.

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Acknowledgements: This study was funded by a grant from Dairy Farmers of Canada. Dairy Farmers of Canada had no role in the implementation, analysis or interpretation of the data. Yaseer Shakur also received funding from a Comprehensive Research Experience for Medical Students scholarship from the Faculty of Medicine, University of Toronto.

Conflict of Interest: None to declare.

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Shakur, Y.A., Lou, W. & L’Abbe, M.R. Examining the effects of increased vitamin D fortification on dietary inadequacy in Canada. Can J Public Health 105, e127–e132 (2014).

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