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Am J Clin Nutr. 2017 Jun;105(6):1512-1520. doi: 10.3945/ajcn.116.151415. Epub 2017 May 10.

The positive impact of general vitamin D food fortification policy on vitamin D status in a representative adult Finnish population: evidence from an 11-y follow-up based on standardized 25-hydroxyvitamin D data.

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Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland.
Calcium Research Unit, Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland.
Finnish Meteorological Institute, Helsinki, Finland.
Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, and.
Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital and Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Joensuu, Finland.
Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; and.
Finnish Institute of Occupational Health, Oulu, Finland.
Department of Medicine, University College Cork, Cork, Ireland.
Calcium Research Unit, Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland;


Background: A systematic vitamin D fortification of fluid milk products and fat spreads was started in 2003 in Finland to improve vitamin D status. Objective: We investigated the effects of the vitamin D fortification policy on vitamin D status in Finland between 2000 and 2011.Design: Serum 25-hydroxyvitamin D [S-25(OH)D] concentrations of a nationally representative sample comprising 6134 and 4051 adults aged ≥30 y from the Health 2000 and Health 2011 surveys, respectively, were standardized according to the Vitamin D Standardization Program with the use of liquid chromatography-tandem mass spectrometry. Linear and logistic regression models were used to assess the change in S-25(OH)D concentrations.Results: Between 2000 and 2011, the mean S-25(OH)D increased from 48 nmol/L (95% CI: 47, 48 nmol/L) to 65 nmol/L (95% CI: 65, 66 nmol/L) (P < 0.001). The prevalence of vitamin D supplement users increased from 11% to 41% (P < 0.001). When analyzing the effect of fortification of fluid milk products, we focused on supplement nonusers. The mean increase in S-25(OH)D in daily fluid milk consumers (n = 1017) among supplement nonusers was 20 nmol/L (95% CI: 19, 21 nmol/L), which was 6 nmol/L higher than nonconsumers (n = 229) (14 nmol/L; 95% CI: 12, 16 nmol/L) (P < 0.001). In total, 91% of nonusers who consumed fluid milk products, fat spreads, and fish based on Finnish nutrition recommendations reached S-25(OH)D concentrations >50 nmol/L in 2011.Conclusions: The vitamin D status of the Finnish adult population has improved considerably during the time period studied. The increase is mainly explained by food fortification, especially of fluid milk products, and augmented vitamin D supplement use. Other factors, such as the difference in the ultraviolet radiation index between 2000 and 2011, may partly explain the results. When consuming vitamin D sources based on the nutritional recommendations, vitamin D status is sufficient [S-25(OH)D ≥50 nmol/L], and supplementation is generally not needed.


25-hydroxyvitamin D; general fortification; population survey; standardization; vitamin D

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