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Efficacy of food fortification on serum 25-hydroxyvitamin D concentrations: systematic review^1,2,3,4

¹ From the Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Canada (AC and SO); the University of Ottawa Evidence-based Practice Center, Ottawa, Canada (TH, NB, MF, MS, AT, and FY); the Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada (TH and NB); the School of Dietetics and Human Nutrition, McGill University, Montreal, Canada (HAW); the Nutrition and Metabolism Research Laboratory, Department of Pediatrics, McMaster University, Hamilton, Canada (SAA); the Department of Medicine, University of Calgary, Calgary, Canada (DAH); the Departments of Pathology and Laboratory Medicine (DSO) and Pediatrics (LW), University of Ottawa, Ottawa, Canada

² The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the US Department of Health and Human Services.

³ Supported by contract no. 290-020-0021 from the Agency for Healthcare Research and Quality, US Department of Health and Human Services; by the Canadian Institutes of Health Research (to AC); and by a Canada Research Chair (to HAW).

⁴ Reprints not available. Address correspondence to A Cranney, Clinical Epidemiology Program, Ottawa Health Research Institute, Associate Professor, Division of Rheumatology, 1053 Carling Avenue, ASB 2-007 Ottawa, ON, Canada K1Y 4E9. E-mail: ancranney{at}ohri.ca.

Background: Many residents of the United States and Canada depend on dietary sources of vitamin D to help maintain vitamin D status. Because few natural food sources contain vitamin D, fortified foods may be required.

Objective: We aimed to determine the effects of vitamin D–fortified foods on serum 25-hydroxyvitamin D [25(OH)D] concentrations.

Design: We searched MEDLINE (1966 to June Week 3 2006), Embase, CINAHL, AMED, Biological Abstracts, and the Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs) comparing vitamin D–fortified foods with a control and reporting serum 25(OH)D concentrations. Two reviewers independently determined study eligibility, assessed trial quality, and extracted relevant data. Disagreements were resolved by consensus. Meta-analyses of absolute mean change in 25(OH)D were conducted by using a random-effects model, with evaluation of heterogeneity.

Results: Nine RCTs (n = 889 subjects) were included, of which 8 consistently showed a significant beneficial effect of food fortification on 25(OH)D concentrations. Although 7 RCTs (n = 585 subjects) potentially were meta-analyzable, we were unable to combine the overall results because of significant heterogeneity. The individual treatment effects ranged from 14.5 (95% CIs: 10.6, 18.4) nmol/L to 34.5 (17.64, 51.36) nmol/L (3.4–25 µg vitamin D/d). Subgroup analyses showed a reduction in heterogeneity and significant treatment effect when 4 trials that used milk as the fortified food source were combined.

Conclusion: Most trials were small in size and inadequately reported allocation concealment, but results showed that vitamin D–fortified foods improved vitamin D status in adults.