FLOUR / FOOD FORTIFICATION WITH VITAMIN D A STRATEGY TO IMPROVE VITAMIN D STATUS AT THE COMMUNITY LEVEL

Vitamin D deficiency is recognized as a global public health problem. Worldwide, an estimated one billion people are faced with vitamin D insufficiency / deficiency. Research conducted over the past decade suggests that vitamin D plays a much broader disease-fighting role than once thought. Being D-deficient may increase the risk of a host of chronic diseases, such as osteoporosis, CVD, colon and breast cancer, and multiple sclerosis. Supplementation as a short term strategy can reduce the prevalence of vitamin D deficiency. However, food fortification, using staple foods, is the sustainable method to prevent vitamin D deficiency.At the global level vegetable oil, margarine, milk products and both wheat flour are being fortified with vitamin D. Several countries started mandatory or optional vitamin D fortification and the efficiency in improving vitamin D status at population level has been reported.For vitamin D fortification, the selected food source should be widely available especially to those with low socioeconomic status and consumption should not remarkably differ at the household level. Among different carriers for vitamin D fortification, wheat flour is a suitable carriers since bread is widely consumed as staple food and is affordable for all population groups. Fortification of industrially processed wheat flour, when appropriately implemented, is an effective, simple and inexpensive strategy for supplying vitamin D to the diets of large segments of the world’s population. The efficacy of vitamin D-fortified bread with different dosages in raising circulating calcidiol has been reported . A meta-analysis of the absolute mean change in circulating 25(OH)D concentrations was conducted using a random effects model. Sixteen studies from 15 publications were included, of which 14 showed a significant effect of fortified foods on 25(OH)D concentrations. As conclusion, Vitamin D food fortification increases circulating 25(OH)D concentrations in community-dwelling adults. Safe and effective food-based strategies could increase 25(OH)D across the population distribution and prevent vitamin D deficiency with potential benefit for public health. In Iran, mandatory flour fortification with Iron and Folic acid is being implemented and adding vitamin D is one of the main strategy to improve vitamin D status at the population level.