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Lunch session A Lugasi Lunch session A Lugasi Presentation Transcript

  • How to reach the optimalVitamin D intake for the Hungarian population? Andrea LugasiNational Institute for Food and Nutrition Science, Budapest, Hungary
  • Sources of vitamin DTraditional foods: fish, offal, meats, milk, milk products a few food items with significant amount of vitamin D Vitamin D Vitamin D content contentCow milk 0,03 μg Cod liver oil 300 μgCheese 0.8-1.1 μg Pork 0.6 μgButter 1.5 μg Calf meat 4 μgSalmon 9-15 μg Chicken liver 1.3 μgSardine 11 μg Mushrooms 1.5-3 μgHerring 15 μg Egg 2.8 μgEel 26 μg Egg yolk 7.8 μg per 100 g or 100 ml
  • Sources of vitamin D Functional food - foods with significant vitamin D levelFortified Increase of the amount of the original nutrientEnriched Addition of a new nutrient to a complex foodstuff Substitution of a nutritionally disadvantageousAltered compound for a advantageous oneEnhanced Change of the ingredients of a complex foodstuff View slide
  • Sources of vitamin D Fortified/enriched/enhanced functional foods Before 2002 • only in foods which naturally contain vitamin D • vitamin D level could be less than 5 μg in a daily dose • could be marketed after authorization by NIFNS At present • under the scope of the Regulation (EC) No 1925/2006 of the European Parliament and of the Council on the addition of vitamins and minerals and of certain other substances to foods • Food matrix and the highest level are not restricted • Formation which may be added to foods: ergocalciferol (D2), cholecalciferol (D3) • Vitamin D content in the daily dose has to be labelled • No information on the products on the market fortified by vitamin D and the level of added vitamin View slide
  • Sources of vitamin D Fortified/enriched/enhanced functional foods Vitamin D Number of content productsYellow fat spreads 5-7.5 μg/100 g ?Yoghurts 2.5 μg/daily dose ?Breakfast cereals 1-2 μg/daily dose ?Milk and milk products 1-2 μg/100 ml ?Fruit juices 1-2 μg/100 ml ?Infant formulas 1-2 μg/100 ml ~100
  • Fortified/enriched foods - many countries have implemented either mandatory or discretionary food fortification Daily Absolute mean Population, Dietary source intake change in serum Study from FF 25(OH)D, nmol/L duration CG IG μg CG IGChee et al, Postmenop. Skim milk 2.8  17.3 2003, women, Usual diet 10 powder 13.1 13.3Malaysia 24 mode Jong et al, Elderly Nutrient-dense Regular1999, persons, fruit & dairy 10 59 35  18 productsNetherlands 4 mo based productsDaly et al, Ambulatory 14.4  4.2 2006, men, > 50 y, Usual diet Fortified milk 20 20.3 20.0Australia 24 mo ElderlyKeane et al, 6.75  22.25  persons, Usual diet Fortified milk 51998, Ireland 10.9 10.9 12 mo Persons 19-Tangpricha et Unfortified Fortified 22.3  57.0  60 y old, 25al, 2003, USA orange juice orange juice 17.3 26.2 3 mo FF: fortified food, IG: intervention group, CG: control group
  • Sources of vitamin D Food supplements Since 2004 harmonised legislation with 46/2002/EC: Order of the Ministry of Health No. 37/2004. (IV. 26.) Definition: food containing vitamins, minerals and any other nutritionally or physiologically effective substances in concentrated forms No authorization, no official control before marketing Only obligatory notification sent to NIFNS Food business operator must notify the product first marketing in Hungary not later than the day of placing it to the Hungarian market
  • Sources of vitamin D Food supplements Leading principle: products must be safe for the consumers even during a long time consumption, without medical supervision D2 , D3 RDA: 5 μg Minimum: 15 % RDA (0.75 μg/daily dose) No maximum levels for vitamins/minerals have been established legally Upper safe level determined based on a safety assessment by EU SCF/EFSA UL for adults (pregnants and lactating mothers), children 11-17 y: 50 μg (2000 IU) UL for children (3-10 y): 25 μg (1000 IU)
  • Notified food supplements in Hungary 01/05/2004 – 30/05/20112000 1744 15851600 13441200 921 812 800 699 415 400 249 189 194 217 150 152 1 43 0 2004 2005 2006 2007 2008 2009 2010 2011 notified notified with objection Number of notified products: 7670, products with objections: 1077 (14%)
  • Notified food supplement in Hungary1200 containing vitamin D 1019 Vitamin D content in daily dose: 0.25 - 50 μg1000 10 - 2000 IU 800 600 400 212 193 122 139 160 115 200 33 45 0 2004 2005 2006 2007 2008 2009 2010 2011 total 13 % of notified food supplements contain vitamin D
  • Sources of vitamin D Sunshine vitamin D3 is formed in the skin when 7-dehydrocholesterol reacts with UVB light at wavelengths between 270 and 300 nm conversion of 7-dehydrocholesterol leads to the pre-vitamin D3 formation and subsequent thermal isomerization to vitamin D3 in the epidermis the level of synthesis is influenced by a number of factors: season of the year, skin pigmentation, latitude, use of sunscreen, clothing, and amount of skin exposed toxic levels of vitamin D do not occur from prolonged sun exposure
  • Dietary intake of vitamin Din the Hungarian population
  • National Diet and Nutritional Status Survey (OTÁP2009) conducted and performed by NIFNS took place in September and November 2009 a mixed health information/examination survey that collected nutrition and dietary habits data as well as anthropometric measurement of weight, height and waist circumference data was collected by dietetics, district nurses and specialized nurses additionally trained for the study dietary habits were assessed using the internationally recommended 3-day nutrition record
  • Sampling method target population: non- institutionalized adults aged 18 and older sampling method: two-stage, stratified sampling method sample: 1165 persons who completed the 3-day nutrition record and had anthropometric measures the group of the survey’s participants is representative of the Hungarian adult population by age and gender
  • Average (μg/day  SE) dietary intake of vitamin D in Hungary6 μg/day Hungarian recommendation: 5 μg EU RDAx: 5 μg4 3,0x 2,5a 2,3y 2,0y 1,9b 2,0x 1,9x 1,7x20 Total 18-34 y 35-64 y >65 y Total 18-34 y 35-64 y >65 y Men Women X: Commission Directive 2008/100/EC amending Council Directive 90/496/EEC on nutrition labelling for foodstuffs as regards recommended daily allowances
  • Dietary intake of vitamin D in some European countries12 μg/day 10,9 male 10,110 female 8 7,1 5,9 6 5,2 3,6 3,6 3,8 3,7 3,7 4 3,4 2,8 2,8 2,5 1,8 2,0 1,6 1,9 1,8 2 1,2 0 Austria Denmark Estonia Finland Germany Ireland Norway Poland Spain Hungary European Nutrition and Health Report, 2009
  • Vitamin D intake recommendations in different countries 15 μg, US IOM, 2010 Dtsch Arzteibl Int 2010, 107(37): 638-43.
  • Proportion of the foodstuffs in the dietary vitamin D intake Men: 2.5  0.07 μg/day Women: 1.9  0.04 μg/day Veget- Offal Veget- Offal ables, Cereals 0.03 μg ables, Others Others 0.04 μg 0.09 μg 2% greens greens 0.03 μg Cereals 0.03 μg 2% 0.07 μg 4% 2% 0.06 μg 0.09 μg 1% 3% 5% 3% Fish 0.11 μg Fish 5% 0.15 μg 8% Milk, Fats Fats milk 0.82 μg Meats,1.02 μg products 41% meat 41% products 0.16 μg 0.21 μg 7% 11% Meats, meat Milk, milk products products Egg 0.37 μg Egg 0.23 μg 0.52 μg 15% 0.31 μg 12% 22% 16%
  • Rate of the population consumed less vitamin D than the 70% of RDA % 95,3 100 89,6 83,0 90 80 70 60 50 men women total
  • Conclusions Low vitamin D status is a global problem mainly because of – limited solar UVB radiation, and/or – limited number of foods containing natural vitamin D, and – most of them are not usually consumed every day and may not easily be a part of diet Vitamin D intake of the Hungarian population is significantly lower than required, less than 50 % of RDA Habit of being on direct sunshine has been decreasing because of the fear of melanoma (+ using sunscreen with high SPF)
  • Recommendations• There is an urgent requirement for greater awareness among consumers, clinicians and patients of the high prevalence of vitamin D inadequacy and of the way to reach the adequate intake. HOW?1. In the summer months, short UV exposures of up to 15 minutes per day on parts of the body not covered by clothing (face, hands, and arms) are considered to suffice for adequate vitamin D synthesis and thus are recommended.
  • Recommendations2. Increase the intake of traditional vitamin D sources like (sea)fish, offal, mushroom, etc.3. Recommendation of regular food supplement use may not be practical on a population level4. Supplement use may be dependent on individual circum- stances such as financial status and may not be fully implemented in a population.5. From a public health point of view it is better to increase the potential sources of vitamin D by fortifying specific products that are consumed commonly in a whole population, or if necessary by especially vulnerable groups.6. Medicines and food supplements with high level of vitamin D only in case of diagnosed vitamin D deficiency
  • Thanks for your attention! www.oeti.hu