1. How to reach the optimal
Vitamin D intake for the
Hungarian population?
Andrea Lugasi
National Institute for Food and Nutrition
Science, Budapest, Hungary
2.
3. Sources of vitamin D
Traditional foods: fish, offal, meats, milk, milk products
a few food items with significant amount of vitamin D
Vitamin D Vitamin D
content content
Cow milk 0,03 μg Cod liver oil 300 μg
Cheese 0.8-1.1 μg Pork 0.6 μg
Butter 1.5 μg Calf meat 4 μg
Salmon 9-15 μg Chicken liver 1.3 μg
Sardine 11 μg Mushrooms 1.5-3 μg
Herring 15 μg Egg 2.8 μg
Eel 26 μg Egg yolk 7.8 μg
per 100 g or 100 ml
4. Sources of vitamin D
Functional food - foods with significant vitamin D
level
Fortified Increase of the amount of the original nutrient
Enriched Addition of a new nutrient to a complex foodstuff
Substitution of a nutritionally disadvantageous
Altered
compound for a advantageous one
Enhanced Change of the ingredients of a complex foodstuff
5. 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
6. Sources of vitamin D
Fortified/enriched/enhanced functional foods
Vitamin D Number of
content products
Yellow 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
7. 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 IG
Chee et al, Postmenop.
Skim milk 2.8 17.3
2003, women, Usual diet 10
powder 13.1 13.3
Malaysia 24 mo
de Jong et al, Elderly Nutrient-dense
Regular
1999, persons, fruit & dairy 10 59 35 18
products
Netherlands 4 mo based products
Daly et al, Ambulatory
14.4 4.2
2006, men, > 50 y, Usual diet Fortified milk 20
20.3 20.0
Australia 24 mo
Elderly
Keane et al, 6.75 22.25
persons, Usual diet Fortified milk 5
1998, Ireland 10.9 10.9
12 mo
Persons 19-
Tangpricha et Unfortified Fortified 22.3 57.0
60 y old, 25
al, 2003, USA orange juice orange juice 17.3 26.2
3 mo
FF: fortified food, IG: intervention group, CG: control group
8. 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
9. 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)
11. Notified food supplement in Hungary
1200
containing vitamin D
1019
Vitamin D content in daily dose: 0.25 - 50 μg
1000
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
12. 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
14. 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
15. 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
16. Average (μg/day SE) dietary intake of
vitamin D in Hungary
6 μg/day
Hungarian recommendation: 5 μg
EU RDAx: 5 μg
4
3,0x
2,5a 2,3y
2,0y 1,9b 2,0x 1,9x 1,7x
2
0
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
17. Dietary intake of vitamin D in some
European countries
12 μg/day 10,9
male
10,1
10 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
18. Vitamin D intake recommendations in
different countries
15 μg,
US IOM,
2010
Dtsch Arzteibl Int 2010, 107(37): 638-43.
20. 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
21. 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)
22. 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.
23. Recommendations
2. 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 level
4. 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
