Evidence of low vitamin D intakes in the Australian population points to a need for data-driven nutrition policy for improving population vitamin D status

Dietary Patterns and Nutrient Intake in Pregnancy and Lactation

Optimal nutrition during pregnancy and lactation is essential for the health and well-being of both the mother and the developing child [...].

Modeling Vitamin D Fortification Scenarios for the Australian Population

BACKGROUND

Low vitamin D status (circulating 25-hydroxyvitamin D concentration <50 nmol/L) is prevalent in Australia, and 95% of Australians have been estimated to have low vitamin D intake (mean range 1.8-3.2 μg/d). Increasing the dietary supply of vitamin D could improve vitamin D status across the population.

OBJECTIVES

We modeled 4 vitamin D fortification scenarios to support useful and safe fortification strategies for Australia.

METHODS

We used cross-sectional food consumption data from the 2011-2012 National Nutrition and Physical Activity Survey (n = 12,153 aged 2-85 y) and analytical food composition data. Scenario 1 modeled the systematic addition of the maximum permitted amount of vitamin D to all foods for which vitamin D fortification is mandated (edible oil spreads) or optional (dairy products/plant-based alternatives, formulated beverages, permitted ready-to-eat breakfast cereals). Scenarios 2-4 modeled the addition of vitamin D to edible oil spreads and fluid milk/alternatives at higher concentrations than permitted and the addition of the maximum permitted amount to scenario 2, dairy products/alternatives other than fluid milk, formulated beverages; scenario 3: scenario 2 plus eligible ready-to-eat breakfast cereals; scenario 4: scenario 3 plus bread (not permitted for vitamin D fortification in Australia). We used the National Cancer Institute method to model the usual intake of vitamin D for each scenario by sex and age group. Dietary adequacy and safety were assessed using the North American Estimated Average Requirement (10 μg/d) and the Australian upper level of intake (80 μg/d).

RESULTS

Under scenarios 1-4, respectively, the projected proportion of Australians with vitamin D intake <10 μg/d was 80%, 84%, 73%, and 60%. No participant exceeded the upper level of intake under any scenario.

CONCLUSIONS

A systematic fortification strategy could support a nutritionally meaningful improvement in vitamin D intake across the Australian population. An optimal strategy would require amendments to the Australia New Zealand Food Standards Code.

Quantifying vitamin D intake among Aboriginal and Torres Strait Islander peoples in Australia

BACKGROUND/OBJECTIVE

Vitamin D deficiency (serum 25-hydroxyvitamin D [25(OH)D] concentration < 50 nmol/L) is prevalent among Aboriginal and Torres Strait Islander peoples in Australia. Alternative to sun exposure (the primary source of vitamin D), vitamin D can also be obtained from food (e.g. fish, eggs, and meat) and supplements. However, the vitamin D intake of this population group is unknown. We aimed to provide the first quantification of vitamin D intake using nationally representative data from Aboriginal and Torres Strait Islander peoples.

METHODS

We used food consumption data collected in the 2012-2013 National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey (n = 4109) and vitamin D food composition data to quantify vitamin D intake by sex, age group, and remoteness of location. Wilcoxon rank-sum test was used to assess the difference in vitamin D intake between sexes and remoteness of location.

RESULTS

The median (25th, 75th percentile) vitamin D intake among Aboriginal and Torres Strait Islander peoples aged ≥ 2 years was 80 (45, 145) IU/day. Vitamin D intake was statistically significantly different between males and females (p = < 0.001). There was no statistically significant difference between vitamin D intake in non-remote and remote areas (p = 0.292).

CONCLUSIONS

Vitamin D intake among Aboriginal and Torres Strait Islander peoples is low. Food-based public health strategies guided by Aboriginal and Torres Strait Islander Elders and communities could be developed to promote higher vitamin D intake among this population.

Executive function impairment is associated with low serum vitamin D levels in children with epilepsy

PURPOSE

Executive function (EF) impairment and vitamin D deficiency are common clinical features among children with epilepsy (CWE). Recently, vitamin D has become a potential modification factor that affects cognitive status in individuals with neurological disorders. In this study, we investigated the association between EF status and vitamin D levels in patients with CWE.

METHODS

In total, 79 CWE patients and 39 healthy controls (HCs) were recruited in this study. Each participant's EF was assessed using the Behavior Rating Inventory of Executive Function-Parent form (Brief-P), and the serum level of 25-OH vitamin D was measured using liquid chromatography-tandem mass spectrometry (LC-MS/MS).

RESULTS

Compared with those in the HC group, the CWE group had higher T scores of Brief-P scale, including global executive composite (GEC) (51.01(45.12, 60.69) vs. 44.08(39.24, 49.96), p＜0.001), behavioral regulation index (BRI) (51.29(45.67, 59.13) vs. 45.67(40.06, 51.29), p＜0.001), metacognition index (MI) (51.83(46.77, 59.43) vs. 46.13(40.44, 51.83), p＜0.001), and lower serum vitamin D (14.85(10.24,23.2) vs. 22.5(16.91,30), p＜0.001) levels. After adjustment for covariates, multivariate linear regression models suggested that for every 1 ng/ml increase in vitamin D, the GEC, BRI, and MI would decrease by 0.52 (Coeff = -0.48; 95 % CI = -0.69, -0.26; p = 0.000), 0.45 (Coeff = -0.45; 95 % CI = -0.69, -0.20; p = 0.000), and 0.47 (Coeff = -0.45; 95 % CI = -0.67, -0.22; p = 0.000), respectively.

CONCLUSION

There may be an association between decreased vitamin D levels and EF impairment in CWE. Future research should consider longitudinal variations in EF related to improving vitamin D deficiency.

Mushrooms: a food-based solution to vitamin D deficiency to include in dietary guidelines

Vitamin D deficiency and insufficiency is a public health issue, with low dietary vitamin D intakes a contributing factor. Rates of vitamin D deficiency are 31% in Australia, and up to 72% in some regions globally. While supplementation is often prescribed as an alternative to additional sun exposure, complementary approaches including food-based solutions are needed. Yet, food-centric dietary guidelines are not always adequate for meeting vitamin D needs. Edible mushrooms such as Agaricus bisporus can produce over 100% of vitamin D recommendations (10 μg/day, Institute of Medicine) per 75 g serve (18 μg) on exposure to UV-light, with the vitamin D2 produced showing good stability during cooking and processing. However, mushrooms are overlooked as a vitamin D source in dietary guidelines. Our dietary modelling shows that four serves/week of UV-exposed button mushrooms can support most Australian adults in meeting vitamin D recommendations, and UV-exposed mushrooms have been found to increase vitamin D status in deficient individuals. While recent evidence suggests some differences between vitamin D2 and vitamin D3 in physiological activities, vitamin D2 from mushrooms can be part of a larger solution to increasing dietary vitamin D intakes, as well as an important focus for public health policy. Mushrooms exposed to UV represent an important tool in the strategic toolkit for addressing vitamin D deficiency in Australia and globally. Health authorities lead the recognition and promotion of mushrooms as a natural, vegan, safe, and sustainable vitamin D food source.

Effect of household cooking on the retention of vitamin D2 and 25-hydroxyvitamin D2 in pulse UV-irradiated, air-dried button mushrooms (Agaricus bisporus)

Vitamin D deficiency has widespread global prevalence. Fresh mushrooms exposed to ultraviolet (UV) radiation generate vitamin D₂ which remains after drying. It is not clear if vitamin D₂ is retained after rehydration and cooking of dried mushrooms. The aim of this study was to determine the true retention of both vitamin D₂ and 25-hydroxyvitamin D₂ (25(OH)D₂) after cooking UV-irradiated, air-dried, then rehydrated button mushrooms (Agaricus bisporus). Mushrooms were exposed to pulsed UV radiation, then air-dried in a convection oven, followed by rehydration in warm water. Samples were cooked in three different ways: frying (5 min), baking (10 min, 200 °C) and boiling (20 min, 90 °C). Compared to rehydrated, uncooked controls, there was a high retention of D vitamers (≥95%) after cooking. Frying and baking resulted in significantly higher vitamin D₂ retention compared to boiling (p < 0.0001). UV-irradiated, dried mushrooms are a valuable source of vitamin D₂ after rehydration and cooking.

The Retention of Vitamin D2 and 25-Hydroxyvitamin D2 in Pulse UV-Irradiated Dried Button Mushrooms (Agaricus bisporus) after 12 Months of Storage

Fresh mushrooms exposed to ultraviolet (UV) radiation prior to drying generate high concentrations of vitamin D2. The aim of this study was to determine the retention of D vitamers in mushrooms that were pulse UV irradiated, then air dried, and stored for up to 12 months. Fresh button mushrooms (A. bisporus) were exposed to pulsed UV radiation (dose 200 mJ/cm2, peak of 17.5 W/cm2), air dried and vacuum sealed before being stored in the dark at room temperature. After storage, samples were freeze dried and quantified for D vitamers using triple quadrupole mass spectrometry. After 3, 6 and 12 months of storage, there was 100% (11.0 ± 0.8 µg/g dry weight (DW), 93% (10.1 ± 0.6 µg/g DW) and 58% (5.5 ± 0.6 µg/g DW) retention of vitamin D2 and 88% (0.14 ± 0.01 µg/g DW), 71% (0.11 ± 0.01 µg/g DW) and 68% (0.1 ± 0.01 µg/g DW) retention of 25-hydroxyvitamin D2 (25(OH)D2), respectively. Compared to the irradiated dried mushrooms that were not stored, the D vitamer concentration was statistically significantly lower (p < 0.05) at 6 and 12 months for 25(OH)D2 and at 12 months for vitamin D2. Sufficient vitamin D2 (99 µg) remained after 12 months storage to provide at least 100% of daily dietary vitamin D requirements in a 20 g serving.

A preliminary investigation of the clinical and cognitive correlates of circulating vitamin D in bipolar disorder

The role that vitamin D plays in the cognitive and clinical characteristics of bipolar disorder (BD) is unclear. We examined differences in the levels and deficiency status of vitamin D in an Australian sample of BD patients compared to healthy controls; and determined the extent to which vitamin D is associated with clinical variables and cognitive function in the sample. 22 healthy controls and 55 stable outpatients with a diagnosis of BD and low-grade mood symptomatology provided a sample of blood and completed cognitive tests and clinical measures. Plasma concentrations of 25-hydroxyvitamin D (vitamin D) were assayed and used to segregate participants into subgroups with sufficient or deficient levels of vitamin D. Subgroups were then compared in terms of global cognition and a range of sociodemographic and clinical factors (number of past mood episodes, illness duration, seasonal mood pattern, mood symptom severity), while mean levels of vitamin D were compared between patients and controls. Although almost 27% of the current sample were vitamin D deficient, no significant differences in mean vitamin D levels or the prevalence of vitamin D deficiency were evident between BD patients and controls. Vitamin D was not associated with global cognition in either patients or controls, nor any of the clinical measures assessed in the study. In conclusion, we observed no difference in the vitamin D levels and deficiency status of an Australian sample of healthy individuals and BD patients with low grade mood symptomatology compared to controls. Clinical symptoms and global cognition also appear to be independent of vitamin D levels in BD.

Vitamin D Fortification of Milk Would Increase Vitamin D Intakes in the Australian Population, but a More Comprehensive Strategy Is Required

Low vitamin D status (serum 25-hydroxyvitamin D (25(OH)D) concentration < 50 nmol/L) is prevalent in Australia, ranging between 15% and 32% in the adolescent and adult populations. Vitamin D intakes are also low across the population and were recently estimated at 1.8−3.2 µg/day on average, assuming equal bioactivity of the D vitamers. In combination, these findings strongly suggest that data-driven nutrition policy is needed to increase vitamin D intake and improve status in the Australian population. Food fortification is a potential strategy. We used up-to-date vitamin D food composition data for vitamin D3, 25(OH)D3, vitamin D2, and 25(OH)D2, and nationally representative food and supplement consumption data from the 2011−2013 Australian Health Survey, to model a fortification scenario of 0.8 µg/100 mL vitamin D for fluid dairy milks and alternatives. Under the modelled fortification scenario, the mean vitamin D intake increased by ~2 µg/day from baseline to 4.9 µg/day from food only (7.2 µg/day including supplements). Almost all individual intakes remained substantially below 10 µg/day, which is the Estimated Average Requirement in North America. In conclusion, this modelling showed that fortification of fluid milks/alternatives with vitamin D at the current permitted level would produce a meaningful increase in vitamin D intake, which could be of potential benefit to those with a low vitamin D status. However, this initial step would be insufficient to ensure that most of the population achieves the North American EAR for vitamin D intake. This approach could be included as an effective component of a more comprehensive strategy that includes vitamin D fortification of a range of foods.