Canada's Updated Vitamin D Fortification Strategy is Anticipated to Improve Vitamin D Intakes and Status based on Modeling of National Data.
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BACKGROUND: Inadequate vitamin D status remains a public health concern in Canada. To help address this, Health Canada implemented an updated (2022-2024) vitamin D fortification strategy. The strategy increased the mandated amounts of vitamin D in cow's milk and margarine, supported higher voluntary fortification of plant-based beverages (PBB) and permitted voluntary fortification of yogurt/kefir. OBJECTIVE: The objectives of this study were to model the potential impact of recent vitamin D fortification measures on vitamin D intakes and status among people living in Canada. METHODS: Usual intakes (UI) from the cross-sectional 2015 Canadian Community Health Survey-Nutrition (n=19,369, ≥1 year) were modeled using National Cancer Institute methodology and increased amounts of vitamin D in cow's milk, fortified PBB (2 μg/100 mL), and margarine (26 μg/100 g), and new permission for yogurt/kefir (∼5 μg/serving). For each life-stage, self-reported racial or Indigenous-identity group, risk was evaluated using the proportion <Estimated Average Requirement (EAR: 10 μg/day) and the proportion >Tolerable Upper Intake Level (UL). Canadian Health Measures Survey (2012-2019, n=21,387 3-79 years) cross-sectional data were modeled to evaluate the impact of the updated vitamin D fortification strategy on inadequate vitamin D status (<40 nmol/L serum 25-hydroxyvitamin D). RESULTS: In 2015, the %<EAR was >85.7% across life-stages. Modeling using higher amounts of vitamin D in fortified foods reduced the %<EAR to: 34.3 to 66.3% among children/adolescents, 62.8 to 80.6% among non-pregnant/lactating adults, and 51.0% in pregnant/lactating females; and was reduced according to racial group and Indigenous-identity. No group exceeded the UL. The prevalence of inadequate vitamin D status with modeling declined from 15.3 to 10.6% in children/adolescents, and from 19.6 to 14.6% in adults. CONCLUSIONS: Health Canada's vitamin D fortification strategy appears to safely increase population level UI and status of vitamin D. The impact will need to be confirmed using new surveillance data.