Vitamin D - A European Perspective Needs Intake and Status 20 th May 2014

Transcription

1 Vitamin D - A European Perspective Needs Intake and Status 20 th May 2014 Ayela Spiro British Nutrition Foundation

2 Before we start, some important acknowledgements We would like to warmly thank: Conference chair and speakers Members of the European Nutrition Foundations Network Birdem Amoutzopoulos (TR), Isabelle Sioen (BE), Flora Correia (PT), Caroline van Rossum (NL) Kellogg s Europe (Dr Toine Hulshof) Sarah Alderton (administration), Sarah Coe (live streaming) and rest of BNF team

3 Why are we holding this conference? Vitamin D in Media Vitamin D in Health

4 What do we want to cover? European perspective on: Source (latitude) Intake Prevalence of low status What can be done - supplementation policies, fortification policies Aim must be to ensure adequate status all year round in all population groups

5 How much vitamin D do Europeans need? Enough to prevent deficiency (rickets and osteomalacia)? Enough to prevent complications of insufficiency? Complex as exposure to sun (endogenous) has impact, but in high latitude areas dietary sources (exogenous) important, particularly for people with low exposure RNI tended to have been revised upwards in Europe (as in US IOM)

6 European Recommend ed intakes µg/d Infants <1y Young childn 1-3 y Childn 4-10y Adolesc y Adults Older Adults Pregnancy D-A-CH Belgium France Ireland Italy Spain Sweden Turkey Netherlands NNR UK EU Other IOM WHO/FAO Lactn. Should we include endogenous synthesis?

7 Do intakes meet requirements? Adults EPIC European Mean 4.8 and 3.3 µg/d Variation high around mean Reviews of European Adult Surveys show patterns lowest in Spain < 2µg/d, typically 2-4 µg/d in most other countries and higher in Scandinavian countries. Similar pattern in children Report Adults µg/d Elderly µg/d Roman Vinas et al Mensink et al Diet & supp Diet only Diet & supp Ref Value 10 µg/d

8 As we know, few dietary sources Vitamin D: Sun, natural dietary sources, fortified foods, supplements Dietary sources in different countries: Meat in UK and Ireland (30%), fish in Spain (68%), France (31%), fats food group in NL (36%) Depends on habitual consumption (e.g. fish eating countries and types of fish consumed)

9 Hot off the Press: UK NDNS 2014 Meat and meat products 21-35% (adults highest) Fat spreads 19-21% Cereal and cereal products 13-20% (children 4-10y highest) Fish 17-23% adults, 8-9% children (elderly highest) Milk and milk products 24% in years Average daily vitamin D intakes (µg/d) 1.5-3y 4-10y 11-18y 19-64y 65+y From food only From food + supp

10 Is low intake reflected in low status? Yes: For many Europeans living at high latitude and not having sufficient sun exposure (using deficient <25nmol/l or insufficient <50nmol status) Higher in summer compared to winter Higher in Northern compared to Southern Europe Mean figures mask High risk groups More important to look at % population with deficient (or insufficient) status No current consensus on optimal status but low in large percentage of European populations, and particularly in certain subgroups

11 % with deficient status % deficient cut-off UK adults summer 8.4 <25nmol/l UK adults winter 39.3 <25nmol/l UK adults all year 23.0 <25nmo/l Netherlands ethnic Dutch men 8.4 <30nmol/l Netherlands Asian Surinamese men 40.9 <30nmol/l Austrian adolescents 22.3 <25nmol/l Austrian adults 11.6 <25nmol/l Spanish adults 33.9 <45nmol/l Studies: Look at cut-off points and that study reflects general population

12 Percent of young (12.5 ± 0.5 y, n = 199); and old (71.8 ± 1.4y, n = 221) with serum 25(OH)D considered to be deficient (<25 mmol/l) or suboptimal ( mmol/l) graphed from data presented in Andersen et al. Tylavsky F A et al. J. Nutr. 2006;136: by American Society for Nutrition

13 European public health solutions Supplements European acceptance variable Health professional awareness variable Strength of policy promotion Fortification Mandatory/voluntary Which vehicles? Promote consumption of natural sources oily fish consumption low

14 Supplementation in Europe Most European countries recommend vitamin D supplements (10 µg/d) for infants, for those with little sun exposure and the elderly population Supplements can increase vitamin D blood levels but only if they are taken e.g. poor uptake in pregnancy in UK despite guidelines! Irish Adults 3.1µg/d (food only) 4.3 µg/d (food + suppl.) Elderly 3.8 µg/d(food only) 6.9 µg/d(food + suppl.) Proportion of European population with intake below LRNI even with supplements is still high Infants up to 91% diet only, up to 74% with supplements In UK infants supplements mean intake from 27 to 32% RNI Higher supplement intake in Scandinavia

15 Fortification Fortification with D2 or D3 permitted by EU regulations, with claims allowed at 15% RDI of 5µg Some mandatory fortification of margarine and milk Some voluntary fortification including breakfast cereals and dairy products

16 BNF Vitamin D European Review Vitamin D intake through dietary sources low in many European countries Comparative data would be facilitated by reporting proportions of populations with status below 25nmol/l and 50nmol/l, and a summer, winter and all year round figure Public health solutions to increase vitamin D status include supplements, fortification of foods and awareness of health professionals and general population Adoption of such policies may need to rely on national population characteristics