Findings from a public health study found an urgent need for more focused plans to increase fat-soluble vitamin intake such as vitamin A and D in the Belgian population.
“These scenario analyses will be very useful from a policy point of view,” the study concluded.
“They should allow identifying which measures will ensure effective and safe increases in vitamin A and D intake.”
The study also found that while the intakes of these vitamins were suboptimal, vitamin E supplementation was close to adequate.
In addition, the researchers decided there was a low risk of inadequate vitamin K intake along with vitamin E.
EU fortification and supplementation
The past 30 years have seen diets in high-income countries become more energy-dense and nutrient-poor resulting in insufficient intakes of key vitamins in European populations.
Adequate intake of micronutrients can be achieved through health promotion, as well as through fortification and supplementation practices.
However, while fortified foods are well adopted in the USA, Europeans are more sceptical of fortification. Despite a uniform regularisation within the EU, fortification and supplementation practices differ substantially between countries.
In Belgium, fortified foods and supplements require notification, and the Belgian Royal Decree (Koninklijk besluit (KB) 3/3/1992) governs the level of vitamins added.
Fortification in Belgium is mandatory for margarines (fat content (FC) more than 80%) and spreadable fats (FC 39%-41%) (KB 02/10/1980) and officially encouraged for spreadable fats with other fat contents.
Similar to other countries, the Belgian Superior Health Council advises a vitamin D supplement for the entire population in the case of minimal exposure to sunlight.
Independently of their intake from food, a supplementation of 10 micrograms per day (μg/day) for children and 15 μg/day for adolescents and adults is recommended.
This supplementation advice however is currently based on the population reference intake. Dietary intake data are needed to fine-tune these recommendations in correspondence with Belgian dietary habits, as well as with intake from fortified foods and supplements.
Researchers from the Scientific Institute of Public Health (WIV-ISP) and Ghent University in Belgium gathered data from the 2014 Belgian food consumption survey.
A sample size of 3200 people aged 3–64 years old was formed to assess vitamin A, D, E and K intake from the consumption of foods, fortified foods and supplements.
Food and supplement consumption data in adults and adolescents (10–64 years old) were collected using two 24-hour dietary recalls and a self-administered food frequency questionnaire (FFQ).
In children (3–9 years old), consumption data were collected using two non-consecutive one-day food diaries, a completion interview and a self-administered FFQ.
Findings revealed that the prevalence of inadequate intake of vitamin A was lowest in children aged 3–6 (6–7%) and highest in adolescents (girls, 26%; boys, 34–37%).
Except for women aged 60–64 years, more than 95% of the subjects had vitamin D intake from all sources below the adequate intake (AI) of 15 μg/day.
The risk for inadequate intake of vitamins K and E was low with the median value higher than the AI value.
For vitamin A, a small proportion (1–4%) of young children were at risk of exceeding the upper intake level (UL), according to the research team, led by Dr Isabelle Moyersoen, scientific researcher at WIV-ISP.
For vitamin D, inclusion of supplements slightly increased the risk for excessive intakes in adult women and young children.
“The present results are in line with European review studies when comparing intake levels,” the study explained.
“Higher intakes of vitamin A from foods are found in countries (Germany, Poland, Italy) with high consumption of sausages, liver and vegetables. Higher vitamin D intake levels from food are found in Scandinavian countries were oil-rich fish and milk are more frequently consumed.
“Our results for vitamin D intake from foods and fortified foods in young children (3–6 years) were somewhat higher, but in the same order as the results of the Flemish preschoolers.”
The team also noticed their results for vitamin E were in line with German results reporting fortified foods to be effective in raising low intake values of vitamin E closer to the reference values.
For vitamin D, however, they did not observe the same effect. Even the inclusion of fortified foods barely increased median vitamin D levels in the Belgian population.
Concerning fat-soluble vitamins, excessive intakes were reported for retinol in the study.
“Excessive intakes for retinol were mainly related to higher intakes from the base diet (Poland) or from supplements (Ireland).
“Fortified foods had little effect on the higher intakes (P95) due to the limited amounts of foods fortified with retinol. These results are in line with our findings.”
The study found that fortified foods had little effect on the higher intakes (P95) due to the limited amounts of foods fortified with retinol.
“Intake data of the Belgian population provide an ideal starting point for modelling of fortification and supplementation scenarios,” the study concluded.
“They should allow identifying which measures will ensure effective and safe increases in vitamin A and D intake.
“These scenario studies might give an insight into how a potential change in policy may affect intake levels of vitamins A and D at a population level.”
Published online ahead of print: doi:10.3390/nu9080860
“Intake of Fat-Soluble Vitamins in the Belgian Population: Adequacy and Contribution of Foods, Fortified Foods and Supplements.”
Authors: Isabelle Moyersoen et al