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| LETTER TO EDITOR |
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| Year : 2021 | Volume
: 4
| Issue : 1 | Page : 80-81 |
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Childhood Vitamin D deficiency: Time for policy change
Reem Abdullah Al Khalifah1, Yossef Alnasser2
1 Department of Pediatric, Division Pediatric Endocrinology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
2 Department of Pediatric, Division Pediatric Endocrinology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Department of Pediatric, BC Children's Hospital, University of British Columbia, Vancouver, Canada
| Date of Submission | 18-Jun-2020 |
| Date of Decision | 01-Aug-2020 |
| Date of Acceptance | 18-Aug-2020 |
| Date of Web Publication | 06-Jan-2021 |
Correspondence Address:
Reem Abdullah Al Khalifah
Department of Pediatric, Division Pediatric Endocrinology, College of Medicine, King Saud University, Riyadh
Saudi Arabia
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/JNSM.JNSM_69_20
How to cite this article:
Al Khalifah RA, Alnasser Y. Childhood Vitamin D deficiency: Time for policy change. J Nat Sci Med 2021;4:80-1 |
Dear Editor,
Vitamin D (vitD) deficiency is a silent public health problem worldwide and in Saudi Arabia. In Saudi Arabia, the prevalence of vitD deficiency is alarming like other gulf countries. The prevalence of 25(OH) vitamin D (25[OH] D) concentration <50 nmol/l among newborns, children, adolescents, adults, and pregnant women has been reported to reach 81.0%.[1] Furthermore, given vitD possible anti-inflammatory and antioxidant properties, it could have a potential role in the pathogenesis of some diseases such as asthma, eczema, diabetes mellitus, and cancer.[2]
Its deficiency is primarily caused by a lack of foods naturally rich in vitD along with inadequate sun exposure. Thus, we urgently need effective population-level intervention. Interventions such as mass vitD supplementation are not effective because they depend on the consumer's knowledge about micronutrient deficiency and compliance with its intake. All these facts make it hard to rely on children and adolescents at their variable development stages to take necessary nutrition for their growing bodies.
The Saudi Food and Drug Authority (SFDA) had allowed the food industry to implement voluntary fortification policy. Notably, major retailers for dairy products had opted to fortify their products by 40 IU/100 ml. In our recently published systematic review and meta-regression, we determined the effectiveness of the vitD fortification of staple foods on children (aged 0–18 years) health outcomes.[3] VitD fortification significantly improved 25(OH)D concentrations by a mean difference (MD) of 15.07 nmol/L (95% confidence interval (CI): 6.28–24.74). The multivariate regression model is shown in [Table 1]. Furthermore, food fortification reduced vitD deficiency by a risk ratio of 0.53. This means one case of vitD deficiency will be prevented for every six children receiving vitD fortification products. Fortified milk was the most effective food vehicle for improving 25(OH)D concentrations by an MD of 23.72 nmol/L, followed by juice, cereal, and yogurt and cheese. Moreover, children's IQ improved by MD 1.22 (95% CI: 0.65–1.79). This improvement is considered significant at a community level. Our meta-analysis was performed using studies from both high- and low-income countries, making the results widely generalizable. Similarly, the prevalence of vitD deficiency was reduced from 58.5% to 13.7% after 11 years of mandatory fortification in Finland.[4],[5] | Table 1: Expected changes in 25-hydroxyvitamin D concentration with changes in the vitamin D dose and baseline 25-hydroxyvitamin D concentration
Click here to view |
We urge the SFDA policymakers and neighboring Gulf countries to implement a mass mandatory vitD fortification strategy of at least one staple food product similar to North American and European countries. In addition, ensuring fortification does not drive the market price higher to avoid making products less accessible to middle- and low-income families. We recommend fortifying milk over juice to avoid increased consumption of juice leading to an increased prevalence of obesity among our children and youths. Another alternative food vehicle that might be culturally accepted is wheat. Longitudinal modeling study using data from England suggested that fortification of wheat reduces vitD deficiency by 25%, while fortification of wheat and milk reduces vitD deficiency by a further 8%.[6] Moreover, based on our model, we recommend the fortification dose to be at least 400 IU per serving to improve the mean population 25(OH)D concentration [Table 1].
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Al-Daghri NM. Vitamin D in Saudi Arabia: Prevalence, distribution and disease associations. J Steroid Biochem Mol Biol 2018;175:102-7.  |
| 2. | Hossein-nezhad A, Holick MF. Vitamin D for health: A global perspective. Mayo Clin Proc 2013;88:720-55. |
| 3. | Al Khalifah R, Alsheikh R, Alnasser Y, Alsheikh R, Alhelali N, Naji A, et al. The impact of Vitamin D food fortification and health outcomes in children: A systematic review and meta-regression. Syst Rev 2020;9:144. |
| 4. | Jaaskelainen T, Itkonen ST, Lundqvist A, Erkkola M, Koskela T, Lakkala K, et al. The positive impact of general Vitamin D food fortification policy on Vitamin D status in a representative adult Finnish population: Evidence from an 11-y follow-up based on standardized 25-hydroxyvitamin D data. Am J Clin Nutr 2017;105:1512-20. |
| 5. | Piirainen T, Laitinen K, Isolauri E. Impact of national fortification of fluid milks and margarines with Vitamin D on dietary intake and serum 25-hydroxyvitamin D concentration in 4-year-old children. Eur J Clin Nutr 2007;61:123-8. |
| 6. | Aguiar M, Andronis L, Pallan M, Hogler W, Frew E. The economic case for prevention of population vitamin D deficiency: A modelling study using data from England and Wales. Eur J Clin Nutr 2020;74:825-33. |
[Table 1]
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