The impact of vitamin D food fortification and health outcomes in children: a systematic review and meta-regression
Abstract Objective Vitamin D (vitD) deficiency is a global childhood health problem. Food fortification is a promising strategy to curb vitD deficiency. We aimed to assess the effectiveness of utilizing vitD fortification in staple foods to improve 25hydroxyvitamin D (25(OH)D) concentration and to r...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2020-06-01
|
| Series: | Systematic Reviews |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13643-020-01360-3 |
| _version_ | 1818477304278417408 |
|---|---|
| author | Reem Al Khalifah Rawan Alsheikh Yossef Alnasser Rana Alsheikh Nora Alhelali Ammar Naji Nouf Al Backer |
| author_facet | Reem Al Khalifah Rawan Alsheikh Yossef Alnasser Rana Alsheikh Nora Alhelali Ammar Naji Nouf Al Backer |
| author_sort | Reem Al Khalifah |
| collection | DOAJ |
| description | Abstract Objective Vitamin D (vitD) deficiency is a global childhood health problem. Food fortification is a promising strategy to curb vitD deficiency. We aimed to assess the effectiveness of utilizing vitD fortification in staple foods to improve 25hydroxyvitamin D (25(OH)D) concentration and to reduce the prevalence of vitD deficiency among healthy children. Methods We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating the use of vitD fortified food products compared to no fortification among healthy children aged 1–18 years old. We searched Medline, Embase, Global Health, and Cochrane (CENTRAL) databases from database inception until May 2019. Independently, six reviewers in pairs screened titles and abstracts, assessed the full text for eligibility, and performed data extraction and quality assessment. The primary outcome is the impact of fortification on 25(OH)D concentration. The secondary outcomes included the impact of fortification on the prevalence of vitD deficiency, school performance, cognitive function, school absences, infection rate, hospital admission length, and compliance with fortified food product consumption. Results We identified 2229 articles. After assessing eligibility, 20 RCTs met the inclusion criteria. The eligible RCTs assessed the fortification of milk, cereal, juice, bread, yogurt, and cheese compared with no fortification. All RCTs, except for three, had a low risk of bias. Food fortification improved 25(OH)D concentration by a mean difference (MD) of 15.51 nmol/L (95% confidence interval (CI) 6.28, 24.74; I 2 = 99%), which resulted in a mean increase of 3 nmol/l for every 100 IU of vitD, when adjusted for baseline 25(OH)D concentration and country latitude. Additionally, the prevalence of vitD deficiency decreased by a risk ratio of 0.53 (95% CI 0.41, 0.69; I 2 = 95%), and cognitive function improved by a MD of 1.22 intelligence quotient (IQ) points (95% CI 0.65, 1.79; I 2 = 0%). The overall evidence quality was high. Conclusion VitD food fortification is an effective way to improve 25(OH)D concentration, prevent vitD deficiency, and improve IQ levels. Systematic review registration PROSPERO CRD42017057631 |
| first_indexed | 2024-12-10T09:36:21Z |
| format | Article |
| id | doaj.art-3dd3c8f4d21f4d1ab36ccf4047844b7a |
| institution | Directory Open Access Journal |
| issn | 2046-4053 |
| language | English |
| last_indexed | 2024-12-10T09:36:21Z |
| publishDate | 2020-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Systematic Reviews |
| spelling | doaj.art-3dd3c8f4d21f4d1ab36ccf4047844b7a2022-12-22T01:54:10ZengBMCSystematic Reviews2046-40532020-06-019112110.1186/s13643-020-01360-3The impact of vitamin D food fortification and health outcomes in children: a systematic review and meta-regressionReem Al Khalifah0Rawan Alsheikh1Yossef Alnasser2Rana Alsheikh3Nora Alhelali4Ammar Naji5Nouf Al Backer6Division of Pediatric Endocrinology, Pediatric Department, College of Medicine, King Saud UniversityPediatric Department, King Saud UniversityCollege of Medicine, King Saud UniversityPediatric Department, King Saud UniversityCollege of Medicine, King Saud UniversityCollege of Medicine, King Saud UniversityCollege of Medicine, King Saud UniversityAbstract Objective Vitamin D (vitD) deficiency is a global childhood health problem. Food fortification is a promising strategy to curb vitD deficiency. We aimed to assess the effectiveness of utilizing vitD fortification in staple foods to improve 25hydroxyvitamin D (25(OH)D) concentration and to reduce the prevalence of vitD deficiency among healthy children. Methods We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating the use of vitD fortified food products compared to no fortification among healthy children aged 1–18 years old. We searched Medline, Embase, Global Health, and Cochrane (CENTRAL) databases from database inception until May 2019. Independently, six reviewers in pairs screened titles and abstracts, assessed the full text for eligibility, and performed data extraction and quality assessment. The primary outcome is the impact of fortification on 25(OH)D concentration. The secondary outcomes included the impact of fortification on the prevalence of vitD deficiency, school performance, cognitive function, school absences, infection rate, hospital admission length, and compliance with fortified food product consumption. Results We identified 2229 articles. After assessing eligibility, 20 RCTs met the inclusion criteria. The eligible RCTs assessed the fortification of milk, cereal, juice, bread, yogurt, and cheese compared with no fortification. All RCTs, except for three, had a low risk of bias. Food fortification improved 25(OH)D concentration by a mean difference (MD) of 15.51 nmol/L (95% confidence interval (CI) 6.28, 24.74; I 2 = 99%), which resulted in a mean increase of 3 nmol/l for every 100 IU of vitD, when adjusted for baseline 25(OH)D concentration and country latitude. Additionally, the prevalence of vitD deficiency decreased by a risk ratio of 0.53 (95% CI 0.41, 0.69; I 2 = 95%), and cognitive function improved by a MD of 1.22 intelligence quotient (IQ) points (95% CI 0.65, 1.79; I 2 = 0%). The overall evidence quality was high. Conclusion VitD food fortification is an effective way to improve 25(OH)D concentration, prevent vitD deficiency, and improve IQ levels. Systematic review registration PROSPERO CRD42017057631http://link.springer.com/article/10.1186/s13643-020-01360-3Vitamin DFood fortificationPediatricMeta-analysis |
| spellingShingle | Reem Al Khalifah Rawan Alsheikh Yossef Alnasser Rana Alsheikh Nora Alhelali Ammar Naji Nouf Al Backer The impact of vitamin D food fortification and health outcomes in children: a systematic review and meta-regression Systematic Reviews Vitamin D Food fortification Pediatric Meta-analysis |
| title | The impact of vitamin D food fortification and health outcomes in children: a systematic review and meta-regression |
| title_full | The impact of vitamin D food fortification and health outcomes in children: a systematic review and meta-regression |
| title_fullStr | The impact of vitamin D food fortification and health outcomes in children: a systematic review and meta-regression |
| title_full_unstemmed | The impact of vitamin D food fortification and health outcomes in children: a systematic review and meta-regression |
| title_short | The impact of vitamin D food fortification and health outcomes in children: a systematic review and meta-regression |
| title_sort | impact of vitamin d food fortification and health outcomes in children a systematic review and meta regression |
| topic | Vitamin D Food fortification Pediatric Meta-analysis |
| url | http://link.springer.com/article/10.1186/s13643-020-01360-3 |
| work_keys_str_mv | AT reemalkhalifah theimpactofvitamindfoodfortificationandhealthoutcomesinchildrenasystematicreviewandmetaregression AT rawanalsheikh theimpactofvitamindfoodfortificationandhealthoutcomesinchildrenasystematicreviewandmetaregression AT yossefalnasser theimpactofvitamindfoodfortificationandhealthoutcomesinchildrenasystematicreviewandmetaregression AT ranaalsheikh theimpactofvitamindfoodfortificationandhealthoutcomesinchildrenasystematicreviewandmetaregression AT noraalhelali theimpactofvitamindfoodfortificationandhealthoutcomesinchildrenasystematicreviewandmetaregression AT ammarnaji theimpactofvitamindfoodfortificationandhealthoutcomesinchildrenasystematicreviewandmetaregression AT noufalbacker theimpactofvitamindfoodfortificationandhealthoutcomesinchildrenasystematicreviewandmetaregression AT reemalkhalifah impactofvitamindfoodfortificationandhealthoutcomesinchildrenasystematicreviewandmetaregression AT rawanalsheikh impactofvitamindfoodfortificationandhealthoutcomesinchildrenasystematicreviewandmetaregression AT yossefalnasser impactofvitamindfoodfortificationandhealthoutcomesinchildrenasystematicreviewandmetaregression AT ranaalsheikh impactofvitamindfoodfortificationandhealthoutcomesinchildrenasystematicreviewandmetaregression AT noraalhelali impactofvitamindfoodfortificationandhealthoutcomesinchildrenasystematicreviewandmetaregression AT ammarnaji impactofvitamindfoodfortificationandhealthoutcomesinchildrenasystematicreviewandmetaregression AT noufalbacker impactofvitamindfoodfortificationandhealthoutcomesinchildrenasystematicreviewandmetaregression |