Bread as a vehicle vitamin D fortification: Application to nursing home residents

Abstract

Vitamin D has become recognized by policy makers as a nutrient that needs to be provided to institutionalized seniors, because it prevents osteoporotic fractures. • Since older adults receive many medications, it may be preferable to fortify their food with vitamin D, rather than provide it as yet another pill. • In a clinical trial in Eastern Europe, nursing-home residents had average serum levels of 25-hydroxyvitamin D (the measure of vitamin D status) that were at the threshold of severe osteomalacia, and after 12 months of receiving bread daily that was fortified with 320 μg elemental calcium and 5,000 IU (125 μg) vitamin D, they exhibited substantial gains in bone mineral density at both the hip and spine. • Since bread is baked at high temperatures, it is a suitable option for fortification with heat-stable nutrients such as minerals and vitamin D. • The vitamin D3 is the most potent vitamin D and it should be used for food fortification. • Food fortification policy for vitamin D should provide bread that contributes a suitable amount of vitamin D per serving, which would typically be about 20 % of the recommended daily vitamin D intake, i.e., about 3 μg (120 IU) per serving of bread. • To ensure the serum 25-hydroxyvitamin D levels recommended by medical groups for bone health in the older nursing residents, the practical experience shows that much higher amounts of vitamin D3 are required. Fortification of bread and cereals is a feasible way to improve vitamin D nutrition and a dose of 10 μg (400 IU) vitamin D3 per 100 g serving from any sources is safe.