The method of applying nutrients or non-nutrient bioactive ingredients to edible items is known as fortification. By using current distribution systems for industry-manufactured goods, food fortification raises micronutrient availability to minimize nutritional shortages in the population. Fortification is the best opportunity to increase vitamin D supply to the public. Food fortification offers the greatest way to improve the population's vitamin D intake. Around the time of the World Wars, fortification of many micronutrients became popular to avoid micronutrient malnutrition and to fix nutritional shortages during food production.
Vitamin D, also known as calciferol, is a fat-soluble vitamin that is not naturally present in many foods, but is fortified in many foods and available as a dietary additive. When UV rays from the sun penetrate the skin, they induce vitamin D synthesis, which is the primary way our bodies receive it. The small intestine is where it is utilized. Vitamin D must be hydroxylated twice before it can be absorbed and used by the body. The first hydroxylation occurs in the liver. Vitamin D is transformed into hydroxyvitamin D. The resulting hydroxylation, which occurs mostly in the kidney, yields the physiologically active ‘calcitriol’ (Institute of Medicine, 2010). Vitamin D aids calcium synthesis in the intestines. Individuals who have insufficient sun exposure, reduced oral consumption, or poor intestinal absorption are generally at risk for vitamin D deficiency (Holick, Chen, Lu and Sauter, 2007). The easiest way to assess vitamin D sufficiency is to calculate the 25-hydroxyvitamin D content in the blood. Average daily vitamin D consumption in the general population and existing dietary reference intake values are often insufficient to sustain optimum vitamin D levels (Kennel, Drake and Hurley, 2010). Vitamin D is also well-known for its interaction with calcium. Calcium is critical for preserving healthy bones and avoiding the development of osteoporosis. It allows the intestine to absorb the calcium we ingest. Osteoporosis is a debilitating condition caused by a lack of calcium. The bones of the body grow fragile and porous. It is known as 'the invisible disease' and there are no signs or symptoms until anyone threatens to break bones. This disease, on the other hand, is far from invisible. The effects of undiagnosed and untreated osteoporosis are catastrophic. Bone is a living tissue that is constantly removed and substituted. Bones include natural sex hormones, calcium, vitamin D, enough calories, proteins, and weight-bearing strengthening activity to remain healthy (Sahota, 2000).
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It is recommended that babies from birth to the age of 1, if breastfed, should be given a vitamin D supplement of 5 mcg daily. This is recommended due to their rapid growth during this short period of time. Babies from birth to the age of 1 who are formula fed do not need any supplementation as formula is usually fortified with vitamin D. These recommendations are for healthy term babies (INDI, 2020). The current minimum dietary daily amount of vitamin D is 5 mcg. Food, including supplements, need to provide 10 mcg of vitamin D daily for everyone over the age of 5 years. In older adults, aged 65 and over, supplementation is needed. For healthy older adults who get sunlight outdoors each day, should take a 10 mcg supplement from October to March. People with naturally darker skin should be taking 10 mcg all year round as their dark complexion makes it harder to absorb vitamin D. Housebound older adults should be taking 15 mcg all year round, as they are not exposed to UV rays. The FSAI is intended to discuss the vitamin D needs of other 'at-risk' populations, such as pregnant women and children aged 12 months to five years, at a later date (FSAI, 1999). Last reviewed in 2020.
Since 2007, many widely consumed foods have been supplemented with vitamin D on a voluntary basis. Milks, yoghurts, and breakfast cereals are examples of these foods. However, only people who eat fortified forms of these items get more vitamin D and the fortified forms are limited to a few brands. Avonmore Super Milk is the most well-known and is advertised regularly. A 250ml glass of Avonmore Whole and Low Fat Super Milk contains 100% of the recommended daily intake of vitamin D, as well as many other micronutrients. Vitamin D fortification projects introduced in the United States and Canada have strengthened these countries' vitamin D status. In February 1927, Quaker Oats obtained the first license to produce vitamin D-enriched oats. Pharmaceutical firms were awarded licenses to produce a therapeutic vitamin D medication. This method had been expanded by 1934 to manufacture vitamin D fortified milk. Soon, vitamin D fortification was accomplished at a low cost by directly applying vitamin D to milk. In Australia, margarine, as well as milk and yoghurts, are now fortified with vitamin D. In New Zealand, fortification of margarine is not required, but voluntary fortification of fats and products has been allowed since 1996. Margarine and margarine-like spreads are the only items in the UK that are allowed by law to contain vitamin D.
The cost of doing nothing is huge. In infants and children, rickets is a huge risk. Rickets in children are caused by a deficiency of vitamin D and a lack of exposure to sunlight. Vitamin D deficiency is also a problem in older children and teenagers (Wagner and Greer, 2008). Rickets, long believed to be extinct, is reappearing. Bone growth in children is affected by rickets. Bone pain, slow growth and fragile bones contribute to bone distortions. Children may be born in rare circumstances of inherited ricket types. It may also occur if another disease inhibits the body's absorption of vitamins and minerals, like coeliac disease. Rickets can be treated effectively for most children by consuming foods containing calcium and vitamin D, or vitamin supplements. A diet that includes vitamin D and calcium, spending some time under the sun and, if necessary, taking vitamin D supplements, can easily prevent rickets (Chick et al., 1922). Symptoms include pains in bones, dental problems, fragile bones prone to fractures, and stunted growth.
Adults can experience a similar condition, which is known as osteomalacia or soft bones. Osteomalacia is a bone weakening condition. Osteomalacia is a bone condition caused by a lack of mineralization in the skeleton. Types that require vitamin D must be differentiated from hypophosphatemic types. Bone pain, muscle fatigue, and fragility fractures are common signs and symptoms. Serious fragility fractures in the pelvis, sacrum, lower arms, and legs are strong signs of osteomalacia (Tiefenbach, Scheel and Maier, 2018).
Adults can also develop a condition called osteoporosis. Osteoporosis is similar to osteomalacia. Osteomalacia is a problem with bones that do not harden, whereas osteoporosis is a problem with bone weakness. Osteoporosis is caused by a decrease in bone density, and osteomalacia caused by impaired mineralization. Because of the secondary complications of a bone fracture, 20% of people aged 60 and over who break their hip will die within 6 to 12 months. When an individual over the age of 60 breaks their hip, half of them lose their rights and independence. They would be unable to bathe, shave, or simply walk about the room without help. Only 15% of people in Ireland suffer from bone loss, leaving 280,000 people without a diagnosis and at risk of losing their freedom. These statistics emphasize the importance of people taking care of their bone health and determining whether they are at risk. It is estimated that up to 300,000 Irish people have osteoporosis. While it is more frequent in menopausal females, it may also affect men.
This puts a huge impact on our health system, as well as the citizens of Ireland. In order to improve the situation educating the population is critical. Education is key from a young age as individuals reach their peak bone mass before aged 30. Education in primary schools and post primary schools is essential to make children and teenagers aware of the situation and how to rectify it. Third level students should also be educated on the topic. TV adverts or public health leaflets can be used as a means to educate the older population.
Studies in Ireland have shown that low vitamin D intake and vitamin D deficiency are widespread in the population of Ireland. Due to our geographic location, and multiple combinations of factors that adversely affect vitamin D intake in the population, most of us should be taking vitamin d supplements. People of every age at risk of developing bone disorders due to vitamin D deficiency. Education is the best and most effective way of improving the situation. This problem does not just put a burden on our health system, but also on the people of Ireland.
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