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

Background: A systematic Vitamin D fortification of fluid milk products and fat spreads was started in 2003 in Finland to improve Vitamin D status. Objective: We investigated the effects of the Vitamin D fortification policy on Vitamin D status in Finland between 2000 and 2011. Design: Serum 25-hydroxyVitamin D [S-25(OH)D] concentrations of a nationally representative sample comprising 6134 and 4051 adults aged ≥30 y from the Health 2000 and Health 2011 surveys, respectively, were standardized according to the Vitamin D Standardization Program with the use of liquid chromatography-tandem mass spectrometry. Linear and logistic regression models were used to assess the change in S-25(OH)D concentrations. Results: Between 2000 and 2011, the mean S-25(OH)D increased from 48 nmol/L (95% CI: 47, 48 nmol/L) to 65 nmol/L (95% CI: 65, 66 nmol/L) (P < 0.001). The prevalence of Vitamin D supplement users increased from 11% to 41% (P < 0.001). When analyzing the effect of fortification of fluid milk products, we focused on supplement nonusers. The mean increase in S-25(OH)D in daily fluid milk consumers (n = 1017) among supplement nonusers was 20 nmol/L (95% CI: 19, 21 nmol/L), which was 6 nmol/L higher than nonconsumers (n = 229) (14 nmol/L; 95% CI: 12, 16 nmol/L) (P < 0.001). In total, 91% of nonusers who consumed fluid milk products, fat spreads, and fish based on Finnish nutrition recommendations reached S-25(OH)D concentrations >50 nmol/L in 2011. Conclusions: The Vitamin D status of the Finnish adult population has improved considerably during the time period studied. The increase is mainly explained by food fortification, especially of fluid milk products, and augmented Vitamin D supplement use. Other factors, such as the difference in the ultraviolet radiation index between 2000 and 2011, may partly explain the results. When consuming Vitamin D sources based on the nutritional recommendations, Vitamin D status is sufficient [S-25(OH)D ≥50 nmol/L], and supplementation is generally not needed. Am J Clin Nutr 2017;105:1512-20.