Background: In Germany, vitamin D intake from food and synthesis in the skin is low, which leads to low 25(OH)D\r\nserum concentrations. In contrast to many other countries, general vitamin D food fortification is still prohibited in\r\nGermany, although the European Commission published a regulatory framework to harmonize addition of vitamins\r\nto foods. Thus the purpose of our study was to develop a vitamin D fortification model, taking into account all\r\nvitamin D sources with the goal to fulfill requirements of intake recommendations or preferable 25(OH)D serum\r\nconcentrations. Finally, the aim was to assess the suitability of different carriers and associated risks.\r\nMethods: We developed a mathematical bottom-up model of 25(OH)D serum concentrations based on data about\r\nvitamin D sources of the German population such as sunlight, food and supplements for all federal states taking\r\nseasonal and geographical variations into account. We used this model to calculate the optimal fortification levels\r\nof different vitamin D carriers in two approaches. First we calculated required fortification levels based on fixed\r\nintake recommendations from e.g. the IOM or the DGE and second based on achieving certain 25(OH)D serum\r\nconcentrations.\r\nResults: To lift 25(OH)D serum concentration in Germany to 75 nmol/L, e.g. 100 g bread has to be fortified with\r\n11.3 �µg during winter, resulting in a daily vitamin D intake of 23.7 �µg. Bread seems to be a suitable carrier for base\r\nsupply. However, overdose risk with a single fortified product is higher than the risk with several fortified carriers.\r\nConclusions: With the model in hand, it is possible to conceive vitamin D fortification strategies for different\r\nfoodstuffs and model its impact on 25(OH)D serum concentrations.
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