Starting in 2024, milk and bread will be fortified with vitamin D in Chile

On July 5, Decree 48 was published, which modifies the Food Sanitary Regulations in favor of vitamin D fortification. The regulations were altered as part of a bill, presented this year by the senators of the commission of Health, which promoted the strengthening of the consumption of this vitamin in the population, given the evidence of the low levels shown in recent years.

The project was based on the National Health Survey (ENS) for the year 2016-2017, which studied women of childbearing age, between 15 and 49 years old, and adults over 65 years old. The target groups revealed that only slightly more than 13% of the population have optimal levels of vitamin D. If we look at the details, 52% of women of childbearing age and 59% of older people had some degree of vitamin D deficiency.

Another study in children between 4 and 14 years of age, developed in 2019 in large cities of the country (Santiago, Concepción and Antofagasta), showed that more than three quarters of them had low levels of vitamin D.

According to the study Vitamin D deficiency: Chilean model proposal for a national food fortification policy of the Center for Public Policy of the Catholic University of 2020, vitamin D deficiency is associated with low levels of sun exposure and low dietary intake.

The former could be considered “an epidemic of the modern lifestyle” since it is associated with the prevalence of a sedentary lifestyle, the latitude of the country where the arrival of UVB rays is minimal in areas further south, especially in autumn and winter, and obesity, since increased body fat decreases circulating vitamin D levels.

Among the main functions of vitamin D is strengthening the immune systemin addition to the regulation of calcium and phosphorus excretion in the kidneys, contribute to brain development, participate in bone formation or its important anti-inflammatory role.

The problems associated with the lack of this vitamin can produce clinical effects in bone health, such as rickets, osteoporosis, osteomalacia, fractures, among other complications.

However, Carla Leiva, nutritionist and Master in Nutritional Sciences and one of the authors of the study, explains that “it is much more than just bone”since it has also been seen that vitamin D has functions in the immune system, on muscle mass and at a neurological level.

“It has to do with super-relevant functions, which is why it is currently called a hormone or prohormone, because it ultimately participates in practically all the organs of our body and therefore it is important to keep the population above the desired levels,” he says.

The decree modifies the Sanitary Regulation of Food, requiring that all milk, liquid and powder, and flour that are produced or marketed in Chile must be fortified with vitamin D3. To define the formula to put into practice, Leiva was invited to the government work table to jointly prepare and choose the best foods to be fortified.

Leiva explains that milk and dairy products were chosen because “they are the best vehicle always thinking that they not only have vitamin D to be fortified, but also calcium”, although it recognizes that Chile has a low intake of dairy products.

“Chileans consume less than two glasses of milk a day. So it couldn’t be the only vehicle. And there within the modeling that we did, we identified that the only vehicle that worked with respect to intake in Chile were the flourbecause it was highly consumed in the country and does not discriminate by socioeconomic level, nor from the social point of view and also has a low cost”, he explains.

A worker handles flour to make bread. Photo: Francisco Saavedra, Agency One

According to Leiva, the cost of vitamin D is pennies on the dollar for a company. So it practically does not increase the cost and it is not complicated for the industry because it is not something new. “It is not the first time that Chilean mills have been fortified with other nutrients. Basically it is adding vitamin D to the premix that they already use.”

The decree will enter into force 24 months after its publication in the Official Gazette, that is, on July 6, 2024, that is, in two years the Chilean population will begin to eat foods fortified with vitamin D.

“It is always important to give this red flag time in the background so that they [la industria] start implementing the policy. And of course, the idea is that after that they begin to control, they begin to evaluate if it is really being fulfilled, because obviously that is the idea, that everyone does it”, says Carla Leiva.

For 50 years they have fortified the flours in Chile with iron, thiamine, riboflavin and niacin. In 2000, folic acid was added, a micronutrient that must be present in the diet of women before conception, in order to prevent neural tube defects, according to a document from the Ministry of Health (Minsal).

The document mentions the iodization of salt, which was initiated several decades ago, and has led to the suppression of endemic school goiter as a public health problem in Chile.

Drinking water is also fortified with fluoride, and there is a desire among some national researchers to add lithium to it, as a way to prevent suicide and mental disorders. In the United States there are some data: the levels of lithium in water are much higher on the northeast and east coast, and very low in the west. This is consistent with suicide rates: much lower in the northeastand higher in the west.

This implies that if that 50 to 60 percent reduction is applied to the US, where nearly 45,000 people died by suicide in 2016, they will be saved. between 22 thousand to 27 thousand people a year.