According to a new study that will be presented today (Saturday 21 May at 12:00 noon CEST) at the
24th European Congress of Endocrinology in Milan, Italy on vitamin D food fortification working better with
water and milk than in juice. By measuring the maximum concentration over time, the researchers found
bioavailability of vitamin D to be higher in milk and water.
Vitamin D insufficiency is a global health problem
Vitamin D insufficiency has been linked with multiple health issues, including the immune response to COVID-
191. Estimates show that as much as 40% of the European population could be suffering from vitamin D
deficiencies, with 13% potentially suffering from severe vitamin D deficiency2. Vitamin D supplements are
therefore vital – and knowing whether they will be absorbed and how best to aid absorption is crucial.
To answer this question, Dr. Rasmus Espersen of Aarhus University in Denmark and his colleagues
conducted a randomised trial on 30 postmenopausal women aged 60-80 with vitamin D deficiency. The study
aimed to measure immediate changes in blood concentrations in response to the consumption of various
food items containing 200 g D3. In a random order, 500 mL of water, milk, juice, juice with vitamin D bound
to whey protein isolate as well as 500 mL of water without vitamin D (placebo) were presented to the study
participants. Blood samples were collected at 0h, 2h, 4h, 6h, 8h, 10h, 12h, and 24h on each study day.
“One aspect that surprised me was the fact that the results seen in the water and milk groups were equal.
This was quite unexpected given the fact that milk contains more fat than water.” stated Dr. Espersen.
The study revealed that whey protein isolate in apple juice did not enhance maximum concentration of D3
compared to juice without WPI. However, compared to juice, D3 concentrations were significantly higher in
response to intake of milk and water. No difference was observed between milk and water. Therefore, the
conclusion from this study is that vitamin D fortification works better in water or milk than in juice.
1 Bilezikian et al., (2020), MECHANISMS IN ENDOCRINOLOGY: Vitamin D and COVID-19, European Journal of
Endocrinology, Volume 183:5, https://doi.org/10.1530/EJE-20-0665
2 Amrein et al., (2020), Vitamin D deficiency 2.0: an update on the current status worldwide, European Journal of
Clinical Nutrition, Volume 74, pp 1498-1513, https://www.nature.com/articles/s41430-020-0558-y#Sec23
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President Martin Reincke Munich, Germany. President-elect Jérôme Bertherat Paris, France. Secretary Mónica Marazuela Madrid, Spain. Treasurer Djuro Macut Belgrade, Serbia. Executive Committee members:
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Netherlands. Ex-Officio members: EYES Representative Eva Coopmans, Rotterdam, Netherlands. Nurse Representative Sherwin Criseno West Bromwich, UK. ECAS Representative Anton Luger Vienna, Austria.
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-ENDSNotes
for Editors
1. The presentation “What is the most efficient way to fortify food items with vitamin D? A
randomised, multiple crossover study” will be presented on Saturday 21 May, 2022 at 12:00 CEST
at ECE 2022, which will be held in Milan on 21-24 May 2022. You can access more information about
the event here.
2. The European Society of Endocrinology was created to promote research, education, and clinical
practice in endocrinology by the organisation of conferences, training courses and publications, by
raising public awareness, liaison with national and international legislators and by any other
appropriate means.
About the European Society of Endocrinology
The European Society of Endocrinology (ESE) provides a platform to develop and share leading research
and best knowledge in endocrine science and medicine. By uniting and representing every part of the
endocrine community, we are best placed to improve the lives of patients. Through the 54 National
Societies involved with the ESE Council of Affiliated Societies (ECAS) ESE represents a community of over
20,000 European endocrinologists. We inform policy makers on health decisions at the highest level
through advocacy efforts across Europe.
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European Society of Endocrinology
Starling House, 1600 Bristol Parkway North, Bristol, BS34 8YU, UK Tel +44 1454 642247 info@euro-endo.org www.ese-hormones.org
President Martin Reincke Munich, Germany. President-elect Jérôme Bertherat Paris, France. Secretary Mónica Marazuela Madrid, Spain. Treasurer Djuro Macut Belgrade, Serbia. Executive Committee members:
Philippe Chanson Paris, France. Mirjam Christ-Crain Basel, Switzerland. Martin Fassnacht Würzburg, Germany. Simona Glasberg Jerusalem, Israel. Riccarda Granata Torino, Italy. Robin Peeters Rotterdam, The
Netherlands. Ex-Officio members: EYES Representative Eva Coopmans, Rotterdam, Netherlands. Nurse Representative Sherwin Criseno West Bromwich, UK. ECAS Representative Anton Luger Vienna, Austria.
Registered in England and Wales No. 5540866. Registered Office: Redwood House, Brotherswood Court, Great Park Road, Almondsbury Business Park, Bradley Stoke, Bristol, BS32 4QW, UK. Company Limited by
Guarantee. Registered Charity No. 1123492.
Abstracts
RC8.3
What is the most efficient way to fortify food items with vitamin D? A randomised, multiple crossover
study.
Rasmus Espersen1,2, Lene Ring Madsen3,4,5, Caroline Nebel6,7, Marianne Danielsen6,7, Trine Dalsgaard6,7, Lars
Rejnmark1,2
1Aarhus University, Department of Clinical Medicine, Denmark; 2Aarhus University Hospital, Department of
Endocrinology and Internal Medicine, Aarhus, Denmark; 3Regional Hospital West Jutland, Department of
Internal Medicine, Herning, Denmark; 4Steno Diabetes Center Aarhus, Aarhus, Denmark; 5Danish Diabetes
Academy, Odense, Denmark; 6Aarhus University, Department of Food Science, Aarhus, Denmark; 7Aarhus
University, iFood, Centre for Innovative Food Research, Aarhus, Denmark
Introduction:
Vitamin D insufficiency (25-hydroxy vitamin D <50 nmol/l) is a global health problem. Vitamin D food
fortification might be the solution, but knowledge is sparse on whether fortification of various food items
affects the bioavailability differently. It is generally assumed that ingesting vitamin D with a fatty meal
improves the bioavailability of vitamin D. Furthermore, complex formation with whey protein isolate (WPI)
may enhance the stability of vitamin D and thereby improve bioavailability. We studied the efficiency of
fortifying different food items with vitamin D3.
Materials and methods:
In a randomised, multiple (5-periods), crossover trial, we enrolled 30 postmenopausal women with vitamin
D insufficiency aged 60-80 years. We measured immediate changes in plasma concentrations of
cholecalciferol (D3) in response to intake of different food matrices with 200 μg D3 added i.e., 1) 500 mL of
water, 2) 500 mL of milk, 3) 500 mL of juice, 4) 500 mL of juice with D3 complex-bound to WPI, and 5) 500
mL of water without D3 (placebo). The different food matrices were provided in a randomised order with at
least ten days washout period in-between study days. On each study day, blood samples were collected at
0h, 2h, 4h, 6h, 8h, 10h, 12h and 24h.
Results:
Complexation D3-WPI in apple juice did not enhance maximum concentration (Cmax) of serum D3
compared to juice without WPI (25 nmol/l vs. 24 nmol/l; p=0.61), nor the area under the time-D3 curve
(AUC) (370 nmol/l*24h vs. 357 nmol/l*24h; p=0.93). However, compared to juice, Cmax and AUC of serum
D3 were significantly higher in response to intake of milk (30 nmol/l and 452 nmol/l*24h) and water with D3
European Society of Endocrinology
Starling House, 1600 Bristol Parkway North, Bristol, BS34 8YU, UK Tel +44 1454 642247 info@euro-endo.org www.ese-hormones.org
President Martin Reincke Munich, Germany. President-elect Jérôme Bertherat Paris, France. Secretary Mónica Marazuela Madrid, Spain. Treasurer Djuro Macut Belgrade, Serbia. Executive Committee members:
Philippe Chanson Paris, France. Mirjam Christ-Crain Basel, Switzerland. Martin Fassnacht Würzburg, Germany. Simona Glasberg Jerusalem, Israel. Riccarda Granata Torino, Italy. Robin Peeters Rotterdam, The
Netherlands. Ex-Officio members: EYES Representative Eva Coopmans, Rotterdam, Netherlands. Nurse Representative Sherwin Criseno West Bromwich, UK. ECAS Representative Anton Luger Vienna, Austria.
Registered in England and Wales No. 5540866. Registered Office: Redwood House, Brotherswood Court, Great Park Road, Almondsbury Business Park, Bradley Stoke, Bristol, BS32 4QW, UK. Company Limited by
Guarantee. Registered Charity No. 1123492.
added (32 nmol/l and 479 nmol/l*24h) (p<0.05, all). No difference in serum D3 was observed between milk
and water (p=0.29, Cmax; p=0.33, AUC).
Conclusion:
The bioavailability of D3 assessed by Cmax and AUC was superior in water and milk compared to juice,
independent of whether complexation D3-WPI was added to juice.