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Title: Multinutrient-fortified juices improve vitamin D and vitamin E status in children: A randomized controlled trial

Author
item ECONOMOS, CHRISTINA - Tufts University
item MOORE, CAROLYN - Texas Woman'S University
item HYATT, RAYMOND - Tufts University
item KUDER, JULIA - Tufts University
item CHEN, TAI - Boston University
item MEYDANI, SIMIN - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item MEYDANI, MOHSEN - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item KLEIN, ELLEN - Boston University
item BIANCUZZO, RACHAEL - Boston University
item HOLICK, MICHAEL - Boston University

Submitted to: Journal of the Academy of Nutrition and Dietetics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 7/12/2013
Publication Date: 5/18/2014
Citation: Economos, C.D., Moore, C.E., Hyatt, R.R., Kuder, J., Chen, T., Meydani, S.N., Meydani, M., Klein, E., Biancuzzo, R.M., Holick, M.F. 2014. Multinutrient-fortified juices improve vitamin D and vitamin E status in children: A randomized controlled trial. Journal of the Academy of Nutrition and Dietetics. 114:709-717.

Interpretive Summary: Many children are at risk for deficiencies in vitamin D, E and A (known as the fat soluble vitamins). Vitamin D is an essential nutrient in humans and affects the absorption of the mineral calcium. When D is not adequate, bone formation is diminished in a growing child and may cause poor bone health later on in adulthood and old age. Our study focusing on using orange juice supplemented with vitamins D, E and A as an effective way to provide children with these vitamins. Children were divided into 3 groups and supplemented with either calcium, calcium and vitamin D, or calcium with vitamins D, E, and A in their orange juice. Many children (6-10 year old) were vitamin D deficient or insufficient. Compared to the calcium only group, children in the calcium and D or calcium and D, E and A groups were twice as likely to improve their vitamin D status during the 12 week period. The study demonstrated that orange juice supplemented with D and E was effective at increasing the children’s blood levels of these vitamins. Our results suggest that adding orange juice fortified with vitamins is a convenient and tasty source of vitamin D and E for children and should be considered as a nutritional intervention, especially during months with limited exposure to sunlight.

Technical Abstract: Provision of fortified juices may provide a convenient and palatable method to maintain and increase blood fat soluble vitamins. We sought to determine if children consuming orange juice (OJ) fortified with calcium (Ca) and combinations of vitamins D, E and A could increase serum 25-hydroxyvitamin D -25(OH)D-, alpha-tocopherol, and retinol levels while maintaining expected growth weight changes using a randomized, double blind, controlled trial for 12 weeks. Participants were 180 healthy children (8.04 plus or minus 1.42 y) and were recruited at Tufts (n equals70) and Boston University (n=110) during 2005-2006. 176 children were randomized into 3 groups: CaD (700 mg Ca plus 200 IU vitamin D), CaDEA (700 mg Ca plus 200 IU vitamin D plus 12 IU vitamin E plus 2000 IU vitamin A as beta-carotene), or Ca (700 mg Ca). Children consumed two 240 mL glasses of CaD, CaDEA, or Ca fortified orange juice (OJ) for 12 weeks. The main outcome measures were: Serum 25(OH)D, alpha tocopherol, retinol concentrations. Changes in 25(OH)D, alpha tocopherol, retinol, and parathyroid hormone (PTH) over 12 weeks between the three groups were examined. Covariates included sex, age, race/ethnicity, BMI for 25(OH)D, and baseline 25(OH)D, alpha tocopherol, retinol, or PTH. Multivariate models and repeated measures of analysis of variance tested for group differences in children with pre-post measures (N equals141). Results indicated that baseline 25(OH)D was 27.4 plus or minus 11.1 ng/mL with 26.2 percent of participant deficient (less than or equal to 20 ng per mL). The 25(OH)D increase in the CaD group was greater than the Ca group (P equals 0.029). The increase in alpha-tocopherol in the CaDEA group was greater than the Ca or CaD groups (P less than 0.001). Retinol levels did not change and body weight remained as expected for growth. Daily consumption of OJ providing 200 IU of vitamin D and 12 IU of vitamin E increased 25(OH)D and alpha-tocopherol concentrations in young children within 12 weeks.