Multinutrient-Fortified Juice Improves Vitamin D and Vitamin E Status in US Children

05 Dec 2014 --- Based on current estimates, millions of children are likely to have suboptimal vitamin D and vitamin E status. The development of various fortified foods provides a variety of alternative healthy products for the consumer. Given the current overriding concerns about the obesity epidemic in children, the American Academy of Pediatrics has recommended that children aged 7 to 18 years old consume no more than 12 ounces of 100% fruit juice per day.

Juice consumption is common in children and can be an important source of essential nutrients, such as vitamin C and other antioxidants. However, many children prefer juice-based beverages and thus they may serve as an acceptable vehicle for fortification of other micronutrients important for children, including fat-soluble vitamins, such as the antioxidant vitamin E and bone-building vitamin D.

In a newly published study, 180 children (aged 6 to 10 years old) from Boston, Massachusetts were recruited to participate in a 12-week double-blind, randomized, placebo-controlled trial during which they consumed one of three fortified juices: either (1) calcium-fortified orange juice (700 mg Ca); (2) calcium (700 mg) + vitamin D (200 IU); or (3) calcium (700 mg) + vitamin D (200 IU) + vitamin E (12 IU) + vitamin A (2000 IU as β-carotene), as two 240-mL glasses of juice. The main outcomes of this study were changes in micronutrient status assessed by changes in serum 25-hydroxyvitamin D, α-tocopherol, and retinol.

The researchers found that the children receiving 200 IU/day vitamin D, either alone with 700 mg calcium or as 200 IU vitamin D along with vitamin E and β-carotene, caused an increase in vitamin D status. For example, there was a 44% increase in serum 25-hydroxyvitamin D compared to baseline in the Ca + vitamin D group, which was accompanied by a significant reduction in serum parathyroid hormone, an indicator of improved calcium status. In contrast, there was no significant change in serum parathyroid hormone observed in the children receiving calcium alone. The change in vitamin E status (serum α-tocopherol) was significant (28% increase) in the group receiving the calcium + vitamin D + vitamin E + β-carotene treatment. 

Interestingly, the researcher noted no significant change in serum vitamin A status (serum retinol) following consumption of the juice containing 2000 IU β-carotene, a dietary provitamin A compound that is converted into retinol in the intestine. The relatively low bioavailability of vitamin A from β-carotene in the juice drink needs further clarification, but may represent the need for additional fat in the meal for optimal absorption. Nevertheless, this study points to improved vitamin D and vitamin E status in young children following consumption of the micronutrient-fortified orange juice, which could help combat inadequate intakes of fat-soluble vitamins in children. Moreover, this study is also noteworthy because there are very few studies of micronutrient bioavailability from fortified juices in US children.