**5.2 Vitamin D fortification history**

*Vitamin D Deficiency*

*4.3.3 Osteoporosis*

higher risk of fractures [4].

include the following [13]:

**4.4 Vitamin D deficiency prevention steps**

• Sustaining maintenance level.

East have levels beneath 10 ng/ml [19].

20 or 30 nmol/ml [15].

**5. Vitamin D fortification**

General Principles [20].

**5.1 Food fortification basic principles**

patient will have muscular weakness, bone tenderness, and pain and will be at

is essential for preventing and treating osteomalacia in elderly [7].

The decreased ability to produce vitamin D3 in elderly due to the decrease in 7-dehydrocholesterol in the skin results in osteomalacia also. Therefore, vitamin D

Osteoporosis is the result of inability to synthesize or get enough vitamin D from sunlight and food. This results in bone calcium loss and thus fractures [3]. It is due to multiple causes as aging, weakened vitamin D digestion, and decreased estrogen levels. It is widely seen in elderly, postmenopausal women, and those taking steroids [4].

Vitamin D deficiency can in fact be prevented by different methods. These can

• Expose body to sun or ultraviolet radiation for the needed time.

• Control serum phosphate in case of kidney disease.

**4.5 Vitamin D deficiency in Middle East and Lebanon**

regions as 57.86% were deficient using a cut-off of 20 ng/ml [15].

• Ingestion of 400–100 IU/day for kids and 800–1000 IU for grown-ups.

International Osteoporosis Foundation (IOF) study showed that almost all countries have 25(OH)D3 levels beneath 30 ng/ml, while South Asia and Middle

The most widely seen medical issue in Middle East and North Africa is vitamin D deficiency. This results in diseases and disorders and most widely osteomalacia. Results showed 50–90% 25(OH)D3 deficiency, and these patients have levels below

Results showed higher rates of vitamin D deficiency in Lebanon especially Beirut

Females are 3 times more prone to have hypovitaminosis D. An investigation on Lebanese grown-up population has demonstrated that hidden ladies had just about 3 times more incidence of extreme hypovitaminosis D than nonhidden subjects [15]. Results verified that females are at more risk to have vitamin D deficiency. Besides, hidden ladies are 3 times more at risk than nonhidden ladies [15].

Fortification is the process of supplementing food with needed nutrients for their health benefits and in order to prevent diseases as defined by the Codex

Fortification levels differ from one nation to another according to different factors. These factors include the dimension of enrichment, the bioavailability of

**84**

In order to prevent or defend rickets, humans usually used one teaspoon of cod liver oil daily (1 teaspoon has 10 μg = 400 IU of vitamin D). Vitamin D food fortification started in the 1940s in the US and other nations such as Britain. In the beginning, vitamin D was supplemented to milk and then to other foods and beverages. However, in the 1950s, events of hypercalcemia appeared, and an adjustment was done for fortifying foods with vitamin D. As a result of that, few side effects of hypercalcemia had been seen in newborn children in the former German Democratic Republic, where babies were enriched with discontinuous portions of 15 mg (600,000 IU) of vitamin D as a push to defend rickets. In these newborns, serum 25(OH)D levels increased to a few hundred nmol/L [17].
