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Open AccessArticle

Exposure to Vitamin D Fortification Policy in Prenatal Life and the Risk of Childhood Asthma: Results from the D-Tect Study

Fanney Thorsteinsdottir, Research Unit for Dietary Studies, The Parker Institute, Bisbebjerg og Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, 2300 Copenhagen, Denmark
Department of Pharmacy, University of Copenhagen, 2100 Copenhagen, Denmark
Department of Respiratory Medicine, Bispebjerg University Hospital, 2400 Copenhagen, Denmark
The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, NSW 2006, Australia
The Department of Public Health, Section for General Practice, University of Copenhagen, 2100 Copenhagen, Denmark
Author to whom correspondence should be addressed.
Nutrients 2019, 11(4), 924;
Received: 4 March 2019 / Revised: 12 April 2019 / Accepted: 18 April 2019 / Published: 24 April 2019
(This article belongs to the Special Issue The Role of Pregnancy Nutrition in Maternal and Offspring Health)
Prenatal vitamin D insufficiency may be associated with an increased risk of developing childhood asthma. Results from epidemiological studies are conflicting and limited by short follow-up and small sample sizes. The objective of this study was to examine if children born to women exposed to the margarine fortification policy with a small dose of extra vitamin D during pregnancy had a reduced risk of developing asthma until age 9 years, compared to children born to unexposed women. The termination of a Danish mandatory vitamin D fortification policy constituted the basis for the study design. We compared the risk of inpatient asthma diagnoses in all Danish children born two years before (n = 106,347, exposed) and two years after (n = 115,900, unexposed) the termination of the policy. The children were followed in the register from 0–9 years of age. Data were analyzed using Cox proportional hazards regression. The Hazard Ratio for the first inpatient asthma admission among exposed versus unexposed children was 0.96 (95%CI: 0.90–1.04). When stratifying by sex and age, 0–3 years old boys exposed to vitamin D fortification showed a lower asthma risk compared to unexposed boys (HR 0.78, 95%CI: 0.67–0.92). Prenatal exposure to margarine fortification policy with extra vitamin D did not affect the overall risk of developing asthma among children aged 0–9 years but seemed to reduce the risk among 0–3 years old boys. Taking aside study design limitations, this could be explained by different sensitivity to vitamin D from different sex-related asthma phenotypes in children with early onset, and sex differences in lung development or immune responses. View Full-Text
Keywords: asthma; fortification; vitamin D; social experiment asthma; fortification; vitamin D; social experiment
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Thorsteinsdottir, F.; Maslova, E.; Jacobsen, R.; Frederiksen, P.; Keller, A.; Backer, V.; Heitmann, B.L. Exposure to Vitamin D Fortification Policy in Prenatal Life and the Risk of Childhood Asthma: Results from the D-Tect Study. Nutrients 2019, 11, 924.

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