Availability and Intake of Foods with Naturally Occurring or Added Vitamin D in a Setting of High Vitamin D Deficiency
Authors: Cooper Morgan , Shanta Shaila , Mahmud Abdullah , Roth Daniel , Gernand Alison 
Published: June 2021

Vitamin D deficiency is common during pregnancy in Bangladesh. We aimed to examine availability and intake of foods with naturally occurring or added vitamin D in pregnant women in an urban, low income setting. We examined baseline data from an ongoing, 5‐arm, randomized controlled trial of vitamin D supplementation enrolling pregnant women at 17 to 24 weeks gestation in in Dhaka, Bangladesh (n=319; “MDIG” Trial goal n=1300, ClinicalTrials.gov: NCT01924013). A focused, semi‐quantitative food frequency questionnaire was used to estimate dietary intake of foods containing vitamin D and potentially fortified with vitamin D in the past month. Further, local food markets were visited to document the availability of vitamin D fortified foods. Median (IQR) fish intake was 2.6 (1.3, 4.6) times per week, with only 5% of women reporting no fish intake (Table 1). Fresh milk was commonly consumed (21% drank once per day) but powdered milk was not (80% never consumed). In market analysis, the only locally available, packaged foods labeled as vitamin D fortified were powdered milk and ice cream. Fresh milk, cheese, yogurt, breakfast cereals, and crackers were not vitamin D fortified. Powdered milk was widely available; we identified 13 different powdered milk products (Table 2). All were vitamin D fortified, yet only 3 products indicated 100 IU or more per serving (approximate amount in one serving of milk in the US). Promoting use of powdered milk and fortifying fresh milk should be explored as practical ways to improve vitamin D intake in pregnant women in Bangladesh

Support

Gates Foundation (OPP1066764) and NIH BIRCWH award (K12HD055882).

Table 1. Prevalence of food intake in pregnant women for foods with naturally occurring or added vitamin D, Dhaka, Bangladesh, 2014 (n=319).

No. of pregnant women self‐reporting intake over past month

Never
&amp;lt; once per week
Once per week
2‐6 times per week
Once per day
&amp;gt; once per day

Food
n (%)

Milk, fresh1
60 (18.8)
83 (26.0)
19 (6.0)
88 (27.6)
68 (21.3)
1 (0.3)

Powdered milk1
254 (79.6)
19 (6.0)
10 (3.1)
15 (4.7)
17 (5.3)
4 (1.3)

Yogurt1
159 (49.8)
138 (43.3)
16 (5.0)
6 (1.9)
0 (0)
0 (0)

Ice cream
104 (32.6)
144 (45.1)
27 (8.5)
39 (12.2)
4 (1.3)
1 (0.3)

Cheese
293 (91.9)
23 (7.2)
2 (0.6)
1 (0.3)
0 (0)
0 (0)

Egg
29 (9.0)
61 (19.1)
36 (11.3)
128 (40.1)
62 (19.4)
3 (0.9)

Poultry
51 (16.0)
121 (37.9)
62 (19.4)
82 (25.7)
2 (0.6)
1 (0.3)

Beef/Mutton/Pork
56 (17.6)
122 (38.2)
57 (17.9)
81 (25.4)
3 (0.9)
0 (0)

Organ meats
183 (57.4)
114 (35.7)
13 (4.1)
7 (2.2)
2 (0.6)
0 (0)

Fish (fresh or dried)
17 (5.3)
45 (14.1)
76 (23.8)
133 (41.7)
25 (7.8)
23 (7.2)

1 Trace amount of vitamin D naturally occurring per the Food Composition Table for Bangladesh, 1st Edition, University of Dhaka, June 2013.

Table 2. Vitamin D content and cost of powdered milk products in Dhaka, Bangladesh, 2014.1

Milk Brand Name
Package Weight
Cost per 25 g serving1,2
Vitamin D content per 25 g serving
Cost per 100 IU vitamin D1

Horlicks3
200 g
0.33 USD
46 IU
0.70 USD

Complan Growth3
200 g
0.49 USD
38 IU
1.30 USD

Fresh
250 g
0.21 USD
200 IU
0.10 USD

NIDO Fortified3
350 g
0.28 USD
58 IU
0.48 USD

Mark's
400 g
0.26 USD
“enriched”
‐‐

Dano
400 g
0.24 USD
100 IU
0.25 USD

Anchor
400 g
0.23 USD
38 IU
0.61 USD

Junior Horlicks3
400 g
0.32 USD
42 IU
0.75 USD

Shape Up
400 g
0.28 USD
100 IU
0.29 USD

Women's Horlicks3
400 g
0.34 USD
28 IU
1.21 USD

Horlicks3
450 g
0.40 USD
46 IU
0.86 USD

Diploma
500 g
0.22 USD
50 IU
0.44 USD

Diploma
1000 g
0.22 USD
50 IU
0.44 USD

1 Conversion rate: 77.3 Taka (currency of Bangladesh) = 1 USD (US Dollar).

2 For comparison, fresh liquid milk (515 g package) was 16 Taka per serving and was not fortified with vitamin D.

3 Malted milk products.