Meeting

First draft statement on the guidance levels for the fortificants in the bread and flour regulations

TOX/2023/03

Last updated: 31 January 2023

This is a paper for discussion.

This does not represent the views of the Committee and should not be cited

Introduction

1.             In 2022, the Department for Environment, Food and Rural Affairs (Defra) held a consultation on the Bread and Flour Regulations (BFR) 1998 to increase the fortification level to allow harmonisation with EU retained Regulation (EU) No 1169/2011. Defra asked whether the consultees agreed with the proposal to raise the minimum levels of calcium carbonate, iron and niacin added to non-wholemeal flour to 15% of the nutrient reference values (NRV). The minimum amount of thiamin required to be present in non-wholemeal wheat flour would remain the same at 19% of the NRV. NRVs are established guidelines for the recommended daily energy and nutrient consumption.

2.             The Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT) have been asked by the Department of Health and Social Care (DHSC) to provide an assessment on the dietary exposure of calcium carbonate, iron, nicotinic acid and thiamin (Vitamin B1) at current and proposed fortification levels. The exposure assessment should provide a comparison to the UK Expert Group on Vitamins and Minerals (EVM) safe levels and upper levels (UL) and assess whether there is a potential risk to human health from the proposed increased fortification in non-wholemeal wheat flour.

3.             A paper (TOX/2022/48) was brought to the Committee in October. DHSC have requested that a statement be published with the conclusions of the Committee. Annex A contains the first draft statement for the consideration of the Committee.

Questions on which the views of the Committee are sought

Members are invited to consider the following questions:

i).       Do the Members have any comments on the structure and content of the first draft statement?

ii).       Do Members have any further comments?

 

Secretariat

February 2023

TOX/2023/03 Annex A

Background

1.             In 2022, the Department for Environment, Food and Rural Affairs (Defra) held a consultation on the Bread and Flour Regulations (BFRs) 1998 to increase the fortification level to allow harmonisation with EU retained Regulation (EU) No 1169/2011. Defra asked whether the consultees agreed with the proposal to raise the minimum levels of calcium carbonate, iron and niacin added to non-wholemeal flour to 15% of the nutrient reference values (NRV). The minimum amount of thiamin required to be present in non-wholemeal wheat flour would remain the same at 19% of the NRV. NRVs are established guidelines for the recommended daily energy and nutrient consumption.

2.             The Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT) have been asked by the Department of Health and Social Care (DHSC) to provide an assessment on the dietary exposure of calcium carbonate, iron, niacin (nicotinic acid) and thiamin (Vitamin B1) at current and proposed fortification levels. The exposure assessment should provide a comparison to the UK Expert Group on Vitamins and Minerals (EVM) safe levels and upper levels (UL) and assess whether there is a potential risk to human health from the proposed increased fortification in non-wholemeal wheat flour.

Introduction

3.             The BFR 1998 stipulates the levels of calcium carbonate, iron, thiamin (vitamin B1) and niacin (nicotinic acid) that are required to be present in all wheat flour other than wholemeal (i.e. non-wholemeal flour). Calcium is added in the form of calcium carbonate. Natural calcium found in food would not be present in the form of calcium carbonate. Therefore, exposure to calcium from fortified food can be distinguished from natural or supplementary sources when analysed. Niacin is added to flour using either nicotinic acid or nicotinamide.

4.             The existing BFRs (1998) set a minimum fortification level for thiamin (vitamin B1) of 0.24 mg for thiamin hydrochloride, which is equivalent to 0.21 mg of thiamin or 19% of the NRV. The minimum fortification levels of calcium, iron and niacin have been set at 15% of the nutrient reference value (NRV) as stated in Annex XIII of regulation EC No. 1169/2011 (in point 1 of Part A). In practise, foods are not currently fortified at these respective levels, but industry are looking to increase fortification to the set minimum levels. The Daily NRVs for calcium carbonate, iron, niacin and thiamin (Vitamin B1) are 800, 14, 16 and 1.1 mg, respectively.  

Toxicity

Calcium

5.             High intakes of calcium carbonate of around 4,000 mg/day (equivalent to 1,600 mg calcium) can result in a condition called milk-alkali syndrome in people with underlying medical conditions such as peptic ulcers (EFSA, 2006). This condition is characterised by hypercalcaemia, alkalosis and renal impairment, which is associated with symptoms of hypertension, neurological problems, abdominal pain and tissue calcification (EVM, 2003).

6.             Calcium supplements have been administered to people with colonic polyps or people who are at risk of colonic polyps. Gastrointestinal (GI) effects were reported in a small number of patients receiving 1,600 or 2,000 mg/day of calcium (EVM, 2003).  

7.             High calcium diets can affect the bioavailability of other minerals such as iron, zinc, magnesium and phosphorous by inhibiting the absorption of iron salts, haem-iron and zinc, reducing magnesium absorption and excretion, and the binding of calcium acetate and calcium carbonate to phosphate in the intestinal lumen (EFSA, 2006).

Iron

8.             Iron toxicity is particularly hazardous in children and most poisoning cases are reported in children consuming iron supplements intended for adults. Symptoms in infants include gastrointestinal irritation at acute doses of around 20 mg/kg bw and other systemic effects which occur at doses <60 mg/kg bw. The lethal dose in children is between 200-300 mg/kg bw (EVM, 2003).

9.            In adults, gastrointestinal effects such as constipation, nausea, vomiting and diarrhoea have been reported at therapeutic doses of 50-220 mg/day (EFSA, 2006). Iron toxicity can lead to inflammation and perforation of the gastrointestinal tract and iron disrupts the cellular metabolism in the central nervous system, liver and heart. Free iron in the serum, enters and concentrates in the mitochondria where it forms free radicals, which can impair energy metabolism and can eventually lead to cell death (Baranwal and Singhi, 2003; Yuen and Becker, 2022). However, iron poisoning in adults is rare, individual case reports suggest a lethal dose of 1,400 mg/kg bw (EVM, 2003).

Niacin (nicotinic acid/vitamin B3)

10.          Symptoms of acute toxicity from niacin include flushing, itchy skin, nausea, vomiting and gastrointestinal issues (such as diarrhoea and constipation). Long term intakes of 3,000 mg/day of niacin have been reported to cause jaundice, hyperglycaemia and abdominal pain. In addition to elevated serum bilirubin, increased alkaline phosphatase and aminotransferase levels have been reported in a small number of cases. Anorexia, ophthalmological effects, skin hyperpigmentation and precipitation of incipient psychosis have also been reported as side effects of niacin therapy (EVM, 2003).

11.          Patients with hypercholesterolaemia that have been treated with niacin at 3-9 g/day over a period of months to years showed symptoms of severe liver dysfunction which has the potential to be life threatening and may require liver transplantation (EFSA, 2006).

Thiamin

12.          Thiamin is considered to be of very low toxicity with symptoms such as headache, nausea, irritability, insomnia, rapid pulse and weakness being seen at high oral doses of ≥7,000 mg thiamin hydrochloride (EVM, 2003).

13.          However, a small number of case reports have shown association with adverse effects such as muscle tremors, rapid pulse and nerve hyperirritability at low daily doses of 17 mg/day of thiamin hydrochloride. In one case, a patient consuming thiamin at 100 mg/day for a period of 15 days, 2 months prior to consumption of a single oral dose of thiamin of 100 mg, experienced an anaphylactic reaction followed by death. In another case, a patient experienced exacerbated eczema after receiving an oral dose of 200 mg of thiamin in an experimental provocation (EVM, 2003).                                                                                                                                                       

14.          Tolerable upper levels (TUL) nor safe upper levels (UL) have been established for calcium, iron, niacin (nicotinic acid) and thiamin by the Expert Group on Vitamins and Minerals (EVM) due to the lack of insufficient animal and human data (EVM, 2003).

15.          However, the EVM stated that “1,500 mg/day of supplemental calcium would not be expected to result in any adverse effect, but that higher doses could result in adverse gastrointestinal symptoms in a few people” (EVM, 2003). Literature publicly available at the time of the COTs assessment (EVM, 2003) did not provide any new information or data indicating that any other level of calcium should be used as a safe UL. The Scientific Committee on Food (SCF) established a TUL of 2,500 mg/day for calcium in 2003 (SCF, 2003). This TUL was based on different long duration intervention studies in which total daily calcium intakes of 2,500 mg from both diet and supplements were tolerated without adverse effects and was endorsed by EFSA in 2012 (EFSA, 2012).

16.          The EVM proposed that a supplemental intake of 17 mg/day for iron would not be expected to produce adverse effects in the majority of individuals. However, this guidance value does not apply to individuals who have an increased susceptibility to iron overload, a condition which is associated with a homozygous haemochromatosis genotype (with an estimated prevalence of up to 0.4% in the Caucasian population). An UL for iron has not been established by EFSA. The National Institutes of Health Office of Dietary Supplements in the United States have advised safe ULs of 40 mg/day for individuals aged 0 months to 13 years and 45 mg/day for individuals aged 14 years and over (Institute of Medicine, 2001). However, moderate symptoms of iron toxicity have been reported from 20 mg/kg bw/day (Madiwale and Liebelt, 2006). However, Madiwale and Liebelt (2006) reported that ingestion <20 mg/kg is non-toxic and moderate symptoms of iron toxicity can occur between 20 to 60 mg/kg.

17.          The EVM proposed that a guidance level of 17 mg/day for niacin (nicotinic acid) would not be expected to result in any adverse effects. However, it was noted by the EVM that this guidance level is for supplementation only, as adverse effects from niacin seem to be related to acute, bolus intakes. Adverse effects from long term exposure of niacin in food would be less likely as free niacin levels in food are low. Additionally, the EVM noted that the guidance level is based on intakes of conventional formulations of niacin. This would not be applicable to sustained release preparations and niacin contained in dietary supplements is not in the sustained release form (EVM, 2003). In 2002, the SCF set an UL of 10 mg/day for niacin based on flushing of skin (EFSA, 2014).

18.          The EVM proposed a guidance level for supplemental thiamin of 100 mg/day which would not be expected to result in adverse effects. The EVM noted however that this guidance level was only applicable to the water-soluble forms of thamin. Furthermore, the study by Gokhale et al. (1999), used to derive the guidance level, was conducted in young women (EVM, 2003). An UL for thiamin was not established by the SCF due to limited data on adverse effects in humans and lack of dose-response studies (EFSA, 2016). Whilst there is a lack of evidence of toxicity from a high intake of thamin from food or supplements (Martel et al., 2021), symptoms such as headache, nausea, irritability, insomnia, rapid pulse and weakness have been seen at high oral doses of ≥7,000 mg/day thiamin hydrochloride (EVM, 2003).

Exposure assessment

19.          Exposures to calcium, iron, niacin and thiamin were determined using consumption data from the Diet and Nutrition Survey of Infants and Young Children (DNSIYC) and the National Diet and Nutrition Survey (NDNS). Levels of these nutrients in the entire diet were obtained from the nutrient databank (Bates et al., 2014, 2016, 2020; Roberts et al., 2018). Levels of nutrients in non-wholemeal flour used in the exposure assessment were those currently in use by industry. Exposure to the nutrients based on the proposed increases were also determined, except for thiamin, where no increases have been proposed. Table 2 provides information about current and proposed fortification levels for each nutrient where applicable. Exposure to these nutrients were calculated in Crème Global, the software that the FSA uses to interrogate dietary data and calculate exposure. Exposure estimates were derived by multiplying food consumption amounts by the levels of the nutrients in the foods. Chronic exposure or intake of these nutrients are presented. Chronic intake is derived from the average amount of flour consumed over the survey days multiplied by the levels of nutrients. Chronic exposure or intake is calculated for each consumer. The mean and P97.5 are then computed.

 Table 1. Concentration data used to derive exposure to calcium, iron, niacin and thiamin.

Nutrient

 

 

Nutrient reference value (mg/person/day)

Current minimum levels (mg/100 g non-wholemeal flour)

Level based on fortification at 15% (mg/100 g non-wholemeal flour)

Calcium

800

94

120

Iron

14

1.65

2.1

Niacin

16

1.6

2.4

Thiamin

1.1

0.24

NA*

* A change in fortification level has not been proposed.

Methodology for estimating current and proposed exposures from non-wholemeal flour

20.          Exposures based on current and proposed levels were calculated from foods containing non-wholemeal flour. This by definition is wheat flour without whole grain wheat. The recipe database associated with the NDNS food groupings identified foods containing non-wholemeal flour (n=1835). A selection of food groups (foods with non-wholemeal flour), each containing more than 20 foods are shown in Table A1 in Annex A.

21.          The fortification level for thiamin remains unchanged, therefore exposures at the proposed fortification levels were only calculated for calcium, iron, and niacin.

22.          Exposures to these nutrients from supplements were also considered. Data for supplements were obtained from market sources (e.g., websites of major retailers). Concentrations of calcium supplements ranged from 200-1200 mg for adults and 80-450 mg for children. Whereas concentrations of iron supplements ranged from 14-28 mg in adults and 2.8-7.5 mg in children. Concentrations of niacin supplements ranged from 50-1000 mg in adults and 4.8-20 mg in children. Ultimately, concentrations of thiamin supplements ranged from 100-500 mg for adults and 0.7-5 mg for children.    

Exposures from the entire diet and from flour at the current and proposed fortification levels

23.          Exposure to the nutrients from the entire diet was estimated using all food groups from NDNS years 1-11, which are presented in Table A2 of Annex B. All food groups including the foods containing non-wholemeal flour are detailed in paragraph 20. The levels of the nutrient for each of the foods included were derived from the nutrient databank from the NDNS.

24.         Exposure to calcium, iron, niacin and thiamin from the entire diet and from flour fortification at current and proposed levels are shown in Table 2-5.

25.          For calcium, across all age groups (4 months to 65+ years), the maximum mean and maximum 97.5th percentile exposures at the current level of fortification were 68 and 140 mg/person/day, respectively. The maximum mean and 97.5th percentile exposures at the proposed level of fortification are 87 and 180 mg/person/day, respectively. The maximum exposures to calcium from the entire diet are 820 and 1,600 mg/person/day at mean and 97.5 the percentile levels respectively (Table 3).

26.          For iron, across all age groups (4 months to 65+ years), the maximum mean and maximum 97.5th percentile exposures at the current level of fortification are 1.2 and 2.5 mg/person/day respectively. The maximum mean and 97.5th percentile exposures at the proposed level of fortification are 1.5 and 3.2 mg/person/day respectively. The maximum exposures to iron from the entire diet are 10 and 19 mg/person/day at mean and 97.5th percentile levels respectively (Table 4).

27.          For nicacin, across all age groups (4 months to 65+ years), the maximum mean and maximum 97.5th percentile exposures at the current level of fortification are 1.2 and 2.4 mg/person/day respectively. The maximum mean and 97.5th percentile exposures at the proposed level of fortification are 1.7 and 3.6 mg/person/day respectively. The maximum exposure to niacin from the entire diet are 36 and 68 at the mean and 97.5th percentile, respectively (Table 5).

28.          For thiamin, across all age groups (4 months to 65+ years), the maximum mean and maximum 97.5th percentile exposures at the current level of fortification are 0.17 and 0.36 mg/person/day. The maximum exposure to thiamin from the entire diet are 1.5 and 2.8 mg/person/day at the mean and 97.5th percentile, respectively (Table 6).

Table 2. Chronic exposures to calcium from the diet and from flour fortification at current and proposed levels (15% of the nutrient reference value supplied by 100 g flour) levels.

  Age group

Category

Chronic exposure to calcium (mg/person/day)

Mean

97.5th Percentile

Infants (4-18 months)

Entire diet

680

1200

Current

Levels in flour

15

48

Proposed

Levels in flour

19

61

1.5-3 years

Entire diet

740

1300

Current

Levels in flour

34

78

Proposed

Levels in flour

43

99

4 - 10 years

Entire diet

760

1400

Current

Levels in flour

55

110

Proposed

Levels in flour

71

140

11 – 18 years

 

Entire diet

770

1500

Current

Levels in flour

68

140

Proposed

Levels in flour

87

180

19 – 64 years

Entire diet

810

1600

Current

Levels in flour

58

140

Proposed

Levels in flour

74

180

65 + years

Entire diet

820

1500

Current

Levels in flour in flour

49

120

Proposed

Levels

62

150

Table 3. Chronic exposures to iron from the diet and from flour fortification at current and proposed (15% of the nutrient reference value supplied by 100 g flour) levels.

  Age group

Category

Chronic exposure to iron (mg/person/day)*  Mean

 

97.5th Percentile

Infants (4-18 months)

Entire diet

6.8

12

Current

Levels in flour

0.27

0.84

Proposed

Levels in flour

0.34

1.1

1.5-3years

Entire diet

6

10

Current

Levels in flour

0.6

1.4

Proposed

Levels in flour

0.76

1.7

4 - 10 years

Entire diet

8.1

14

Current

Levels in flour

0.97

1.9

Proposed

Levels in flour

1.2

2.4

11 – 18 years

Entire diet

9.3

17

Current

Levels in flour

1.2

2.5

Proposed

Levels in flour

1.5

3.2

19 - 64 years

Entire diet

10

19

Current

Levels in flour

1

2.4

Proposed

Levels in flour

1.3

3.1

65 + years

Entire diet

9.7

17

Current

Levels in flour

0.85

2.1

Proposed

Levels in flour

1.1

2.6

Table 4. Chronic exposures to niacin equivalents from the diet and from flour fortification at current and proposed (15% of the nutrient reference value supplied by 100 g flour) levels.

Age group

Category

Chronic exposures to niacin   (mg/person/day)*
Mean

97.5th Percentile

Infants (4-18 months)

Entire diet

14

25

Current

Levels in flour

0.26

0.81

Proposed

Levels in flour

0.39

1.2

1.5-3years

Entire diet

18

28

Current

Levels in flour

0.58

1.3

Proposed

Levels  in flour

0.87

2

4 - 10 years

Entire diet

25

39

Current

Levels in flour

0.94

1.9

Proposed

Levels  in flour

1.4

2.8

11 -  18years

Entire diet

31

55

Current

Levels in flour

1.2

2.4

Proposed

Levels  in flour

1.7

3.6

19 - 64 years

Entire diet

36

68

Current

Levels in flour

0.98

2.4

Proposed

Levels  in flour

1.5

3.6

65 + years

Entire diet

31

52

Current

Levels in flour

0.83

2

Proposed

Levels in flour

1.2

3

Table 5: Chronic exposures to thiamin in the diet and from flour fortification at current (19% of the nutrient reference value supplied by 100g flour; there is no proposed increase to thiamin) levels.

Age group 

Category

Chronic intake of thiamine

(mg/person/day)*

Mean

97.5th Percentile

Infants (4-18 months)

Entire diet

0.81

1.3

Current

Levels in flour

0.039

0.12

1.5-3years

Entire diet

1

1.8

Current

Levels in flour

0.087

0.2

4 - 10 years

Entire diet

1.3

2.3

Current

Levels in flour

0.14

0.28

11 -  18years

Entire diet

1.4

2.8

Current

Levels in flour

0.17

0.36

19 - 64 years

Entire diet

1.5

2.8

Current

Levels in flour

0.15

0.36

65 + years

Entire diet

1.5

2.7

Current

Levels in flour

0.12

0.3

* Rounded to 2.s.f.

Exposure from supplements

29.          It should be noted that supplements data were derived from various online sources in Tables A5-A8 in Annex A. The exact consumption by the population was unknown therefore exposures were calculated based on recommended serving sizes.

30.          Across all age groups (4 months to 65+ years) the upper exposures of supplemental calcium were up to 1,200 mg/day. In adults aged over 19 years, this exposure is equivalent to 1.48- and 0.75-fold the mean and 97.5th percentile calcium exposures from the entire diet (which includes all food groups including non-wholemeal flour), respectively.   

31.          Across all age groups (4 months to 65+ years) the upper exposures of supplemental iron were up to 28 mg/day. In adults aged over 19 years, this exposure is equivalent to 3- and 1.6-fold the mean and 97.5th percentile calcium exposures from the entire diet, respectively.

32.          Across all age groups (4 months to 65+ years) the upper exposures of supplemental niacin were up to 1,000 mg/day. In adults aged over 19 years this exposure is equivalent of up to 32- and 19-fold of the mean and 97.5th percentile niacin exposures from the entire diet, respectively.

33.          Across all age groups (4 months to 65+ years) the upper exposures of supplemental thiamin were up to 500 mg/day. In adults aged over 19 years, this exposure is equivalent to 330- and 185-fold the mean and 97.5th percentile thamin exposures from the entire diet.

Risk characterisation

Exposures from food

34.          Chronic exposure of calcium at the current and proposed fortification levels (Table 3) did not exceed the guidance levels of 1,500 mg/day (EVM, 2003) and 2,500 mg/day (EFSA, 2012) across all age groups. Exposures from the entire diet were up to 1,600 mg/person day which although it exceeds the EVM guidance level, marginally, is below the SCF TUL of 2,500 mg/day.

35.          Chronic exposures to iron at the current and proposed fortification levels (Table 4) did not exceed the guidance levels of 17 mg/day (EVM, 2003) across all ages. However, it is important to note that the guidance level is based on supplemental intake and does not apply to the population who have an increased susceptibility to iron overload. Moderate symptoms of iron toxicity have been reported to occur from 20 mg/kg bw per day (Madiwale and Liebelt, 2006). Exposures from the entire diet were up to 19 mg/person/day, which would result in marginal exceedance of the EVM guidance level but not the level reported to cause moderate symptoms of iron toxicity. It is not anticipated that there would be a risk to health from iron exposures in the entire diet to most of the population. However, the EVM guidance value does not apply to individuals who have an increased susceptibility to iron overload, a condition which is associated with a homozygous haemochromatosis genotype.

36.          Chronic exposures to niacin equivalents (Table 5) at the current and proposed fortification levels did not exceed the guidance level for niacin of 17 mg/day (EVM, 2003) across all age groups. Exposures to niacin from the entire diet were up to 68 mg/person/day, which exceeds the EVM guidance level up to 4-fold. However, the EVM guidance level is for supplementation only, as adverse effects from niacin seem to be related to acute, bolus intakes. Adverse effects from long term exposure to niacin in food would be less likely as free niacin levels in food are low. It is unlikely that there would be a risk of adverse health effects at these exposures although there is some uncertainty because of the data used to establish the EVM guidance level: that it is intended for supplements, is based on a bolus intake and that the levels of free niacin in food are low.

37.          Chronic exposures to thiamin at the current and proposed fortification levels (Table 6) did not exceed the current guidance level of 100 mg/day (EVM, 2003). Exposures to thiamin from the entire diet were up to 2.8 mg/person/day which were also below the EVM guidance level and it is unlikely that there would be a risk of adverse health effects.

Exposure from supplements

38.          Daily exposure to calcium supplements did not exceed the EVM guidance level of 1,500 mg/day (EVM, 2003) or the SCF guidance level of 2,500 mg/day in adults and children (SCF, 2003). Exposure to higher dosage iron supplements (i.e., 28 mg/day) can exceed the guidance level of 17 mg/day (EVM, 2003) by up to 1.6-fold in adults. Daily exposure to niacin supplements could result in exceedances of the guidance level of 17 mg/day (EVM, 2003), by between 3- and 60-fold. For thiamin supplements, daily exposure could lead to up to a 5-fold exceedance of the guidance level of 100 mg/day (EVM, 2003).

Exposure from supplements and food

39.          Mean calcium exposures from food (the entire diet and flour at the current and proposed fortification levels) and supplements (Table A3) were up to 2,000 mg/person/day, respectively and below either the EVM guidance level and/or the SCF TUL. Exposures associated with 97.5th percentile consumption were between 1,700 and 2,800 mg/person/day. For population groups below 19 years of age, the exposures are below the SCF TUL and it is unlikely that there would be a risk of adverse health effects. Population groups for 19 years and over marginally exceeded the SCF TUL and it is unlikely that there would be a risk of adverse health effects in humans at these exposures.  

40.          Mean and 97.5th percentile iron exposures from food and supplements were up to 20 mg/person/day which were either below or a minor exceedance of the guidance level of 17 mg/day (EVM, 2003) in those aged upto 18 years. There is unlikely to be a risk of adverse health effects in these populations due to exposures from iron. However, in the 19-64 and 65+ years age groups, mean and 97.5th percentile iron exposures were up to 38 and 47 mg/person/day which were exceedances of up to 2.2-fold and 2.8-fold, respectively.  It is unlikely that there is a risk of adverse health effects. The EVM guidance value does not apply to individuals who have an increased susceptibility to iron overload, a condition which is associated with a homozygous haemochromatosis genotype.

41.          Mean and 97.5th percentile niacin exposure from food (entire diet) and supplements exceeded the guidance level of 17 mg/day (EVM, 2003) across all age groups. In those aged up to 18 years exceedances of the 17 mg/day guidance level were up to 3- and 4.4-fold for mean and 97.5th percentile consumption, respectively. In individuals aged up to 3 years the exceedances were approximately half of these (up to 2.2- and .8-fold for mean and 97.5th percentile consumers, respectively). In those aged over 19 years the exceedances of the 17 mg/day guidance level were up to 59- and 65-fold for mean and 97.5th percentile consumers, respectively. Most of this exceedance comes from the consumption of supplements containing niacin at 1,000 mg.

42.          As indicated in paragraph 36, the EVM guidance level is for supplementation only, as adverse effects from niacin seem to be related to acute, bolus intakes. Adverse effects from long term exposure to niacin in food would be less likely as free niacin levels in food are low. It is unlikely that there would be a risk of adverse health effects at the exposures from the entire diet, although there is some uncertainty because of the data used to establish the EVM guidance level. It is intended for supplements and is more considered for a bolus intake. It should also be noted that the levels of free niacin in food are low. Exposures from consumption of supplements containing high levels of niacin e.g. 1,000 mg could be at increased risk of adverse health effects, especially when consumed consistently over a prolonged period of time.

43.          Exposures to thiamin for all age groups below 18 years of age are below the guidance level of 100 mg/day (EVM, 2003). Mean and 97.5th percentile intakes from food and supplements only exceeded the guidance level for thiamin of 100 mg/day (EVM, 2003) in the 19-64 years and 65+ years age groups. In these age groups both exceeded the guidance level by 5-fold. This was predominantly from consumption of supplements which may contain up to 500 mg.  It is unlikely that these exposures would cause adverse health effects.

Conclusion

44.          Chronic exposures of calcium, iron, niacin and thamin from non-wholemeal flour at the current and proposed fortification levels did not exceed the guidance level. For each of the nutrients, the difference in exposure between current and proposed levels of fortification is very small, especially when compared to exposures form the entire diet and from supplements. Therefore, the change to the proposed levels of fortification would not increase the risk to adverse health effects when taken in consideration of the entire diet and consumption of supplements.

45.          Intakes of calcium from supplements alone did not exceed the guidance level. Consumption of higher dosage iron, niacin and thamin supplements may result in exceedances of the guidance level. However, it is important to note that not all members of the population will consume supplements.

46.          Calcium exposure from food and supplements only exceeded the guidance level EFSA TUL of 2,500 mg/day marginally and only in 97.5th percentile consumers in those aged over 19 years. There is unlikely to be a risk of adverse health effects based on these exposures.

47.          Iron exposures from food and supplements exceeded the guidance levels in some age groups, up to a maximum of 2.8-fold the 17 mg/day guidance level. There is unlikely to be a risk of adverse health effects based on these exposures. However, the EVM guidance value does not apply to individuals who have an increased susceptibility to iron overload, a condition which is associated with a homozygous haemochromatosis genotype.

48.          In those aged up to 18 years niacin exceedances of the 17 mg/day guidance level (EVM, 2003) were up to 3- and 4.4-fold for mean and 97.5th percentile consumption, respectively. In those aged over 19 years the exceedances of the 17 mg/day guidance level were up to 59- and 65-fold for mean and 97.5th percentile consumers, respectively. Most of this exceedance comes from the consumption of supplements containing niacin at 1,000 mg. Adverse effects from long term exposure to niacin in food would be less likely as free niacin levels in food are low. However, there is some uncertainty because of the data used to establish the EVM guidance level. It is intended for supplements and is more considered for a bolus intake. Exposures from consumption of supplements containing high levels of niacin e.g. 1,000 mg could lead to increased risk of adverse health effects, especially when consumed consistently over a prolonged period of time.

49.          Exposures to thiamin for all age groups below 18 years of age are below the guidance level of 100 mg/day (EVM, 2003). Mean and 97.5th percentile intakes from food and supplements only exceeded the guidance level for thiamin in consumers aged over 19, by a maximum of upto 5-fold. This was predominantly from consumption of supplements which may contain up to 500 mg. It is unlikely that these exposures would cause adverse health effects.

50.          The NHS states that “most people do not need to take vitamin supplements and can get all the vitamins and minerals they need by eating a healthy, balanced diet”.

51.          While the Committee noted that there would be a possible exceedance in individuals that consume supplements, the COT overall concluded that an increase in the minimum fortification level of calcium, iron and niacin to 15% of the NRV would not result in any additional risk when compared to current fortification levels.

Secretariat

February 2023

List of Abbreviations and Technical Terms

BFR

Bread and Flour Regulations

COT

Committee on Toxicity Chemicals in Food, Consumer Products and the Environment

DHSC

Department of Health and Social Care

SCF

Scientific Committee on Food

TUL

Tolerable Upper Level

NRV

Nutrient reference Value

References

Bates B, Lennox A, Prentice A, Bates C, Page P, Nicholson S, Swan G (2014). National Diet and Nutrition Survey Results from Years 1, 2, 3 and 4 (combined) of the Rolling Programme (2008/2009 – 2011/2012): Main heading (publishing.service.gov.uk).

Bates, B.; Cox, L.; Nicholson, S.; Page, P.; Prentice, A.; Steer, T.; Swan, G. (2016) National Diet and Nutrition Survey Results from Years 5 and 6 (combined) of the Rolling Programme (2012/2013 – 2013/2014): Main heading (publishing.service.gov.uk).

Bates, B.; Collins, D.; Jones, K.; Page, P.; Roberts, C.; Steer, T.; Swan, G.(2020) National Diet and Nutrition Survey Results from years 9, 10 and 11 (combined) of the Rolling Programme (2016/2017 to 2018/2019) Available at: National Diet and Nutrition Survey (publishing.service.gov.uk).

Baranwal, A.K. and Singhi, S.C. (2003) ‘Acute iron poisoning: management guidelines’, Indian Pediatrics, 40(6), pp. 534–540.

DH (2013). Diet and Nutrition Survey of Infants and Young Children (DNSIYC), 2011. Available at: Diet and nutrition survey of infants and young children, 2011 - GOV.UK (www.gov.uk).

EFSA (2006). Tolerable Upper Intake Levels for Vitamins and Minerals. Scientific Committee on Food: complet_chapitres.indd (europa.eu).

EFSA (2012). Scientific opinion on the tolerable upper intake level of calcium. EFSA Journal, 10(7), p.2814: Scientific Opinion on the Tolerable Upper Intake Level of calcium (wiley.com).

EFSA (2014). Scientific opinion on dietary reference values for niacin. EFSA Journal 2014;12(7):3759: Scientific Opinion on Dietary Reference Values for niacin (wiley.com).

EFSA (2016). Dietary reference values for thiamin. EFSA Journal, 14(12), p.e04653: Dietary reference values for thiamin (wiley.com).

Expert Group on Vitamins and Minerals (2003). Safe Upper Levels for  Vitamins and Minerals. vitmin2003.pdf (food.gov.uk)

Gokhale, LB (1996). Curative treatment of primary (spasmodic) dysmenorrhea. Indian Journal of Medical Research 103, 227-231.

Institute of Medicine: Food and Nutrition Board. (2001) Dietary Reference intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc: a Report of the Panel on Micronutrients.

Madiwale, T. and Liebelt, E. (2006). Iron: not a benign therapeutic drug. Current opinion in pediatrics, 18(2), pp.174-179.

Martel, J.L., Kerndt, C.C., Doshi, H. and Franklin, D.S.(2021). Vitamin B1 (thiamine). In StatPearls [Internet]. StatPearls Publishing.

Roberts, C.; Steer, T.; Maplethorpe, N.; Cox, L.; Meadows, S.; Page, P.; Nicholson, S.; Swan, G. (2018) National Diet and Nutrition Survey Results from Years 7 and 8 (combined) of the Rolling Programme (2014/2015 – 2015/2016) Available at: NDNS: results from years 7 and 8 (combined) - GOV.UK (www.gov.uk).

Scientific Committee on Food (2003). SCF (Scientific Committee on Food), 2003. Opinion on the Tolerable Upper Intake Level of Calcium. CF/CS/NUT/UPPLEV/64 Final, 39 pp.

Yuen, H.-W. and Becker, W. (2022) ‘Iron Toxicity’, in StatPearls. Treasure Island (FL): StatPearls Publishing. Available at: Iron Toxicity - StatPearls - NCBI Bookshelf (nih.gov) (Accessed: 30 August 2022).

Secretariat

February 2023

TOX/2023/03 Annex A

Table A1: A selection of food groups containing foods with non-wholemeal flour.

Food group

Number of foods assessed in the group

Biscuits (manufactured/retail)

105

Brown, granary and wheatgerm bread

25

Buns cakes and pastries (homemade)

118

Buns cakes and pastries (manufactured)

103

Burgers and kebabs purchased

24

Fruit pies (homemade)

20

Manufactured coated chicken/turkey products

34

Meat pies and pastries (homemade)

39

Meat pies and pastries (manufactured)

38

Other breakfast cereals (not high fibre)

24

Other cereal based puddings (homemade)

40

Other cereals

41

Other manufactured vegetable products (including ready meals)

21

Other sausages (including homemade dishes)

30

Pasta (manufactured products and ready meals)

26

Savoury sauces pickles gravies & condiments

31

White bread (not high fibre, not multiseed bread)

56

White fish coated or fried

112

Table A2: All food groups from the NDNS used to estimate the intake of nutrients from the entire diet.

Food group

Number of foods assessed in the group

1% Milk (60R)

5

Alcoholic soft drinks (Alcopops) (49E)

4

 Apples and pears not canned (40A)

27

Artificial sweeteners (55R)

11

Baked beans (37C)

8

Bananas (40C) 

5

Beans and pulses (including ready meal & homemade dishes) (37I) 

72

Beers and lagers (49A) 

29

Beverages dry weight (50A)

44

Biscuits (homemade) (7B) 

15

Biscuits (manufactured/retail) (7A)

153

Block margarine (20A)  

2

Bottled water still or carbonated (51D)

11

Brown, granary and wheatgerm bread (59R)

42

Buns cakes and pastries (homemade) (8E)

132

Buns cakes and pastries (manufactured) (8D)

113

Burgers and kebabs purchased (29R)

31

Butter (17R)

6

Calcium only or with vitamin D (54F)

17

Canned fruit in juice (40D)

24

Canned fruit in syrup (40E)  

41

Carrots (raw) (36A)

4

Carrots not raw (37E)

11

Cereal based milk puddings (homemade) (9D)

26

Cereal based milk puddings (manufactured) (9C)

40

Cheddar cheese (14B)

9

Chips purchased including takeaway (38A)

42

Chocolate confectionery (44R)

53

Cider and perry (49C)  

7

Citrus fruit not canned (40B)

12

Cod liver oil and other fish oils (54A)

1

Cod liver oil and other fish oils (including with vitamins A,D,E) (54N)

47

Coffee (made up weight) (51A)

25

Commercial toddlers drinks (52A)

9

Commercial toddlers foods (52R)

131

Cottage cheese (14A)

5

Cream (including imitation cream) (13B)

41

Crisps and savoury snacks (42R)

43

Dairy desserts (homemade) (15D)

11

Evening primrose oil and other plant oils (54B)  

18

Folic acid (54D)

2

Fortified wine (48B)

10

Fromage frais and other dairy desserts (manufactured) (15C)

51

Fruit juice (45R)

45

Fruit pies (homemade) (8C)

24

Fruit pies (manufactured) (8B)

7

Green beans not raw (37B)  

8

Herbal tea (made up) (51C)  

3

High fibre breakfast cereals (5R)

128

Ice cream (53R)

40

Infant formula (13A)

82

Iron only or with vitamin C (54E)   

11

Leafy green vegetables not raw (37D)

28

Liqueurs (47A)

9

Liver and dishes (28R)

36

Low alcohol & alcohol free beer & lager (49B)

9

Low alcohol & alcohol free cider & perry (49D)

3

Low alcohol and alcohol free wine (48C)

4

Low fat spread not polyunsaturated (19R)

7

Manufactured beef products (including ready meals) (23A)

49

Manufactured canned tuna products (including ready meals) (34G)

8

Manufactured chicken products (including ready meals) (27A) - 79 foods.  

79

Manufactured coated chicken/turkey products (26A)

34

Manufactured egg products including ready meals (16C)

18

Manufactured lamb products (including ready meals) (24A)

11

Manufactured oily fish products (including ready meals) (35A)

45

Manufactured pork products (including ready meals) (25A)

9

Manufactured shellfish products (including ready meals) (34E)

17

Manufactured white fish products (including ready meals) (34C)

8

Meat alternatives (including ready meals and homemade dishes) (37K)

41

Meat pies and pastries (homemade) (31B)

39

Meat pies and pastries (manufactured) (31A)

38

Minerals (two or more including multiminerals) no vitamins (54H)

4

Multivitamins and/or minerals with omega (54P)

30

Non-nutrient supplements (including herbal) (54J)

46

Nutrition powders and drinks (50E)

62

Nuts and seeds (56R)

53

Other bacon and ham (including homemade dishes) (22B)

66

Other beef & veal (including homemade recipe dishes) (23B)

135

Other bread (4R)

17

Other breakfast cereals (not high fibre) (6R)

70

Other canned tuna (including homemade dishes) (34H)

7

Other cereal based puddings (homemade) (9H)

58

Other cereal based puddings (manufactured) (9G)

23

Other cereals (1R)

106

Other cheese (14R)

80

Other chicken/turkey (including homemade recipe dishes) (27B)

146

Other cooking fats and oils not polyunsaturated (20C

28

Other eggs and egg dishes including homemade (16D) -   

98

Other fried/roast potatoes (including homemade dishes) (38D) -

55

Other fruit not canned (40R)

193

Other lamb (including homemade recipe dishes) (24B)

80

Other manufactured potato products fried/baked (38C)

20

Other manufactured vegetable products (including ready meals) (37L)

49

ther meat (including homemade recipe dishes) (32B)

66

Other meat products (manufactured including ready meals) (32A)

34

Other milk (13R)

72

Other nutrient supplements (54K)

55

Other oily fish (including homemade dishes) (35B) - 71 foods.  

71

Other pork (including homemade recipe dishes) (25B)

69

Other potato products and dishes (manufactured) (39A)

20

Other potatoes (including homemade dishes) (39B)

50

Other sausages (including homemade dishes) (30B)

46

Other shellfish (including homemade dishes) (34F)

45

Other vegetables (including homemade dishes) (37M)

217

Other white fish (including homemade dishes) (34D)

83

Pasta (manufactured products and ready meals) (1D)

39

Pasta (other, including homemade dishes) (1E)

36

Peas not raw (37A)

20

Pizza (1C)

12

lyunsaturated low fat spread (19A)

10

Polyunsaturated margarine (18A)

1

Polyunsaturated oils (18B)

7

Preserves (41B)

22

Ready meals based on sausages (30A)

2

Ready meals/meal centres based on bacon and ham (22A)

3

Reduced fat spread (not polyunsaturated) (21B)

16

Reduced fat spread (polyunsaturated) (21A)

9

Rice (manufactured products and ready meals) (1F)

9

ice (other, including homemade dishes) (1G)

53

Salad and other raw vegetables (36B)

93

Savoury sauces pickles gravies & condiments (50R)

203

Semi-skimmed milk (11R)

9

Single vitamins/minerals not Folic acid, iron, calcium or vitamin C (54M)

61

Skimmed milk (12R)

11

Smoothies (61R)

10

Soft drinks low calorie carbonated (58B)

24

Soft drinks low calorie concentrated (58A)

13

Soft drinks low calorie, ready to drink, still (58C)

26

Soft drinks not low calorie carbonated (57B)

39

Soft drinks not low calorie concentrated (57A)

23

Soft drinks not low calorie, ready to drink, still (57C)

43

Soft margarine not polyunsaturated (20B)

3

Soup (homemade) (50D)

39

Soup (manufactured/retail) (50C)

48

Spirits (47B)

1

Sponge puddings (homemade) (9F)

10

Sponge puddings (manufactured) (9E)

9

Sugar (41A)

15

Sugar confectionery (43R) 

54

Sweet spreads fillings and icing (41R)

23

Tap water only (51R) -

2

Tea (made up) (51B) -

9

Tomatoes not raw (37F

14

Tomatoes raw (36C)

3

White bread (not high fibre, not multiseed bread) (2R)

58

White fish coated or fried (33R)

139

Whole milk (10R)

11

Wholemeal bread (3R) 

31

Wine (48A)

16

Yogurt (15B)

82

Table A3: Calcium exposure from foods and supplements.

Age group

Category

Chronic exposure of calcium from food (mg/person/day)*

Mean

97.5th Percentile

Calcium exposure from supplements, upper range (mg/person/day)

Calcium exposure from supplements and diet (mean)

(mg/person/day)

Calcium exposure from supplements and diet (97.5th percentile)

(mg/person/day)

Infants (4-18 months)

Entire diet

680

1200

450

1100

1700

Current

Levels in flour

15

48

450

470

500

Proposed

Levels in flour

19

61

450

470

500

1.5-3years

Entire diet

740

1300

450

1200

1800

Current

Levels in flour

34

78

450

490

530

Proposed

Levels in flour

43

99

450

490

550

4 - 10 years

Entire diet

760

1400

450

1200

1900

Current

Levels in flour

55

110

450

510

560

Proposed

Levels in flour

71

140

450

520

590

11 -  18years

Entire diet

770

1500

450

1200

2000

Current

Levels in flour

68

140

450

520

590

Proposed

Levels in flour

87

180

450

540

630

19 - 64 years

Entire diet

810

1600

1200

2000

2800

Current

Levels in flour

58

140

1200

1300

1300

Proposed

Levels in flour

74

180

1200

1300

1400

65 + years

Entire diet

820

1500

1200

2000

2700

Current

Levels in flour

49

120

1200

1200

1300

Proposed

Levels in flour

62

150

1200

1300

1400

Table A4: Iron exposure from food and supplements.

  Age group

Category

Chronic exposure to iron (mg/person/day)*

Mean

97.5th Percentile

Iron exposure from supplements, upper range (mg/person/day)

Iron exposure from supplements and diet (mean)

(mg/person/day)

Iron exposure from supplements and diet (97.5th percentile)

(mg/person/day)

Infants (4-18 months)

Entire diet

6.8

12

7.5

14.0

20

Current

Levels in flour

0.27

0.84

7.5

7.8

8.3

Proposed

Levels  in flour

0.34

1.1

7.5

7.8

8.6

1.5-3years

Entire diet

6

10

7.5

14

18

Current

Levels in flour

0.6

1.4

7.5

8.1

8.9

Proposed

Levels

0.76

1.7

7.5

8.3

9.2

4 - 10 years

Entire diet

8.1

14

7.5

16

22

Current

Levels in flour

0.97

1.9

7.5

8.5

9.4

Proposed

Levels  in flour

1.2

2.4

7.5

8.7

9.9

11 -  18years

Entire diet

9.3

17

7.5

17

25

Current

Levels in flour

1.2

2.5

7.5

8.7

10

Proposed

Levels  in flour

1.5

3.2

7.5

9

11

19 - 64 years

Entire diet

10

19

28

38

47

Current

Levels in flour

1

2.4

28

29

30

Proposed

Levels  in flour

1.3

3.1

28

29

31

65 + years

Entire diet

9.7

17

28

38

45

Current

Levels in flour

0.85

2.1

28

29

30

Proposed

Levels  in flour

1.1

2.6

28

29

31

Table A5: Exposure to niacin from food and supplements.

Age Group 

Category

Chronic exposure to niacin

(mg/person/day)*

Mean

97.5th Percentile

Niacin exposure from supplements, upper range (mg/person/dy)

Niacin exposure from supplements and diet (mean)

(mg/person/day)

Nacin exposure from supplements and diet (97.5th percentile)

(mg/person/day)

Infants (4-18 months)

Entire diet

14

25

20

34

45

Current

Levels in flour

0.26

0.81

20

20

21

Proposed

Levels in flour

0.39

1.2

20

20

21

1.5-3 years

Entire diet

18

28

20

38

48

Current

Levels in flour

0.58

1.3

20

21

21

Proposed

Levels in flour

0.87

2

20

21

22

4 - 10 years

Entire diet

25

39

20

45

59

Current

Levels in flour

0.94

1.9

20

21

22

Proposed

Levels in flour

1.4

2.8

20

21

23

11 - 18 years

Entire diet

31

55

20

51

75

Current

Levels in flour

1.2

2.4

20

21

22

Proposed

Levels in flour

1.7

3.6

20

22

24

19 - 64 years

Entire diet

36

68

1000

1000

1100

Current

Levels in flour

0.98

2.4

1000

1000

1000

Proposed

Levels in flour

1.5

3.6

1000

1000

1000

65 + years

Entire diet

31

52

1000

1000

1100

Current

Levels in flour

0.83

2

1000

1000

1000

Proposed

Levels in flour

1.2

3

1000

1000

1000

Table A6: Exposure to thiamin from food and supplements.

  Age group

Category

Chronic exposure to thiamin (mg/person/day)*

Mean

97.5th Percentile

Exposure of thiamin from supplements, upper range (mg/person/day)

Thiamin expsoure from supplements and diet (mean)

(mg/person/day)

Thiamin exosure from supplements and diet (97.5th percentile)

(mg/person/day)

Infants (4-18 months)

Entire diet

0.81

1.3

5

5.9

6.3

Current

Levels in flour

0.039

0.12

5

5.0

5.1

1.5-3years

Entire diet

1

1.8

5

6

6.8

Current

Levels in flour

0.087

0.2

5

5.1

5.2

4 - 10 years

Entire diet

1.3

2.3

5

6.3

7.3

Current

Levels in flour

0.14

0.28

5

5.1

5.3

11 -  18years

Entire diet

1.4

2.8

5

6.4

7.8

Current

Levels in flour

0.17

0.36

5

5.2

5.4

19 - 64 years

Entire diet

1.5

2.8

500

500

500

Current

Levels in flour

0.15

0.36

500

500

500

65 + years

Entire diet

1.5

2.7

500

500

500

Current

Levels in flour

0.12

0.3

500

500

500

Table A5. Online sources for iron supplement data.

Supplement   

Iron dosage per day (mg)

Link

Notes

Sainsbury's Health Multivitamins & Iron Tablets 1 a Day x60

14

Sainsbury's Health Multivitamins & Iron Tablets 1 a Day x60 | Sainsbury's (sainsburys.co.uk)

1 tablet per day

Feroglobin Capsules

17

Feroglobin® Capsules | Iron Supplement | Vitabiotics

Iron (as fumerate) 1 tablet per day

Ultra Iron

14

Ultra Iron | Iron Tablets | Vitabiotics

1 tablet per day

Holland & Barrett Gentle Iron 20mg 90 Capsules

20

Holland & Barrett Gentle Iron 20mg 90 Capsules : Amazon.co.uk: Health & Personal Care

1 tablet per day

Iron Complex 90 Capsules

14

Iron Complex 90 Capsules | BioCare

1 tablet per day

Iron & Folic Acid Tablets

14

Iron & Folic Acid Tablets | MYPROTEIN™

1 tablet per day

Nature's Bounty Gentle Iron Complex with Vitamins B12 and C Capsules x100

17

Nature's Bounty Gentle Iron Complex with Vitamins B12 and C Capsules x100 | Sainsbury's (sainsburys.co.uk)

Iron (as Ferrous Bisglycinate) 1 tablet per day

Solgar® Gentle Iron (Iron Bisglycinate) 20 mg Vegetable Capsules - Pack of 90

20

Solgar® Gentle Iron (Iron Bisglycinate) 20 mg Vegetable Capsules - Pack of 90 : Amazon.co.uk: Health & Personal Care

1 tablet per day

Iron 14mg

28

Iron Tablets 14mg | Simply Supplements

1-2 tablet per day

Iron (Ferrous Bisglycinate) Capsules (K-Pure® ) 20mg

20

Iron Capsules (K-Pure) | Ferrous Bisglycinate | Bulk™

1 tablet per day

Nature's Bounty, Gentle Iron, 28 mg, 90 Capsules

28

Nature's Bounty, Gentle Iron, 28 mg, 90 Capsules (iherb.com)

1 tablet per day

Range

14-28

n/a

n/a

Supplement

Iron dosage per day (mg)

Link

Notes

Holland and Barrett Kids Multivits & Iron Tablets | Holland & Barrett

7.5

Holland and Barrett Kids Multivits & Iron Tablets | Holland & Barrett

n/a

Tasty Chews, A Chewable Multivitamin and Mineral For Children 4-14 years

2.8

Children's Chewable Multivitamins | Nature's Best (naturesbest.co.uk)

n/a

Wellkid Smart Chewable

7

Wellkid® Smart Chewable By Vitabiotics | Vitamins For Kids

1 tablet per day children aged 4-12 years

Solgar Kangavites Tropical Vitamins for Children - 120 Chewables

5

Solgar Kangavites Tropical Vitamins for Children - 120 Chewables | bodykind

Children 3-5 years 1 tablet per day children 6+ years 2 per day

Table A6. Online sources for calcium supplement data.

Supplement

Calcium dosage per day (mg)

Link

Notes

Calcium & Magnesium Tablets | MYPROTEIN™

800

Calcium & Magnesium Tablets | MYPROTEIN™

3 tablets per day

Osteocare Original

800

Osteocare® Original | Bone Health Tablets | Vitabiotics

2 tablets per day The UK’s No.1 calcium formula for women and men of all ages.

Numark Chewable Calcium & Vitamin D - 30 x 400mg Tablets

800

Numark Chewable Calcium & Vitamin D - 30 x 400mg Tablets | Chemist 4 U (chemist-4-u.com)

1 tablet per day Numark Vitamin D and Calcium Tablets are not suitable for children under the age of 12.

OsteoGuard®, High Strength Calcium and Magnesium Formula

1000

Osteoguard® Calcium & Magnesium Tablets | Nature's Best (naturesbest.co.uk)

1-2 tablets per day This product is suitable for all adults.

Natures Aid Chewable Calcium with Vitamin D - 60 Tablets

800

Natures Aid Chewable Calcium with Vitamin D - 60 Tablets | bodykind

1-2 tablets per day

Calcium + Vitamin D3 + Vitamin K1 Capsules 1000mg

200

Calcium + Vitamin D3 + Vitamin K1 Supplement | Bulk™

1 tablet per day

Super Calcium

780

Super Calcium | Higher Nature

1-3 tablets per day

Nature's Bounty, Calcium Plus Vitamin D3, 600 mg, 220 Rapid Release Softgels

1200

Nature's Bounty, Calcium Plus Vitamin D3, 600 mg, 220 Rapid Release Softgels (iherb.com)

2 per day For adults, take two (2) softgels daily, preferably with meals.

Alive! Calcium Gummies with Vitamin D3 | 60 Chewable Gummies | Specially Formulated for Adults and Children From 3 Years.

500

Alive! Calcium Gummies with Vitamin D3 | 60 Chewable Gummies | Specially Formulated for Adults and Children From 3 Years. : Amazon.co.uk: Health & Personal Care

2 soft gels per day 13+ years

Range

200-1200

n/a

n/a

Supplement

Calcium dosage per day (mg)

Link

Notes

Children's Chewable Multivitamins | Nature's Best (naturesbest.co.uk)

80

Children's Chewable Multivitamins | Nature's Best (naturesbest.co.uk)

 

CALCI-YUMMIES

150

Calci-YUMMies | 1st Phorm

Children 2+ years take 1 gummy per day

Lil Critters Calcium Gummy Bears with Vitamin D-200 Bears

200

Lil Critters Calcium Gummy Bears with Vitamin D-200 Bears : Amazon.co.uk: Health & Personal Care

children aged 3+  advised to take 2 gummies

NaturesPlus Animal Parade Source of Life Calcium Children’s Chewable - Natural Vanilla Sundae Flavour - 90 Chewable Animal Shaped Tablets - Gluten Free - 90 Servings : Amazon.co.uk: Health & Personal Care

250

NaturesPlus Animal Parade Source of Life Calcium Children’s Chewable - Natural Vanilla Sundae Flavour - 90 Chewable Animal Shaped Tablets - Gluten Free - 90 Servings : Amazon.co.uk: Health & Personal Care

2+ years 2 gummies per day

Wellkid Calcium Liquid

300-450

Wellkid® Calcium Liquid By Vitabiotics | Vitamins For Kids

10ml (300mg) children aged 4-6 years and 15 ml (450 mg) for children aged 7-12 years

Calcium and Vitamin D softies 30

280

Haliborange Kids Calcium and Vitamin D softies 30 : Amazon.co.uk: Health & Personal Care

1-2 softies per day Recommended for children

Alive! Calcium Gummies with Vitamin D3 | 60 Chewable Gummies | Specially Formulated for Adults and Children From 3 Years.

250

Alive! Calcium Gummies with Vitamin D3 | 60 Chewable Gummies | Specially Formulated for Adults and Children From 3 Years. : Amazon.co.uk: Health & Personal Care

1 soft gel per day for children aged 3-12 years

Solgar Kangavites Tropical Vitamins for Children - 120 Chewables

128

Solgar Kangavites Tropical Vitamins for Children - 120 Chewables | bodykind

Children 3-5 years 1 tablet per day children 6+ years 2 per day

Table A7. Online sources for Niacin supplement data.

Supplement

Niacin dosage per day (mg)

Link

Notes

Vitamin B3 Niacin/Nicotinic Acid (Flush Effect) 50mg, Magnesium Stearate Free & No Nasty Additives, Made in Wales … (180 Capsules)

50

Vitamin B3 Niacin/Nicotinic Acid (Flush Effect) 50mg, Magnesium Stearate Free & No Nasty Additives, Made in Wales … (180 Capsules) : Amazon.co.uk: Health & Personal Care

1 tablet per day

NOW Foods, Niacin, 500 mg, 250 Tablets

500

NOW Foods, Niacin, 500 mg, 250 Tablets (iherb.com)

1 tablet per day

Solgar Niacin (Vitamin B3) 500 Mg Vegetable Capsules - Pack Of 100

500

Solgar Niacin (Vitamin B3) 500 mg Vegetable Capsules - Pack of 100 – Your Health Store (healthstoreexpress.co.uk)

1 tablet per day

Solgar Niacin 100mg Tablets 100

100

Solgar Niacin 100mg Tablets 100 | Landys Chemist

1 tablet per day

Swanson Niacin, 100mg - 250 tablets

100

Swanson Niacin, 100mg - 250 tablets (lifestylehealthstore.co.uk)

1 tablet per day

Niacin, 100 mg, 300 Tablet

100

Niacin, 100 mg, 300 Tablets | PipingRock Health Products

1 tablet per day

Niacin, 1000 mg, 100 Quick Release Capsules, 2 Bottles

1000

Niacin 1000 mg 2 x 100 Capsules | Niacin 1000 Tablets | PipingRock Health Products

1 tablet per day

Vitamin B3 250mg (Niacin), Contributes to the Normal Function Of The Nervous System

250

Vitamin B3 & Niacin Tablets | Nature's Best (naturesbest.co.uk)

1 tablet per day

Source Naturals, Niacin, 100 mg, 250 Tablets

100

Source Naturals, Niacin, 100 mg, 250 Tablets (iherb.com)

1 tablet per day

Nature's Way, Niacin, Vitamin B3, 100 mg, 100 Capsules

100

Nature's Way, Niacin, Vitamin B3, 100 mg, 100 Capsules (iherb.com)

1 tablet per day

Range

50-1000

n/a

n/a

Supplement

Niacin dosage per day (mg)

Link

Notes

Holland and Barrett Kids Multivits & Iron Tablets | Holland & Barrett

13.5

Holland and Barrett Kids Multivits & Iron Tablets | Holland & Barrett

1 tablet per day suitbale for 4+ years

Children's Chewable Multivitamins | Nature's Best (naturesbest.co.uk)

9

Children's Chewable Multivitamins | Nature's Best (naturesbest.co.uk)

 

Wellkid Peppa Pig Multi-vits

4.8

Wellkid® Peppa Pig Multi Vitamins By Vitabiotics

2 jellies per day children 3+ NE

Wellkid Smart Chewable

9

Wellkid® Smart Chewable By Vitabiotics | Vitamins For Kids

1 tablet per day children aged 4-12 years

Kids Multivitamin Gummies

8.2

Kids Multivitamin Gummies | MYPROTEIN™

1 gummy per day

Solgar Kangavites Tropical Vitamins for Children - 120 Chewables

20

Solgar Kangavites Tropical Vitamins for Children - 120 Chewables | bodykind

Children 3-5 years 1 tablet per day children 6+ years 2 per day

Table A8. Online sources for thiamin supplement data.

Supplement

Thiamin dosage per day (mg)

Link

Notes

Solgar Vitamin B1 (Thiamin) 500 mg Tablets - Pack of 100 - Supports Energy Metabolism and Nervous System - Vegan

500

Solgar Vitamin B1 (Thiamin) 500 mg Tablets - Pack of 100 - Supports Energy Metabolism and Nervous System - Vegan : Amazon.co.uk: Health & Personal Care

1 tablet per day

Natures Aid Vitamin B1 Thiamin - 90 x 100mg Tablets

100

Natures Aid Vitamin B1 Thiamin - 90 x 100mg Tablets | bodykind

1 tablet per day

Vitamed Thiamine 100mg 100 Tablets

107

Vitamed Thiamine 100mg 100 Tablets : Amazon.co.uk: Health & Personal Care

1 tablet per day

Vitamin B1 100mg (Thiamin) 180 Tablets Suitable for Vegans and Vegetarians Made in UK by Futurevits 6 Month Supply, Premium Grade only.

100

Vitamin B1 100mg (Thiamin) 180 Tablets Suitable for Vegans and Vegetarians Made in UK by Futurevits 6 Month Supply, Premium Grade only. : Amazon.co.uk: Health & Personal Care

1 tablet per day

B-1 (Thiamin), 100 mg, 250 Tablets | PipingRock Health Products

100

B-1 (Thiamin), 100 mg, 250 Tablets | PipingRock Health Products

1 tablet per day

HealthAid Vitamin B1 (Thiamin) 100mg - Prolong Release - 90 Tablets

100

HealthAid Vitamin B1 (Thiamin) 100mg - Prolong Release - 90 Tablets : Amazon.co.uk: Health & Personal Care

1 tablet per day

Source Naturals, B-1, Thiamin, 100 mg, 100 Tablets

100

Source Naturals, B-1, Thiamin, 100 mg, 100 Tablets (iherb.com)

1 tablet per day

Holland & Barrett Vitamin B1 + Thiamine 100mg 120 Tablets

100

Holland & Barrett Vitamin B1 + Thiamine 100mg 120 Tablets | Holland & Barrett (hollandandbarrett.com)

1 tablet per day

Lindens Vitamin B1 Thiamine Tablets - 100 Pack - for Heart, Immune and Psychological Function & Energy Release - UK Manufacturer, Letterbox Friendly

100

Lindens Vitamin B1 Thiamine Tablets - 100 Pack - for Heart, Immune and Psychological Function & Energy Release - UK Manufacturer, Letterbox Friendly : Amazon.co.uk: Health & Personal Care

1 tablet per day

Vitamin B1 (Thiamin) 100mg 180 Vegan Tablets

100

Vitamin B1 (Thiamin) 100mg 180 Vegan Tablets : Amazon.co.uk: Health & Personal Care

1 tablet per day

Range

100-500

n/a

n/a

Supplement

Thiamin dosage per day (mg)

Link

Notes

Wellkid Peppa Pig Multi-vits

0.7

Wellkid® Peppa Pig Multi Vitamins By Vitabiotics

2 jellies per day children 3+

Wellkid Smart Chewable

0.9

Wellkid® Smart Chewable By Vitabiotics | Vitamins For Kids

1 tablet per day children aged 4-12 years

Centrum Kids Multivitamins & Minerals, 30 Tablets

0.5

Centrum Kids Multivitamins & Minerals, 30 Tablets : Amazon.co.uk: Health & Personal Care

n/a

[New] Creekside Naturals Mighty Eyes, Eye Vitamin and Mineral Supplement for Children with Lutein, Zeaxanthin, Thiamine, and Zinc, Vegan, Zero Sugar, 30 Soft Chewables

5

[New] Creekside Naturals Mighty Eyes, Eye Vitamin and Mineral Supplement for Children with Lutein, Zeaxanthin, Thiamine, and Zinc, Vegan, Zero Sugar, 30 Soft Chewables : Amazon.co.uk: Health & Personal Care

1 tablet per day

Solgar Kangavites Tropical Vitamins for Children - 120 Chewables

1.5

Solgar Kangavites Tropical Vitamins for Children - 120 Chewables | bodykind

Children 3-5 years 1 tablet per day children 6+ years 2 per day