The HCSP assesses the coverage of the population’s nutritional requirements for iron and vitamin D as part of the update of the nutritional guidelines for the French population.

For iron, the risk of not meeting requirements is mainly for women of childbearing age due to menstruation.

The frequency of iron deficiency anaemia in women of childbearing age in mainland France has not increased in recent years. They are much more frequent in women of low socio-economic status and in the overseas departments, in multiparous women, or in women using an intrauterine device. On the basis of the available data, given the low frequency of iron deficiency anaemia in the general population and the potential negative effects of additional iron intakes, it does not seem appropriate to seek to increase iron intakes for the general population, for example by iron fortification of carrier foods for the adult population. Instead, it is recommended to focus preventive measures on groups at risk of iron deficiency anaemia. With regard to women of childbearing age at high risk, it would seem worthwhile to combine screening and possible martial supplementation: screening directed by risk factors and a suggestive clinical picture. A time-limited martial supplementation will be prescribed if necessary.

For vitamin D, 80-90% of the body’s vitamin D comes from skin biosynthesis under the effect of ultraviolet (UV) radiation from the sun, compared with 10-20% from an exogenous source through the absorption of vitamin D-rich foods. UV exposure is therefore very important in meeting vitamin D requirements.

While serum assays can provide an accurate value at the individual level, there are reservations about the quality and validity of the assays and the heterogeneity in the definition of different thresholds for vitamin D status. Screening for vitamin D deficiency by 25OHD blood test is therefore not appropriate for the general population.

The proportion of the general population with deficiency (< 10 ng/mL) was 4.4% in 2006 (ENNS), and 6.5% in 2015 (ESTEBAN). Population groups at risk of vitamin D deficiency are: people in precarious situations; obese people; people who do not expose themselves to the sun: people living in institutions or wearing very covering clothes; people with highly pigmented skin living in high latitudes.

There are many observational studies of the association between serum vitamin D concentration and various disease states, but to date there are no well-conducted randomized trials confirming the value of vitamin D treatment or supplementation.

The results of fortification policies in some countries are difficult to interpret and the current level of evidence is insufficient to promote such actions in the general population.

The main recommendations:

• promote a healthy lifestyle conducive to vitamin D status:
  • ensure moderate but sufficient sun exposure and compatible with skin cancer prevention messages,
  • promote consumption of vitamin D-rich foods consistent with nutritional recommendations (oily fish up to one portion per week, eggs, cheese and dairy products 2 per day)
• avoid self-prescription of vitamin D-rich food supplements.