Background: Meta-analyses of randomized controlled trials have shown that vitamin D supplementation reduces cancer mortality by 13%. Vitamin D fortification of foods may increase vitamin D levels in a similar manner as vitamin D supplementation and could achieve similar reductions in cancer mortality. Whereas some European countries already implemented widespread fortification of foods with vitamin D, in other countries only few or no foods are fortified. In this study, we estimated the reduction in cancer mortality presumably already achieved by current fortification policies in 2017 and the potential for further reductions if all countries had effective fortification. Methods: We reviewed scientific literature, publicly available information, and contacted health authorities to obtain information on current vitamin D food fortification policies in 34 European countries. Together with country-specific cancer death statistics from Eurostat, information on life expectancy, and country-specific fortification policies, we used data from studies on supplementation and serum 25(OH)D increases and cancer mortality to estimate numbers of probably already prevented cancer deaths and numbers of potentially further preventable deaths and years of life lost. Results: Current vitamin D fortification is estimated to prevent approximately 11,000 in the European Union and 27,000 cancer deaths in all European countries considered per year. If all countries considered here would implement adequate vitamin D fortification of foods, an estimated additional 129,000 cancer deaths (113,000 in the European Union) could be prevented, corresponding to almost 1.2 million prevented years of life lost (1.0 million in the EU) or approximately 9% of cancer deaths (10% in the EU). Interpretation: Systematic fortification of foods might considerably reduce the burden of cancer deaths in Europe.

背景：随机对照试验的荟萃分析表明，补充维生素 D 可将癌症死亡率降低 13%。食品中维生素 D 的强化可能会以与补充维生素 D 类似的方式增加维生素 D 水平，并且可以实现类似的癌症死亡率降低。尽管一些欧洲国家已经在食品中广泛使用维生素 D 强化剂，但在其他国家只有很少或没有食品被强化。在这项研究中，我们估计了 2017 年当前的强化政策可能已经实现了癌症死亡率的降低，以及如果所有国家都有有效的强化政策，则有可能进一步降低癌症死亡率。方法：我们审查了科学文献、公开信息，并联系了卫生当局，以获取有关 34 个欧洲国家当前维生素 D 食品强化政策的信息。连同来自欧盟统计局的特定国家癌症死亡统计数据、预期寿命信息和特定国家强化政策，我们使用来自补充剂和血清 25(OH)D 增加和癌症死亡率的研究数据来估计可能已经预防的癌症死亡人数以及可能进一步可预防的死亡人数和失去的生命年数。结果：据估计，目前的维生素 D 强化剂每年可预防欧盟约 11,000 人和所有欧洲国家 27,000 人因癌症死亡。如果此处考虑的所有国家都对食品实施足够的维生素 D 强化，估计可以预防额外的 129,000 例癌症死亡（欧盟为 113,000 例），相当于避免了近 120 万年的生命损失（欧盟为 100 万年）或大约9% 的癌症死亡（欧盟为 10%）。解释: 食品的系统强化可能会大大减轻欧洲癌症死亡的负担。