the updated labeling regulations was required by 1 January 2020 for manufacturers with US$10 million or more in annual food sales, and by 1 January 2021 for manufacturers with lower volume food sales. A table of the old and new adult daily values is provided at Reference Daily Intake. Fortification According to the Global Fortification Data Exchange, vitamin K deficiency is so rare that no countries require that foods be fortified. The World Health Organization does not have recommendations on vitamin K fortification. Sources Vitamin K1 is primarily from plants, especially leafy green vegetables. Small amounts are provided by animal-sourced foods. Vitamin K2 is primarily from animal-sourced foods, with poultry and eggs much better sources than beef, pork or fish. One exception to the latter is nattō, which is made from bacteria-fermented soybeans. It is a rich food source of vitamin K2 variant MK-7, made by the bacteria. Vitamin K1 Vitamin K2 Animal-sourced foods are a source of vitamin K2. The MK-4 form is from conversion of plant-sourced vitamin K1 in various tissues in the body. Vitamin deficiency Because vitamin K aids mechanisms for blood clotting, its deficiency may lead to reduced blood clotting, and in severe cases, can result in reduced clotting, increased bleeding, and increased prothrombin time. Normal diets are usually not deficient in vitamin K, indicating that deficiency is uncommon in healthy children and adults. An exception may be infants who are at an increased risk of deficiency regardless of the vitamin status of the mother during pregnancy and breast feeding due to poor transfer of the vitamin to the placenta and low amounts of the vitamin in breast milk. Secondary deficiencies can occur in people who consume adequate amounts, but have malabsorption conditions, such as cystic fibrosis or chronic pancreatitis, and in people who have liver damage or disease. Secondary vitamin K deficiency can also occur in people who have a prescription for a vitamin K antagonist drug, such as warfarin. A drug associated with increased risk of vitamin K deficiency is cefamandole, although the mechanism is unknown. Medical uses Treating vitamin deficiency in newborns Vitamin K is given as an injection to newborns to prevent vitamin K deficiency bleeding. The blood clotting factors of newborn babies are roughly 30–60% that of adult values; this appears to be a consequence of poor transfer of the vitamin across the placenta, and thus low fetal plasma vitamin K.