Introduction: For almost nine decades, the fortification of foods with vitamin D has been proven effective in preventing rickets. This study aims to build and economically evaluate a fortification model based on egg biofortification and milk (including yoghurt) fortification.
Methods: A cross-sectional study was carried out between 1. March and 31. May 2021. Three hundred and nineteen healthy women from the Central Slovenian region aged between 44 and 65 were recruited for the study, with 176 participants included in the final analysis. For the fortification model calculations, the vitamin D contents of unenriched milk (including yoghurt) and eggs were replaced by enriched foods containing vitamin D. The economic evaluation was done using available drug and food supplement prices. Fortification costs were calculated using vitamin D prices provided by suppliers.
Results: Mean vitamin D intake from food was 2.19±1.34 µg/d. With fortification Model 1 (enriched eggs), it would be: 6.49±4.45 µg/d, and with Model 2 (enriched eggs and milk): 10.53±6.49 µg/d. Without fortification, none of the participants would reach a daily vitamin D intake >10 µg. With fortification Model 1 (egg fortification), 15.3% would reach >10 µg and with Model 2 (egg and milk fortification) 46.2% would reach >10 µg. The economic comparison of the annual cost of 10 µg vitamin D/d/person was EUR 6.17 for prescription drugs, EUR 6.37 for food supplements, EUR 0.09 for direct milk fortification and EUR 0.12 for egg biofortification with vitamin D.
Conclusions: Egg and milk (including yoghurt) fortification could cost-effectively increase vitamin D intake in the Slovenian population of women between 44 and 65 by almost five-fold, and could significantly lower the prevalence of vitamin D deficiency. Additional research and changes to legislation are needed before this can be introduced.
Uvod: Obogatitev živil z vitaminom D se je kot učinkovita pri preventivi rahitisa izkazala že pred skoraj 90 leti. Namen študije je zgraditi obogatitveni model, temelječ na bioobogatitvi kokošjih jajc preko krme, samostojno in v kombinaciji z mlekom (vključno z jogurtom). Strošek smo ekonomsko ovrednotili v primerjavi z individualnim dodajanjem vitamina D z zdravili ali prehranskimi dopolnili.
Metode: V obdobju med 1. marcem in 31. majem 2021 smo izvedli presečno študijo, v katero je bilo vključenih 319 žensk, starih med 44 in 65 let. Ob upoštevanju izločitvenih dejavnikov smo v končno analizo vključili 176 udeleženk. Za izračun obogatitvenega modela smo vsebnost vitamina D v neobogatenem mleku (vključno z jogurtom) in jajcih nadomestili z vsebnostjo v obogatenih živilih. Ekonomsko vrednotenje smo opravili na podlagi razpoložljivih cen zdravil, prehranskih dopolnil in cen surovin.
Rezultati: Povprečni vnos vitamina D s hrano je bil 2,19 ± 1,34 µg/d. Pri modelu obogatitve 1 bi bil vnos: 6,49 ± 4,45 µg/d in pri modelu 2: 10,53 ± 6,49 µg/d. Brez obogatitve nobena udeleženka ne dosega dnevnega vnosa vitamina D > 10 µg. Vnos > 10 µg/d bi z modelom obogatitve 1 (obogatitev jajc) in modelom 2 (obogatitve jajc in mleka) doseglo 15,3 % in 46,2 % udeleženk. Primerjava letnih stroškov dodajanja 20 µg vitamina D/osebo je bila 6,17 € za zdravila na recept, 6,37 € za prehransko dopolnilo, 0,09 € za neposredno obogatitev hrane in 0,12 € za obogatitev jajc z vitaminom D. ≥ 1 jajce/teden uživa 88,6 % udeleženk.
Zaključki: Obogatitev jajc in mleka (vključno z jogurtom) lahko stroškovno učinkovito poveča vnos vitamina D v slovenski populaciji žensk, starih med 44 in 65 let, za skoraj petkrat in lahko bistveno zmanjša prevalenco pomanjkanja vitamina D. Dodajanje vitamina D preko zdravil in prehranskih dopolnil je učinkovito na individualni ravni, v nasprotju z obogatitvijo živil pa ne doseže najranljivejših populacijskih skupin. Pred implementacijo bodo potrebne dodatne raziskave in prilagoditev zakonodaje.
Keywords: 25(OH) D3; economic evaluation; fortification; post-menopausal women; pre-menopausal women; vitamin D.
© 2023 National Institute of Public Health, Slovenia, published by Sciendo.