Preventing vitamin D deficiency (VDD): a systematic review of economic evaluations

Aguiar, Magda; Andronis, Lazaros; Pallan, Miranda; Högler, Wolfgang; Frew, Emma

doi:10.1093/eurpub/ckw270

Cited by 31 publications

(29 citation statements)

References 37 publications

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“…Universal supplementation of infants [ 49 ], supplementing pregnant women [ 50 ], promoting vitamin uptake [ 51 ] and also food fortification with vitamin D and calcium to prevent fractures in elderly [ 52 ] have been proven cost-effective. However, there is limited data on vitamin D fortification and how fortification programmes compare to population supplementation programmes [ 53 ].…”

Section: Prevention and Public Healthmentioning

confidence: 99%

Nutritional Rickets and Osteomalacia in the Twenty-first Century: Revised Concepts, Public Health, and Prevention Strategies

Uday

Högler

2017

Curr Osteoporos Rep

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110

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Purpose of ReviewNutritional rickets and osteomalacia are common in dark-skinned and migrant populations. Their global incidence is rising due to changing population demographics, failing prevention policies and missing implementation strategies. The calcium deprivation spectrum has hypocalcaemic (seizures, tetany and dilated cardiomyopathy) and late hypophosphataemic (rickets, osteomalacia and muscle weakness) complications. This article reviews sustainable prevention strategies and identifies areas for future research.Recent FindingsThe global rickets consensus recognises the equal contribution of vitamin D and dietary calcium in the causation of calcium deprivation and provides a three stage categorisation for sufficiency, insufficiency and deficiency. For rickets prevention, 400 IU daily is recommended for all infants from birth and 600 IU in pregnancy, alongside monitoring in antenatal and child health surveillance programmes.SummaryHigh-risk populations require lifelong supplementation and food fortification with vitamin D or calcium. Future research should identify the true prevalence of rickets and osteomalacia, their role in bone fragility and infant mortality, and best screening and public health prevention tools.

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Section: Prevention and Public Healthmentioning

confidence: 99%

Nutritional Rickets and Osteomalacia in the Twenty-first Century: Revised Concepts, Public Health, and Prevention Strategies

Uday

Högler

2017

Curr Osteoporos Rep

Self Cite

110

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“…As edible oils are widely believed to be good vehicles for vitamin A fortification, and facilities and processes to support oil fortification in LMICs are increasingly well established, research into the efficacy of adding vitamin D to vitamin A–fortified oils could be conducted to guide recommendations for countries interested in addressing vitamin D deficiency. As with all fortification programs, the cost‐effectiveness of vitamin D fortification programs versus supplementation strategies to correct vitamin D deficiency in specific population groups, particularly those living in LMICs, can be assessed to inform decision making …”

Section: Interventions To Reduce the Prevalence Of Vitamin D Deficienmentioning

confidence: 99%

Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low‐ and middle‐income countries

Roth

Abrams

Aloia

et al. 2018

Annals of the New York Academy of Sciences

406

340

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Vitamin D is an essential nutrient for bone health and may influence the risks of respiratory illness, adverse pregnancy outcomes, and chronic diseases of adulthood. Because many countries have a relatively low supply of foods rich in vitamin D and inadequate exposure to natural ultraviolet B (UVB) radiation from sunlight, an important proportion of the global population is at risk of vitamin D deficiency. There is general agreement that the minimum serum/plasma 25-hydroxyvitamin D concentration (25(OH)D) that protects against vitamin D deficiency-related bone disease is approximately 30 nmol/L; therefore, this threshold is suitable to define vitamin D deficiency in population surveys. However, efforts to assess the vitamin D status of populations in low- and middle-income countries have been hampered by limited availability of population-representative 25(OH)D data, particularly among population subgroups most vulnerable to the skeletal and potential extraskeletal consequences of low vitamin D status, namely exclusively breastfed infants, children, adolescents, pregnant and lactating women, and the elderly. In the absence of 25(OH)D data, identification of communities that would benefit from public health interventions to improve vitamin D status may require proxy indicators of the population risk of vitamin D deficiency, such as the prevalence of rickets or metrics of usual UVB exposure. If a high prevalence of vitamin D deficiency is identified (>20% prevalence of 25(OH)D < 30 nmol/L) or the risk for vitamin D deficiency is determined to be high based on proxy indicators (e.g., prevalence of rickets >1%), food fortification and/or targeted vitamin D supplementation policies can be implemented to reduce the burden of vitamin D deficiency-related conditions in vulnerable populations.

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“…Using these cost distributions and obtaining annual costs for 20 μg (800 IU) vitamin D per day of 0.11 Euros per person and annual costs for 200 mg calcium per day of 0.22 Euros per person it was estimated by Sandmann et al that the implementation of a vitamin D plus calcium fortification programme in Germany would cost 41 million Euros per year while saving 365 million Euros per year as a result of reduced fracture costs ( 139 ). This would translate into a benefit-cost ratio of 9:1 which is even more conservative than other estimates of the cost-effectiveness of pure vitamin D interventions with even higher benefit-cost ratios ( 138 , 140 – 149 ). We are well aware that more data are needed on the cost-effectiveness of systematic vitamin D fortification but we conclude that, despite limited evidence, the available literature suggests that this approach is highly likely to be cost-effective.…”

Section: Cost-effectiveness Of Vitamin D Food Fortificationmentioning

confidence: 86%

Rationale and Plan for Vitamin D Food Fortification: A Review and Guidance Paper

et al. 2018

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Vitamin D deficiency can lead to musculoskeletal diseases such as rickets and osteomalacia, but vitamin D supplementation may also prevent extraskeletal diseases such as respiratory tract infections, asthma exacerbations, pregnancy complications and premature deaths. Vitamin D has a unique metabolism as it is mainly obtained through synthesis in the skin under the influence of sunlight (i.e., ultraviolet-B radiation) whereas intake by nutrition traditionally plays a relatively minor role. Dietary guidelines for vitamin D are based on a consensus that serum 25-hydroxyvitamin D (25[OH]D) concentrations are used to assess vitamin D status, with the recommended target concentrations ranging from ≥25 to ≥50 nmol/L (≥10–≥20 ng/mL), corresponding to a daily vitamin D intake of 10 to 20 μg (400–800 international units). Most populations fail to meet these recommended dietary vitamin D requirements. In Europe, 25(OH)D concentrations <30 nmol/L (12 ng/mL) and <50 nmol/L (20 ng/mL) are present in 13.0 and 40.4% of the general population, respectively. This substantial gap between officially recommended dietary reference intakes for vitamin D and the high prevalence of vitamin D deficiency in the general population requires action from health authorities. Promotion of a healthier lifestyle with more outdoor activities and optimal nutrition are definitely warranted but will not erase vitamin D deficiency and must, in the case of sunlight exposure, be well balanced with regard to potential adverse effects such as skin cancer. Intake of vitamin D supplements is limited by relatively poor adherence (in particular in individuals with low-socioeconomic status) and potential for overdosing. Systematic vitamin D food fortification is, however, an effective approach to improve vitamin D status in the general population, and this has already been introduced by countries such as the US, Canada, India, and Finland. Recent advances in our knowledge on the safety of vitamin D treatment, the dose-response relationship of vitamin D intake and 25(OH)D levels, as well as data on the effectiveness of vitamin D fortification in countries such as Finland provide a solid basis to introduce and modify vitamin D food fortification in order to improve public health with this likewise cost-effective approach.

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Preventing vitamin D deficiency (VDD): a systematic review of economic evaluations

Cited by 31 publications

References 37 publications

Nutritional Rickets and Osteomalacia in the Twenty-first Century: Revised Concepts, Public Health, and Prevention Strategies

Nutritional Rickets and Osteomalacia in the Twenty-first Century: Revised Concepts, Public Health, and Prevention Strategies

Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low‐ and middle‐income countries

Rationale and Plan for Vitamin D Food Fortification: A Review and Guidance Paper

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