Estimated benefit of increased Vitamin D status in reducing the economic burden of disease in Western Europe Feb 11, 2009 (Full article, PDF) – xAbstract
Vitamin D has important benefits in reducing the risk of many conditions and diseases. Those diseases for which the benefits are well supported and that have large economic effects include many types of cancer, cardiovascular diseases, diabetes mellitus, several bacterial and viral infections, and autoimmune diseases such as multiple sclerosis. Europeans generally have low serum 25-hydroxyvitamin D <25(OH)D> levels owing to the high latitudes, largely indoor living, low natural dietary sources of vitamin D such as cold water ocean fish, and lack of effective vitamin D fortification of food in most countries. Vitamin D dose-disease response relations were estimated from observational studies and randomized controlled trials. The reduction in direct plus indirect economic burden of disease was based on increasing the mean serum 25(OH)D level to 40 ng/mL, which could be achieved by a daily intake of 2000–3000 IU of vitamin D. For 2007, the reduction is estimated at €187,000 million/year. The estimated cost of 2000–3000 IU of vitamin D3/day along with ancillary costs such as education and testing might be about €10,000 million/year. Sources of vitamin D could include a combination of food fortification, supplements, and natural and artificial UVB irradiation, if properly acquired. Additional randomized controlled trials are warranted to evaluate the benefits and risks of vitamin D supplementation. However, steps to increase serum 25(OH)D levels can be implemented now based on what is already known.
Thus, the estimated benefit–cost ratio of a vitamin D supplementation program for Europe is nearly 20 to 1.
Summary and Conclusion
This study indicates increasing Europeans’ serum 25(OH)D levels to at least 40 ng/mL all year could significantly reduce rates and economic burdens of several types of diseases. In most European countries, the 25(OH)D levels are typically 15–20 ng/mL below this goal. The most important benefits would come for cancer, cardiovascular disease, diabetes mellitus, respiratory infections, and dental/periodontal diseases. Although this study is based on a review of the scientific evidence to date and not on RCTs of vitamin D supplementation, as would be required for pharmaceutical drugs, the fact that solar UVB and vitamin D have coexisted with humans since our emergence as a species means that there is ample evidence by which to evaluate the benefits and risks. Given that the benefits of higher serum 25(OH)D are large and the risks are minimal, one can conclude that there is much more to gain than to lose by moving forward to implement a new vitamin D policy soon.
Food fortification has led to health benefits. Fortification of grain products with folic acid in Canada and the United States seems to be responsible for reduced risk of stroke (Yang et al., 2006) and birth with spina bifida (De Wals et al., 2008) and, likely, colon cancer (Bentley et al., 2008). A recent economic analysis of folic acid fortification in the United States estimated $3600 million/year saved by increasing the fortification level from 140 µg/100 g of enriched grain to 700 µg/100 g (Bentley et al., 2008).
Taken together, our findings indicate that it would be beneficial for the health ministries of European countries to familiarize themselves with the health benefits of vitamin D. There is a need not only for systems for achieving adequate vitamin D repletion and include the need for ensuring that the public and health care staff are adequately educated on the policy and on possible side effects that should be reported and also the need for the availability of rapid assessment of any possible adverse effects.
The conclusions of this paper are based primarily on ecological and observational studies. Many of the findings have been repeated in several different populations. Nonetheless, widespread acceptance of the health benefit of higher serum 25(OH)D levels would be greatly facilitated by multi-center randomized controlled trials.
- Introduction – p3
- Data and Methods – p4
- Vitamin D–sensitive diseases
- Vitamin D dose–health benefit relations
- Economic burden of diseases in Europe – p5
- Results – p5
- Table 1. Vitamin D dose–disease response relations from observational studies – p5
- Hip fractures
- Cancer, colorectal incidence
- Cancer, breast, incidence
- Colorectal cancer survival
- Breast cancer survival
- Cardiovascular disease, incidence
- Coronary heart disease, incidence
- Coronary heart disease, death
- Hypertensive disease, incidence
- Peripheral artery disease, prevalence
- Diabetes mellitus, prevalence
- Diabetes mellitus, incidence, males
- Congestive heart failure, death
- COPD
- Multiple sclerosis, incidence
- Multiple sclerosis, case-fatality rate
- Mortality rate
- Table 2. Results of RCTs of vitamin D for disease prevention – p7
- Type 1 diabetes mellitus incidence, infants
- Hip fractures
- All-cancer incidence, postmenopausal women
- Seasonal influenza, common cold, postmenopausal black women
- Mortality rate, meta-analysis
- Cancer
- Cardiovascular diseases
- Diabetes mellitus
- Infectious diseases
- Other vitamin D-sensitive diseases
- Beneficial effects for vitamin D–sensitive diseases
- Economic burdens of disease – p12
- Discussion – p12
- Overall effect of increased serum 25(OH)D levels
- Limitations of estimates
- Adverse effects of vitamin D supplementation
- Roles of environment and genetics
- Sources of vitamin D – p14
- Summary and conclusion – p15
- Disclosure
- References