Abstract
Meta-analyses of randomized controlled trials (RCTs) have estimated a 13% reduction of cancer mortality by vitamin D supplementation among older adults. We evaluated if and to what extent similar effects might be expected from vitamin D fortification of foods. We reviewed the literature on RCTs assessing the impact of vitamin D supplementation on cancer mortality, on increases of vitamin D levels by either supplementation or food fortification, and on costs of supplementation or fortification. Then, we derived expected effects on total cancer mortality and related costs and savings from potential implementation of vitamin D food fortification in Germany and compared the results to those for supplementation. In RCTs with vitamin D supplementation in average doses of 820–2000 IU per day, serum concentrations of 25-hydroxy-vitamin D increased by 15–30 nmol/L, respectively. Studies on food fortification found increases by 10–42 nmol/L, thus largely in the range of increases previously demonstrated by supplementation. Fortification is estimated to be considerably less expensive than supplementation. It might be similarly effective as supplementation in reducing cancer mortality and might even achieve such reduction at substantially larger net savings. Although vitamin D overdoses are unlikely in food fortification programs, implementation should be accompanied by a study monitoring the frequency of potentially occurring adverse effects by overdoses, such as hypercalcemia. Future studies on effectiveness of vitamin D supplementation and fortification are warranted.
Highlights
Recent meta-analyses of randomized clinical trials have consistently suggested a reduction of cancer mortality by approximately 13% through vitamin D supplementation [1,2].We previously demonstrated, using cancer registry data from Germany, that vitamin D supplementation could be a very cost-effective if not cost-saving approach to reduce the burden of cancer deaths [3]
Given that it is unlikely if not impossible that effectiveness and cost-effectiveness of vitamin D food fortification with respect to reduction of cancer mortality will ever be evaluated by randomized study designs, we aimed to evaluate the potential of vitamin D food fortification by addressing the following questions: (i) Can vitamin D food fortification achieve similar increases in vitamin D levels as vitamin D supplementation at doses that were found to be effective in reducing cancer mortality? (ii) What would be the costs for such food fortification, and how would they compare with saved costs from prevented cancer deaths?
Higher levels of vitamin D have consistently shown to be associated with lower cancer mortality [41], and recent meta-analyses of randomized controlled trials (RCTs) proved effectiveness of supplementation in reducing cancer mortality [1,17]
Summary
We previously demonstrated, using cancer registry data from Germany, that vitamin D supplementation could be a very cost-effective if not cost-saving approach to reduce the burden of cancer deaths [3]. Another potentially even more cost-saving approach could be food fortification by vitamin D, a policy that has been implemented in a few countries, mainly for purposes other than prevention of cancer mortality [4,5,6,7,8]. We used the results to compare those costs to potential savings from reduced cancer mortality, taking cancer mortality data from Germany as an example The following questions: (i) Can vitamin D food fortification achieve similar increases in vitamin D levels as vitamin D supplementation at doses that were found to be effective in reducing cancer mortality? (ii) What would be the costs for such food fortification, and how would they compare with saved costs from prevented cancer deaths?
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