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Vitamin D fortification of eggs alone and in combination with milk in women aged 44–65 years: Fortification model and economic evaluation

Vid Vičič
Vid Vičič
, 
Ruža Pandel Mikuš
Ruža Pandel Mikuš
, 
Saša Kugler
Saša Kugler
, 
Ksenija Geršak
Ksenija Geršak
, 
Joško Osredkar
Joško Osredkar
 und 
Andreja Kukec
Andreja Kukec
   | 03. Jan. 2023
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Article Category: Original scientific article
Online veröffentlicht: 03. Jan. 2023
Seitenbereich: 30 - 38
Eingereicht: 19. Jan. 2022
Akzeptiert: 17. Nov. 2022
DOI: https://doi.org/10.2478/sjph-2023-0005
Schlüsselwörter
© 2023 National Institute of Public Health, Slovenia, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Flow chart of the study in healthy women from the Central Slovenian region aged between 44 and 65, conducted between 1. March and 31. May 2021.
Flow chart of the study in healthy women from the Central Slovenian region aged between 44 and 65, conducted between 1. March and 31. May 2021.

Figure 2

The differences of serum 25(OH)D3 concentrations between users and non-users of supplements in healthy women from the Central Slovenian region aged between 44 and 65 were assessed between 1 March and 31 May 2021 (n=176).
The differences of serum 25(OH)D3 concentrations between users and non-users of supplements in healthy women from the Central Slovenian region aged between 44 and 65 were assessed between 1 March and 31 May 2021 (n=176).

Figure 3

Vitamin D intake from food, without fortification with projection using fortified eggs and fortified eggs and milk (including yoghurt) in healthy women from the Central Slovenian region aged between 44 and 65, was assessed in the period between 1 March and 31 May 2021 (n=176).
Vitamin D intake from food, without fortification with projection using fortified eggs and fortified eggs and milk (including yoghurt) in healthy women from the Central Slovenian region aged between 44 and 65, was assessed in the period between 1 March and 31 May 2021 (n=176).

Figure 4

Comparison of the annual cost of 10 μg of vitamin D daily for Slovenians >1 year of age (n=2,050,916) (38). (Key: MEUR – millions of Euros). * 25(OH)D3 analysis, physician visits and dispensing costs are not included. The cheapest drug was used. ** Cheapest food supplement per μg, cost with VAT. *** No additional cost is predicted.
Comparison of the annual cost of 10 μg of vitamin D daily for Slovenians >1 year of age (n=2,050,916) (38). (Key: MEUR – millions of Euros). * 25(OH)D3 analysis, physician visits and dispensing costs are not included. The cheapest drug was used. ** Cheapest food supplement per μg, cost with VAT. *** No additional cost is predicted.

Annual costs of 10 μg vitamin D/d/person.

Variables Cost per 10 μg (EUR) Annual costs of 10 μg vitamin D/d/person (EUR)
Supplementation with physician-prescribed vitamin D drugs* 0.016911 6.17
Vitamin D food supplements** 0.017440 6.37
Egg biofortification with vitamin D*** 0.000342 0.12
Direct food (milk) fortification with vitamin D3*** 0.000240 0.09

Fortification model input data.

    Cholecalciferol 25(OH)D3 Vitamin D efficacy*
    μg/1 egg μg/1 egg μg (IU)/1 egg
No fortification Unenriched egg 1.07 0.27 2.4 (80 IU)
Model 1 Enriched eggs** 5.18 1.35 11.98 (479 IU)
Model 2 Enriched eggs** 5.18 1.35 11.98 (479 IU)
  Enriched milk and yoghurt 3 μg/100 mL   3.00 μg (120 IU)/100 mL

Population characteristics, vitamin D status, supplementation and food intake in healthy women from the Central Slovenian region aged between 44 and 65, carried out between 1. March and 31. May 2021 (n=176).

Variables Category/ Unit All participants n=176 Users of supplements n=108 Non-users of supplements N=68 p– value
Age
 year
 53.83±4.99
 54.25±4.83
 53.14±5.17
 0.150
BMI kg/m2 25.74±4.36 25.47±4.18 26.14±4.63 0.322
  18.5–24.9 51.70% 54.63% 47.06%  
  25.0–29.9 32.39% 31.48% 33.82%  
  30.0–34.9 10.80% 8.33% 14.71%  
  35.0–39.9 4.55% 4.63% 4.41%  
 
 over 40.0
 0.57%
 0.93%
 0.00%
  
LABORATORY ANALYSIS 25(OH)D nmol/L 66.42±27.35 76.24±27.06 50.82±19.55 0.000
  <30 8.52% 3.70% 16.18%  
  30–50 15.91% 6.48% 30.88%  
  50–75 43.18% 44.44% 41.18%  
 
 >75
 32.39%
 45.37%
 11.76%
  
Education Primary and secondary school 32.39% 29.63% 36.76%  
 
 Higher education
 67.61%
 70.37%
 63.24%
  
MILK AND EGG INTAKE
  
  
  
  
 0.0400
Milk and yoghurt intake (mL/d)   134.58±160.46 154.26±171.29 103.33±137.03  
Milk consumers (≥200 mL /week)   72.16% 79.63% 73.53% 0.895
Egg intake (pcs/week   3.17±2.44 3.19±2.52 3.14±2.34  
Egg consumers (≥1 egg/week)
  
 88.6%
 86.1%
 92.7%
  
VITAMIN D INTAKE AND SUPPLEMENTATION
  
  
  
  
 0.532
Mean food intake (μg/d)   2.19±1.34 2.24±1.41 2.11±1.22  
Supplement use (≥5 μg vitamin D /d)   61.36% 100% 0.00%  
Mean supplemental intake (μg/d)   21.72±26.24 35.4±25.26 0±0.08 0.000
Mean intake of all sources (μg/d)
  
 24.06±26.19
 37.64±25.17
 2.48±3.33
 0.000
FORTIFICATION MODEL          
  Fortified Fortified eggs Fortified Fortified eggs Fortified Fortified eggs
  eggs and milk eggs and milk eggs and milk
 
 (Model 1) (Model
 2) (Model 1)
 (Model 2)
 (Model 1)
 (Model 2)
Mean vitamin D intake all sources (μg/d) 29.49± 33.52± 43.33± 47.96± 7.49± 10.59±
  26.56 27.24 25.33 25.40 4.22 6.13
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