Volkswirtschaftliche Bedeutung einer Vitamin-D-Anreicherung von Lebensmitteln

Zusammenfassung

Diese Arbeit zeigt auf, dass der Vitamin-D-Mangel in Deutschland wesentlich ausgeprägter ist als bisher wahrgenommen. Zum Erhalt der Skelettgesundheit stellt ein 25-(OH)-D-Serumspiegel von 30 ng/ml den unteren anzustrebenden Grenzwert dar. Die gegenwärtigen Herangehensweisen – von den zu niedrigen Richtwerten bezüglich der als sicher anzusehenden täglichen Vitamin- D-Aufnahme über die fehlende Erstattungsfähigkeit einer Vitamin-D-Supplementation bei Patienten mit Osteopenie ohne bereits stattgehabte Fraktur und den bestehenden Restriktionen einer Vitaminisierung von Lebensmitteln – sind nicht geeignet, hinsichtlich dieser Mangelsituation eine wirkungsvolle Abhilfe zu schaffen. Auf der Basis der Literatur wird gezeigt, dass eine Behebung des für die Volksgesundheit extrem relevanten Vitamin- D-Mangels durch sehr einfache Maßnahmen, wie eine orale Supplementation oder eine Nahrungsmittelanreicherung, möglich wäre und zwar behebbar mittels kostensenkender Lösungen. Unter Berücksichtigung der einzusparenden Kosten im Gesundheitssystem, die im onkologischen Bereich mit jährlich etwa 1,5 Milliarden Euro und im osteologischen Bereich mit etwa einer Milliarde Euro beziffert werden, besonders aber auch im Hinblick auf die jährlich vermeidbaren 23 400 koxalen Femurfrakturen und 39 250 tumor - assoziierten Todesfälle in Deutschland, besteht ein dringender politischer Handlungsbedarf zur Behebung dieses Mangels. In Kenntnis der Evidenzen in der Literatur erscheint es unverständlich, dass die Kostenträger im Gesundheitswesen nicht proaktiv eine Optimierung der Vitamin-D-Versorgung ihrer Versicherten anstreben, um so ihre Ausgabenbelastung zu verringern. In Bezug auf die dargestellte Bedeutung des Vitamin-D-Mangels für die Morbidität und die Mortalität der deutschen Bevölkerung sind aber nicht nur Kostenträger in der Verantwortung, sondern die politischen Entscheidungsträger müssen dringend Rahmenbedingungen schaffen, die es erlauben, diese existierende Gefährdung der Volksgesundheit zu beseitigen. Lösungen bestehen in der Kostenübernahme einer bevölkerungsweiten Vitamin- D-Supplementation durch die Kostenträger des Gesundheitssystems oder aber in der Zulassung der ausreichenden Anreicherung von Lebensmitteln mit Vitamin D und damit der Umsetzung der bestehenden EU-Norm (2002/46/EG) mit der entsprechenden Anpassung des deutschen Lebensmittelrechts.

Summary

Vitamin D deficiency is a major health concern in Germany. For optimal skeletal health the 25-(OH)-D serum levels should reach at least 30 ng/ml. The current situation that includes inadequate low levels of daily vitamin D doses that are regarded to be safe, the lack of reimbursability of vitamin D supplements in osteopenia without a prevalent fracture, and the restrictions in vitamin D supplementation of food, is not appropriate to solve this existing problem. Based on the data in current literature this paper shows that oral vitamin D supplementation or else fortification of food would be two easy, safe, and cost-effective ways to overcome this endemic health problem. In fact in light of 2.5 billion Euro possible annual savings for the German health care system, as well as 23 400 dispensable fractures of the proximal femur and a reduction of tumor associated deaths by 39 250 patients there is a strong need for political action in this regard. The latter especially as the German food law that precludes vitamin D fortification of food which is in power for some 80 years now is not only in sharp contrast to current scientific knowledge on vitamin D biology but also in contradiction to the guideline put forward by the European union (EU norm 2002/46/EG).

Schlüsselwörter

Skelettgesundheit - Vitamin-D-Mangel - Vitamin-D-Supplementation

Keywords

Skeletal health - vitamin D deficiency - vitamin D supplementation

• Literatur

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