Food fortification or individual supplementation? : commentary on the Slovenian guidelines for adequate vitamin D status (2025)

Vičič, Vid (author)

Background: This study critically reviews the recently published “Slovenian guidelines for adequate vitamin D status (2025)”, focusing on the chapter titled Cost assessment of selected recommendations in the Slovenian guidelines for ade-quate vitamin D provision. Several methodological weaknesses were identified in the economic evaluation, which may lead to inefficient and inequitable public health decisions. Methods: A secondary analysis of the guideline’s cost-assessment methodology was performed, together with an inde-pendent cost comparison of vitamin D sources. Results and discussion: The guideline’s cost-effectiveness analysis for reducing acute respiratory infections (ARI) in older adults (>65 years) with serum 25(OH)D <25 nmol/L is based on a subgroup meta-analysis in which >80% of participants were children, making extrapolation to older adults questionable. The model also assumes unrealistically high adherence to vitamin D supplementation. In contrast, population-wide food fortification is proven effective, minimizes adherence problems, is cost-effective, and ensures equitable access. Estimated annual costs for providing 20 μg vitamin D₃ daily to the total population aged ≥1 year (2.1 million people) were: 26.1 million EUR for prescription medicines; 37.3 million EUR for prescription medicines including a yearly short physician visit; 112.1 million EUR for over-the-counter medicines; 30.4 million EUR for food supplements; and 0.4 million EUR for food fortification. Conclusions: Given its demonstrated effectiveness, low cost, and ability to reduce health inequities, population-wide food fortification represents the most realistic strategy for preventing vitamin D deficiency in the entire population.

• Language: English
• Work type: Article
• Typology: 1.04 - Professional Article
• Organization: ZF - Faculty of Health Sciences; MF - Faculty of Medicine
• Publication status: Published
• Publication version: Version of Record
• Publication date: 01.03.2026
• Year: 2026
• Number of pages: Str. 103-110
• Numbering: Letn. 95, št. 3/4
• PID: 20.500.12556/RUL-184164
• UDC: 612.015.612
• ISSN on article: 1318-0347
• COBISS.SI-ID: 280619267
• Publication date in RUL: 01.07.2026

Record is a part of a journal

• Title: Zdravniški vestnik : glasilo Slovenskega zdravniškega društva
• Publisher: Slovensko zdravniško društvo
• ISSN: 1318-0347
• COBISS.SI-ID: 32893696

Licences

• License: CC BY-NC 4.0, Creative Commons Attribution-NonCommercial 4.0 International
• Link: http://creativecommons.org/licenses/by-nc/4.0/
• Description: A creative commons license that bans commercial use, but the users don’t have to license their derivative works on the same terms.

Secondary language

• Language: Slovenian
• Title: Obogatitev živil z vitaminom D ali individualno dodajanje? : komentar na slovenske smernice za zadostno preskrbljenost z vitaminom D (2025)

Abstract

Izhodišča: Raziskava kritično ocenjuje nedavno objavljene “Slovenske smernice za zadostno preskrbljenost z vitaminom D(2025)” s posebnim poudarkom na poglavju Stroškovno ovrednotenje nekaterih priporočil v slovenskih smernicah za za-dostno preskrbljenost z vitaminom D. Ekonomska ocena je ugotovila več metodoloških pomanjkljivosti, ki lahko vodijo do neučinkovitih javnozdravstvenih odločitev in do povečanja neenakosti v zdravju. Metode: Izvedli smo sekundarno analizo metodologije ocenjevanja stroškov v smernicah ter opravili neodvisno primerja-vo stroškov za različne vire vitamina D. Rezultati in razpravljanje: Analiza stroškovne učinkovitosti smernic pri zmanjševanju akutnih respiracijskih okužb (ARI) pri starejših odraslih (> 65 let) s serumskim 25(OH)D <25 nmol/L temelji na metaanalizi podskupine, v kateri je bilo > 80 % udeležencev otrok. Posploševanje teh rezultatov na populacijo starejših odraslih je metodološko vprašljivo. Model pred-postavlja tudi nerealno visoko adherenco pri dodajanju vitamina D. Nasprotno pa je obogatitev živil za celotno populacijo dokazano učinkovita, zmanjšuje težave glede adherence, je stroškovno učinkovita in zagotavlja enakopraven dostop za celotno populacijo. Ocenjeni letni stroški zagotavljanja 20 μg vitamina D3 dnevno za vse osebe, stare ≥1 leto (2,1 milijo-na ljudi), so znašali: 26,1 milijona EUR za zdravila na recept; 37,3 milijona EUR za zdravila na recept s kratkim obiskom zdravnika; 112,1 milijona EUR za zdravila brez recepta; 30,4 milijona EUR za prehranska dopolnila; in 0,4 milijona EUR za obogatitev živil. Zaključki: Glede na dokazani učinek, nizke stroške in sposobnost zmanjševanja neenakosti je obogatitev živil za celotno populacijo najbolj realistična strategija za preprečevanje pomanjkanja vitamina D.

• Keywords: vitamin D, ekonomsko vrednotenje, obogatitev živil, 25(OH)D, Slovenija