how could food supplements contribute to healthcare cost ... bernd habe… · ca/vit. d omega-3...

How could food

supplements contribute to

healthcare cost savings?

Bernd Haber, BASF SE NPN Symposium „Gezondheidswinst metvitamines en mineralen“ , 22.11.2018

28.11.20182

Agenda

Are we living healthy?

Do we know our needs? – example: Vitamin D

Health Care Cost Savings – Can supplements play a role?

1.

2.

3.

28.11.20183

Agenda




1.

2.

3.

28.11.2018 | Optionale Zusatzinformationen4

Healthy nutrition for all – but what is reality?

Energy intake toohigh in many

countries

Increasingoverweight and

obesity

Micronutrient intakeoften below

recommendations

NCDs dominate theglobal pattern of

mortality


More than 50% of Europeans are overweight or obese.


Overweight and obesity is increasing tremendously not only in

Western countries.


Micronutrient deficiency or insufficiency is not only a problem of

developing countries.

[Troesch et al, BJN, 2012]

367

3,966

5,006

9,146

0.5

2.9

2010

2.6

2005

2.0

2000

1.4

1995

0.4

1.0

Japan

China

Germany

USA

2013

BASF Human Nutrition8

Preventing NCDs before treatment makes sense as global health

costs explode

EXPENDITURE ON HEALTH

Total expenditure

in trillion USD

2013 per capita expenditure

in USD

Health promotion

and

disease prevention

have to be a central

part of any national

and international

health policy!


Is there more than improving our diet and lifestyle?

A healthy diet & lifestyle is

the cornerstone of disease

prevention.

Tailored nutrient supply can help

maintaining healthy life and

reducing disease risk.

28.11.201810

Agenda




1.

2.

3.

Vitamin D has multiple health benefits –

bone health is extensively studied

1 out of 3 women and 1

out of 5 men suffer from

osteoporotic fracture.

Every 3 seconds a bone

breaks due to

osteoporosis worldwide.

125 million people

suffer from osteoporosis

in Europe, India, Japan

and the USA.

28.11.201812

Recommendations

Vitamin D / day (dietary

recommendation)

German Nutrition

Society (DGE):

Recommended Intake(when endogenous synthesis is

missing)

20 µg

(800 IU)

IOF:

Recommended Intake

min. 20-25 µg

(800-1000 IU)

Intake from dietAdults in Germany (NVS II, 2008)

2,9 µg (men)

2,2 µg (women)

German Nutrition Society (DGE):

serum 25-hydroxyvitamin D concentrations of 50

nmol/l (20 ng/mL) or higher are considered an

indicator of an optimal vitamin D status.

International Osteoporosis Foundation (IOF):

“… there is emerging evidence and expert opinion

that the minimum blood level of 25(OH)D that

would be optimal for fracture prevention is 70-80

nmol/l (28-32 ng/mL)”


Vitamin D – who knows his status?

28.11.201814

Prevalence of low vitamin D status is globally high.

DEFICIENT INSUFFICIENT (IN)ADEQUATE OPTIMAL25 [nmol/l]50 75 100

88.1% < 75 nmol/l

37.3% < 50 nmol/l

6.7% < 25 nmol/l

DGE IOF

[Hilger et al., BJN, 2014]

28.11.201815

Especially elderly people have a substantial risk of vitamin D

deficiency.

German Nutrition Society (2012)

„Among individuals 65 years and older, there is

greater need to take a vitamin D supplement

because the vitamin D synthesis capability of the skin

decreases significantly with increasing age...“

„The contribution of endogenous synthesis is further

reduced if people stay inside most of the time,

thereby reducing UVB exposure, which is often the

case especially among chronically sick elderly people

in need of care with restricted mobility...“

[German Nutrition Society, Ann Nutr Metab 2012;60:241–246]

[Conzades et al. Nutrients 2017, 9(12), 1276]

28.11.201816

How is the vitamin D status of BASF employees, especially after the

winter season?

Method

◼ More than 1000 employees (BASF

Ludwigshafen)

◼ Determination of 25(OH)D-serum levels on

voluntary basis

◼ Assessment after winter (15.3.-31.4.2017) and

summer season (15.-31.10.2017)

◼ Questionnaire about lifestyle factors especially

sun exposure and intake of vitamin D

supplements

Target

◼ Determination of 25(OH)D-serum

levels of at least 1000 employees at

the end of the winter season

(winter value)

◼ Control of the endogenous synthesis

of vitamin D in the summer months

(summer value)

25(OH)D concentration in serum (winter levels)

28.11.201817

Approx. 70% of BASF employees have deficient or insufficient vitamin D

status after the winter season.

31%

38%

21%

9%

1%

<12ng/ml(Deficiencyl)

12-20ng/ml(Insufficiency)

>20-30ng/ml(Lower normal)

>30-60ng/ml(Upper normal)

>60ng/ml (Abovenormal)

34

40

20

5

1

5

15

32

42

7

0%

10%

20%

30%

40%

50%

<12 12-20 >20-30 >30-60 >60

No supplements

Supplements use

25(OH)-D-concentration in serum (ng/ml)

% o

fin

div

idu

als

Vitamin D3 supplementation significantly improved

the vitamin D3 status after winter season.

28.11.201818

Still approx. 20% of BASF employees have deficient or insufficient

vitamin D status after the summer season.

2%

17%

40%

40%

2%

<12ng/ml(Deficiency)

12-20ng/ml(Insufficiency)

>20-30ng/ml(Lower normal)

>30-60ng/ml(Upper normal)

>60ng/ml (Abovenormal)

25(OH)D concentration in serum (summer levels)

25(OH)-D-concentration in serum (ng/ml)

2

19

43

35

104

22

67

7

0

10

20

30

40

50

60

70

80

No supplements

Supplements use

< 12 12-20 >20-30 >30-60 >60

% o

fin

div

idu

als

Vitamin D3 supplementation further optimized the

vitamin D3 status after the sommer season.


People are different. People have different needs.

Diagnosis is essential for personalized recommendations.

Weizman personalized nutrition

project (2015)Challenges of the future

Diagnose

Monitor

Comply

Solution for the future

Easy diagnosis

leads to consumer

awareness

Positive effect

triggers additional

motivation

Regular

measurement

shows impact of DS

28.11.201820

Agenda



Health Care Cost Savings –

Can supplements play a role?

1.

2.

3.

28.11.201821

The world’s major regions are

expected to see health care spending

increase from 2.4 to 7.5 percent

between 2015 and 2020.

Source: Deloitte

ALTHOUGH PEOPLE ARE LIVING

LONGER, THEY ARE NOT

NECESSARILY HEALTHIER THAN

BEFORE - NEARLY A QUARTER

(23%) OF THE OVERALL GLOBAL

BURDEN OF DEATH AND ILLNESS

IS IN PEOPLE AGED OVER 60

Source: WHO

TOTAL NUMBER OF DISABILITY-ADJUSTED LIFE YEARS

LOST (DALYS) PER COUNTRY DUE TO OSTEOPOROSIS-

ATTRIBUTED BONE FRACTURES, GLOBAL 2015

SOURCE: FROST & SULLIVAN

853.093

348.665

313.813

129.688

110.363

88.215

71.327

35.615

19.939

16.278

14.991

14.841

7.583

5.464

1.606

EU

RUSSIA

CHINA

TURKEY

US

INDIA

JAPAN

BRAZIL

REP KOREA

INDONESIA

ARGENTINA

CANADA

AUSTRALIA

SOUTHAFRICA

NEWZEALAND

Total number of DALYS due to osteoporosis-attributed bone

fractures are exceptionally high in the EU.

The cost of osteoporosis-attributed fractures, in terms of lost

healthy life years lost, is over 2 million years per year globally.

24

What kind of policy action needs to be taken?

Can supplements play a role?

Food Supplements Europe commissioned

Frost & Sullivan to investigate if daily

supplementation of the diet with specific

food compounds would be able to reduce

disease risk in adults over 55+ and result

in healthcare costs savings.

Ca/Vit. D

Omega-3

Phytosterols

The effect of Calcium and

Vitamin D supplementation

Cost of treating bone fractures with wider use of

Calcium + vitamin D supplements

27.8 million

17.6 % of people aged 55 +

in the EU living with osteoporosis



cost of treating these fractures

€26.4bn / year€21,231 / event

1.24m related fractures

occurring

every year

-15%Reduction of risk of

osteoporosis-attributed fractures by regular consumption of

1000 mg Calcium + 15 mcg Vitamin D





Permitted claim:

“Calcium and vitamin D help to

reduce the loss of bone mineral in

post-menopausal women. Low

bone mineral density is a risk factor

for osteoporotic bone fractures.”

The claim may be used only for food supplements which

provide at least 400 mg of calcium and 15 μg of

vitamin D per daily portion. Information shall be given to the

consumer that the claim is specifically intended for women 50

years and older and the beneficial effect is obtained with a

daily intake of at least 1 200 mg of calcium and 20 μg

of vitamin D from all sources. For food supplements with

added calcium and vitamin D the claim may be used only for

those targeting women 50 years and older

The EU has permitted a health claim for calcium and

vitamin D and risk of osteoporosis.

€3.47 return for every

€ 1spent on

calcium + vitamin D

supplements

186,690 osteoporosis-attributed bone fractures

preventable every year

Total savings generated inthe EU over 5 years through regular use ofCalcium + Vitamin D supplements(equivalent to € 3.96 bn per annum)

19.8 billion



The effect of Omega 3

supplementation

Number and percentage of over 55s in the EU considered to be at risk of experiencing a CVD-attributed hospital event

24%

€ 34,637 / event

€ 1.33 trillion

5 years

38.4m

31%Aged 55+

How Omega 3 could save

€13 bn a year

in EU healthcare costs

Reduction in the relative risk of an individual aged 55+ experiencing a CVD-attributed hospital event through the daily consumption of:

1000 mg Omega 3 EPA+DHA

-4.9%


€13 bn a year



€13 bn a year


The EU has permitted several health claims for

omega-3 in the context of heart health.

EPA and DHA contribute to

the normal function of the

heart

DHA and EPA contribute to

the maintenance of normal

blood triglyceride levels

DHA and EPA contribute to

the maintenance of normal

blood pressure

For foods which are at least a

source for omega-3

Min. 250 mg/day

For food which provides a

daily intake of 3 g of EPA and

DHA

For food which provides a

daily intake of 2 g of EPA and

DHA

€ 64.5billionTotal savings generated in the EU over 5 years through more widespread regular use of Omega 3 supplements (equivalent to € 12.9 bn per year)

Number of preventable cases, over 5 years, of CVD in people aged 55+ through more widespread regular use of Omega 3 food supplements

1.5million

€ 2.29return for every

€ 1spent on Omega-3

supplements


€13 bn a year


36

Supplementation of the diet with nutrients and food compounds can

lead to significant reductions of hospital events and thus healthcare

costs.

Ca/Vit. D

Omega-3

Phytosterols

Relative risk

reduction

Number of

preventable

events

(over 5 years)

Healthcare

costs savings

(over 5 years)

Return for every

€ 1 spent

- 4.9 % 1.5 Mn € 64.5 Bn € 2.29

- 2.3 % 0.85 Mn € 26.5 Bn € 4.37

- 15 % 0.93 Mn € 19.8 Bn € 3.47

More information under: www.foodsupplementseurope.org

28.11.201837

Conclusion

◼ A rethink of our understanding of health is needed. Health promotion should be in the center of policy

activities.

◼ Food supplements can play an important role to close nutritional gaps and meet individual needs.

◼ Diagnosis of the individual nutritional needs and regular measurement about the effect of

supplementation are important steps to improve the nutritional status of people and improve their

overall health.

◼ Health care costs are steadily increasing. Food supplements can help to reduce health care costs

and thus should be considered as one measure in policy making.

28.11.201838

Special Thanks

Patrick Coppens

Ute Obermüller-Jevic

Marianne Heer

Mareike Kampmann

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