For instance, vitamin D could be fortified to staples foods such as wheat, rice, as well as dairy products and edible oils.
Vitamin D supplementation could also be embedded into maternal health, childhood immunisation schedules, and elder care services, said the think-tank in its report “Roadmap to Address Vitamin D Deficiency in India” launched on April 8.
While 20 per cent of Indians are vitamin D deficient, there is a higher rate of deficiency among East Indians at 38.81. The rate of deficiency is lower among North Indians at 9.4 per cent.
Children, adolescents, pregnant women and the elderly are the most vulnerable to vitamin D deficiency.
Dietary and culinary habits, such as the prolonged boiling of milk and other dairy-based beverages like tea and coffee, may have reduced the vitamin D content available from food intake, and these are some of the reasons contributing to the deficiency, the report noted.
“A significant proportion of the Indian population, particularly in the southern and eastern regions, is lactose intolerant, limiting their milk consumption and reducing both calcium and vitamin D intake,” states the report.
Staying indoors for a prolonged period of time among urban Indians, and measures taken to achieve fairer skin - such as the use of sunscreen, wearing full-body coverings are some of the other reasons for vitamin D deficiency.
This is exacerbated by higher melanin content in Indian skin, and hence, the need for longer sun exposure for the skin to produce vitamin D.
“The naturally higher melanin content in Indian skin further reduces the efficiency of Vitamin D production, requiring prolonged sun exposure to synthesise adequate levels.
“Studies suggest that individuals with darker skin may require three to six times longer exposure to produce the same amount of vitamin D as those with lighter skin tones.”
In view of the above factors, it has called for stronger food fortification, supplementation programs, and reducing the current 18 per cent GST on vitamin D supplements to improve the situation.
Currently, it said that the average price of a vitamin D tablet, specifically one containing 1000 IU of cholecalciferol or vitamin D3, has been fixed by the National Pharmaceutical Pricing Authority (NPPA) at INR 4.31 (US$0.05).
However, the price of a pack of 10 tablets of cholecalciferol can range between INR 48 (US$0.55) to INR 130 (US$1.50).
It pointed out three reasons for it, including a high GST.
“First, the pricing calculation is not based on the cost of production but on the average price.
“Second, a high goods and service tax (GST) of 18 per cent pushes the price up and third, the NPPA only fixes the price of cholecalciferol derived from animal sources and not that of ergocalciferol, a plant-based alternative,” said the report.
There is also a 10 per cent import duty on vitamin D2 and D3 supplements, which it said should be lowered to enhance affordability and accessibility.
At the same time, it has called for more affordable vitamin D testing services and test kits to help consumers detect and manage vitamin D deficiency.
In this regard, it has proposed local production of cost-effective testing solutions, as well as product reformulation that can be encouraged through subsidies.
“There should be more R&D for domestic production of cost-effective testing solutions, which along with product reformulation, can be incentivised through subsidies.
“Some areas of research should include 1) the efficacy of co-fortification with vitamin D and A, 2) bio-addition of vitamin D in foods, 3) safety and effectiveness of delivering vitamin D with childhood vaccinations and 4) preserving Vitamin D in cooking.”
Food fortification
Currently, food fortification is voluntary in India, which the report has identified as an area to improve vitamin D intake.
“The report identifies gaps in food fortification, which include the voluntary nature of fortification, the lack of incentives for product reformulation, the limited number of products allowed for fortification (only milk and oil), the exclusion of milk from the food given to children under the mid-day meal system, the omission of the unorganised/informal sector from fortification drive, etc.
“Staples are not fortified with vitamin D; therefore, fortification hardly reaches the masses through the public distribution system.”
The report has thus urged for the strengthening of food fortification to address vitamin D deficiency. This includes allowing not just plant-based vitamin D, but also animal-origin ones, to be permitted for food fortification use.
Currently, the Food Safety and Standards Authority of India (FSSAI) permits only plant-based sources of vitamin D for food fortification, the report highlighted.
“Allowing vitamin D derived from animal by-products, such as lanolin (wool grease), could significantly reduce the reliance on costly imports of plant-based Vitamin D,” the report said, adding that animal-origin vitamin D should be subjected to mandatory disclosure.
