How could food supplements contribute to healthcare cost savings?

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1 How could food supplements contribute to healthcare cost savings? Bernd Haber, BASF SE NPN Symposium Gezondheidswinst met vitamines en mineralen,

2 Agenda Are we living healthy? Do we know our needs? example: Vitamin D Health Care Cost Savings Can supplements play a role?

3 Agenda Are we living healthy? Do we know our needs? example: Vitamin D Health Care Cost Savings Can supplements play a role?

4 Healthy nutrition for all but what is reality? Energy intake too high in many countries Increasing overweight and obesity Micronutrient intake often below recommendations NCDs dominate the global pattern of mortality Optionale Zusatzinformationen

5 More than 50% of Europeans are overweight or obese Optionale Zusatzinformationen

6 Overweight and obesity is increasing tremendously not only in Western countries Optionale Zusatzinformationen

7 Micronutrient deficiency or insufficiency is not only a problem of developing countries. [Troesch et al, BJN, 2012] Optionale Zusatzinformationen

8 Preventing NCDs before treatment makes sense as global health costs explode EXPENDITURE ON HEALTH Total expenditure in trillion USD per capita expenditure in USD 9,146 USA Japan Germany China ,006 3, Health promotion and disease prevention have to be a central part of any national and international health policy! BASF Human Nutrition

9 Is there more than improving our diet and lifestyle? A healthy diet & lifestyle is the cornerstone of disease prevention. 9 BASF Human Nutrition Tailored nutrient supply can help maintaining healthy life and reducing disease risk.

10 Agenda Are we living healthy? Do we know our needs? example: Vitamin D Health Care Cost Savings Can supplements play a role?

11 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.

12 Recommendations 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 nmol/l (28-32 ng/ml) German Nutrition Society (DGE): Recommended Intake (when endogenous synthesis is missing) IOF: Recommended Intake Intake from diet Adults in Germany (NVS II, 2008) Vitamin D / day (dietary recommendation) 20 µg (800 IU) min µg ( IU) 2,9 µg (men) 2,2 µg (women)

13 Vitamin D who knows his status? Optionale Zusatzinformationen

14 Prevalence of low vitamin D status is globally high. DGE IOF 88.1% < 75 nmol/l 37.3% < 50 nmol/l 6.7% < 25 nmol/l [nmol/l] DEFICIENT INSUFFICIENT (IN)ADEQUATE OPTIMAL [Hilger et al., BJN, 2014]

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

16 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 ( ) and summer season ( ) 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)

17 % of individuals Approx. 70% of BASF employees have deficient or insufficient vitamin D status after the winter season. 25(OH)D concentration in serum (winter levels) <12ng/ml (Deficiencyl) 12-20ng/ml (Insufficiency) 9% 1% 31% Vitamin D3 supplementation significantly improved the vitamin D3 status after winter season. 50% 40% 30% No supplements Supplements use >20-30ng/ml (Lower normal) 21% 20% >30-60ng/ml (Upper normal) >60ng/ml (Above normal) 38% 10% 0% < >20-30 >30-60 >60 25(OH)-D-concentration in serum (ng/ml)

18 % of individuals Still approx. 20% of BASF employees have deficient or insufficient vitamin D status after the summer season. 25(OH)D concentration in serum (summer levels) <12ng/ml (Deficiency) 12-20ng/ml (Insufficiency) >20-30ng/ml (Lower normal) >30-60ng/ml (Upper normal) >60ng/ml (Above normal) 40% 2% 2% 17% 40% Vitamin D3 supplementation further optimized the vitamin D3 status after the sommer season < >20-30 >30-60 >60 25(OH)-D-concentration in serum (ng/ml) No supplements Supplements use

19 People are different. People have different needs. Diagnosis is essential for personalized recommendations. Weizman personalized nutrition project (2015) Challenges of the future Diagnose Solution for the future Easy diagnosis leads to consumer awareness Monitor Regular measurement shows impact of DS Comply Positive effect triggers additional motivation 19 BASF Human Nutrition

20 Agenda Are we living healthy? Do we know our needs? example: Vitamin D Health Care Cost Savings Can supplements play a role?

21 The world s major regions are expected to see health care spending increase from 2.4 to 7.5 percent between 2015 and Source: Deloitte

22 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

23 Total number of DALYS due to osteoporosis-attributed bone fractures are exceptionally high in the EU. NEW ZEALAND SOUTH AFRICA AUSTRALIA CANADA ARGENTINA INDONESIA REP KOREA The cost of osteoporosis-attributed fractures, in terms of lost healthy life years lost, is over 2 million years per year globally. BRAZIL JAPAN INDIA US TURKEY TOTAL NUMBER OF DISABILITY-ADJUSTED LIFE YEARS LOST (DALYS) PER COUNTRY DUE TO OSTEOPOROSIS- ATTRIBUTED BONE FRACTURES, GLOBAL 2015 SOURCE: FROST & SULLIVAN CHINA RUSSIA EU

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 24

25 The effect of Calcium and Vitamin D supplementation

$treating bone fractures$

26 17.6 % 27.8 million of people aged 55 + in the EU living with osteoporosis Cost of treating bone fractures with wider use of Calcium + vitamin D supplements

$cost of treating these fractures 26.$ $24m related fractures occurring every year$

27 cost of treating these fractures 26.4bn / year 21,231 / event 1.24m related fractures occurring every year Cost of treating bone fractures with wider use of Calcium + vitamin D supplements

$fractures by regular consumption of 1000 mg$ $bone fractures with wider use of Calcium + vitamin$

28 Reduction of risk of osteoporosis-attributed fractures by regular consumption of 1000 mg Calcium + 15 mcg Vitamin D -15% Cost of treating bone fractures with wider use of Calcium + vitamin D supplements

29 The EU has permitted a health claim for calcium and vitamin D and risk of osteoporosis. 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 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 Cost of treating bone fractures with wider use of Calcium + vitamin D supplements

$96 bn per annum) 186,690 osteoporosis-attributed bone fractures preventable every year 3.$

30 19.8 billion Total savings generated in the EU over 5 years through regular use of Calcium + Vitamin D supplements (equivalent to 3.96 bn per annum) 186,690 osteoporosis-attributed bone fractures preventable every year 3.47 return for every 1 spent on calcium + vitamin D supplements Cost of treating bone fractures with wider use of Calcium + vitamin D supplements

31 The effect of Omega 3 supplementation

32 31% Aged m 24% Number and percentage of over 55s in the EU considered to be at risk of experiencing a CVD-attributed hospital event 34,637 / event 1.33 trillion 5 years How Omega 3 could save 13 bn a year in EU healthcare costs

33 -4.9% 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 How Omega 3 could save 13 bn a year in EU healthcare costs

34 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 For foods which are at least a source for omega-3 Min. 250 mg/day DHA and EPA contribute to the maintenance of normal blood triglyceride levels For food which provides a daily intake of 2 g of EPA and DHA DHA and EPA contribute to the maintenance of normal blood pressure For food which provides a daily intake of 3 g of EPA and DHA How Omega 3 could save 13 bn a year in EU healthcare costs

years, of CVD in people aged 55+ through more widespread regular

35 billion Total savings generated in the EU over 5 years through more widespread regular use of Omega 3 supplements (equivalent to 12.9 bn per year) million Number of preventable cases, over 5 years, of CVD in people aged 55+ through more widespread regular use of Omega 3 food supplements 2.29 return for every 1 spent on Omega-3 supplements How Omega 3 could save 13 bn a year in EU healthcare costs

36 Supplementation of the diet with nutrients and food compounds can lead to significant reductions of hospital events and thus healthcare costs. Omega-3 Relative risk reduction Number of preventable events (over 5 years) Healthcare costs savings (over 5 years) Return for every 1 spent % 1.5 Mn 64.5 Bn 2.29 Phytosterols % 0.85 Mn 26.5 Bn 4.37 Ca/Vit. D - 15 % 0.93 Mn 19.8 Bn More information under:

37 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

38 Special Thanks Patrick Coppens Ute Obermüller-Jevic Marianne Heer Mareike Kampmann

Has the science of supplementation reached the breakthrough point?

IADSA Annual Week 19-21 June 2018 The Food Supplement Sector: Evolution and Evaluation Has the science of supplementation reached the breakthrough point? Manfred Eggersdorfer PhD Professor for Healthy