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Ranjana Sundaresan March 01 , 2015
  • Nationwide studies in India are showing a significantly high prevalence of vitamin D deficiency amongst Indians
  • Vitamin D is not just linked to bone health, as low levels have been shown to have a wider, negative impact on overall body functions
  • This holds opportunity for dairy companies to offer vitamin D fortified milk and dairy drinks
90% of Indians are estimated to be deficient in vitamin D
New nationwide studies in India are showing that Indians are chronically deficient in vitamin D, irrespective of age, social status, geographic location (within India), and access to healthcare. Vitamin D deficiency (VDD) has been seen in equal quantities in rural and urban areas; amongst populations that consume a diet rich in vitamin D (for example, fatty fish such as mackerel, salmon, tuna and cod) and those that do not; and even amongst athletes and those who receive plenty of exposure to the sun.

An article titled “Current Status of Vitamin D Deficiency in India” published by the All India Institute of Medical Science puts the prevalence of VDD at as high as 90% amongst all age groups. However, VDD manifests itself in misleading or simple symptoms and sometimes no symptoms at all, which makes diagnosing it all the more difficult.

The study “Vitamin D Deficiency in India: Prevalence, Causalities and Interventions”, published in the journal Nutrients, said that VDD is the most underdiagnosed and undertreated nutritional deficiency, not just in India but across the world. Until recently, it was known that VDD played a significant role in developing brittle bones and other skeletal disorders such as rickets and osteoporosis. India already has a high prevalence of osteoporosis; a World Health Organisation study estimated that nearly half the country’s population would become victim to this condition in the coming decade.

New studies highlight the importance of vitamin D for overall good health
Research is also finding that vitamin D plays a vital role in maintaining overall good health and not just to synthesise and maintain levels of calcium and phosphate in the body. VDD is being linked to a large number  of conditions, including cardiovascular disease, diabetes, hypertension, tuberculosis, depression and even cancer. In 2013, according to a global study coordinated by the Institute for Health Metrics and Evaluation at the University of Washington, tuberculosis and ischemic heart disease were the leading two causes of death in India for those in the 15-49 age group; 408,114 deaths from these two causes were reported during the year.

Vitamin D is also believed to contribute towards regulating cell growth and differentiation. But there is little awareness about these functions.

The most significant source of vitamin D is not dietary; it is synthesised by the body itself upon exposure to ultraviolet B (UVB) rays in sunlight. But for India, this poses a few unique challenges. The maximum impact of UVB rays can be felt on the subcontinent during midday, and not during mornings or evenings, as is commonly believed. The sunrays are at too much of an angle to the earth’s surface for the UVB rays to have much of an impact during the morning/evening. Few Indians would be willing to expose themselves to the midday sun for the fear of tanning and the social preference for a light skin colour – India is one of the largest markets in the world for “fairness creams”.

But darker skin is also richer in melanin, which acts as a natural sunscreen; so darker skin needs a lot more exposure to sunlight than lighter skin to ensure adequate vitamin D.

There is potential for vitamin D fortified dairy drinks
The US-based non-profit Vitamin D Council recommends 1,000IU of vitamin D per day per 25 pounds of body weight for children and 1,500- 2,000IU per day for adults. Our bodies can produce more than enough vitamin D on their own when exposed to enough sunlight. However, with cultural and environmental challenges, the best way to increase vitamin D levels in India is through supplements, particularly since even foods with natural vitamin D do not have enough for consumers to get the recommended amounts.

This holds significant opportunity for dairy companies to address this public health issue by offering vitamin D fortified milk and dairy drinks (milk itself is a source of vitamin D but not a major one). In India, vitamin D fortification is a niche claim and only around 9% of all dairy drink launches claim to have this functionality; the number of such launches increased during 2011-13 but dipped slightly in 2014. (See Figure 1)

Fortifying white milk in particular is important given India’s high milk consumption – in 2013, while per capita consumption in retail was just 7.7 litres, total per capita consumption of milk was 114.7 litres, according to Mintel estimates, based on data from the National Dairy Development Board and the Economist Intelligence Unit. Milk is an everyday staple and, in some cases, dairy is the primary source of protein and calcium for the country’s large vegetarian population. Milk is consumed in a number of other forms, many of which are homemade, such as flavoured milk drinks, yogurt and yogurt-based drinks (buttermilk and lassi), ghee, traditional sweets and paneer.

Milk drink launches in India that have been fortified with vitamin D
MRSDMM Mahanand Wholesome
Toned Milk
This vegetarian product is fortified with vitamin A and D, and free from preservatives. It has been sterilised by the UHT process, and retails in a 1L recyclable pack.

Thirumala Skimmed Milk
This ready-to-drink vegetarian milk product is fortified with vitamins A and D, and free from added preservatives. It is 99% fat free, does not require refrigeration, and can stay fresh for 90 days from the manufacture date. The product retails in a 500 ml recyclable pack.

Amul Kool Premium Kesar
(Premium Saffron Flavoured Milk)
This is sterilised homogenised flavoured milk product that is suitable for vegetarians. It has added vitamin A and vitamin D, and retails in a 200 ml bottle.

Cavin’s Strawberry Milkshake
This is described as a healthy and nourishing drink made with the goodness of pure Cavin’s milk. It provides children with physical and mental energy, is a rich source of calcium and protein and is 100% free from preservatives. The UHT-treated product is suitable for vegetarians and retails in 200 ml recyclable pack.

In fact, given the importance of vitamin D to the body, fortifying all milk at the time of processing and before being sold is something that the Food Safety and Standards   Authority of India (FSSAI) might want to make compulsory. This is a step that is legally mandated in the US and Canada for liquid milk; according to the USFDA, milk should contain 400-600IU per quart (0.95 litre) of milk.

It is also vital to spread awareness of the necessity of vitamin D for the body and the potential public health crisis its deficiency could lead to. National mass media campaigns by government bodies, NGOs and  even companies themselves are likely to go a long way in educating consumers, particularly in getting them out in the sun. There are also opportunities for brands to sponsor check-ups or testing for VDD in neighbourhoods across the country, which in turn will make consumers aware. This will also allow brands to highlight their contribution towards meeting consumers’ nutritional needs.

According to the Internet and Mobile Association of India, the country was expected to see the number of Internet users grow to 302 million by the end of 2014, making it the second largest Internet user base in the world, after China. This opens up new avenues for promotions and campaigns through social media and brand websites.

The analyst's view
  • The high prevalence of vitamin D deficiency in India and the social conditioning that keeps consumers from being exposed to adequate sunlight has made it necessary for India to look at alternate means of getting vitamin D.
  • Given the high consumption of dairy products in India, there is immense scope for dairy companies to offer consumers milk fortified with additional vitamin D, which can then also be used to make other homemade dairy products.
  • As VDD reaches epidemic proportions in India, it is also necessary for the government to look at this condition as a public health issue. By making it mandatory for all milk to be fortified with vitamin D prior to being sold, there is scope to increase the levels of vitamin D in the population.
  • There is also a need to launch nationwide awareness campaigns to educate consumers on the importance of maintaining vitamin D levels in the body.
(The author is food and drink analyst at Mintel India)

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