Nurul Amin, a salesman at a pharmacy in Dhaka's New Eskaton area, has witnessed a sharp rise in vitamin D supplement sales these days, especially since the Covid-19 pandemic.
Having worked at the pharmacy for a decade, he mentions a recent influx of customers -- both with and without doctor's prescriptions -- seeking these supplements.
"Vitamin D supplements have become one of the top-selling vitamin products in recent times," Amin says.
The vitamin and mineral market in Asia-Pacific is the fastest-growing in the region, holding the largest share of the global market valued at $1.3 billion.
This rise has prompted local pharmaceutical companies to ramp up production of vitamin D supplements, while doctors, according to a The Financial Express (FE) market survey, are increasingly prescribing them based on diagnostic tests.
However, public health experts warn that many, especially in urban areas, are still unaware of the health risks associated with vitamin D deficiency.
Sunlight is the primary source of vitamin D, but fortifying widely consumed food products with the nutrient could offer an alternative when adequate sunlight exposure is unavailable.
Neighbouring India and Pakistan have already adopted policies to fortify edible oil with vitamin D and Bangladesh followed suit in 2013 by mandating vitamin A fortification for edible oil producers.
"The simplest way to address widespread vitamin D deficiency is through fortification of commonly consumed edible oils," said Dr Sohel Reza Choudhury, professor and head of the Department of Epidemiology and Research at the National Heart Foundation Hospital & Research Institute.
Making vitamin D fortification in edible oil mandatory through legislation, similar to the existing policy for vitamin A, would largely reduce deficiency rates, especially among low-income groups, Dr Choudhury argued.
This would provide them with a cost-effective way to address the issue, as he acknowledges that the full course of vitamin D supplements can be unaffordable for many in the face of stubbornly high inflation.
The doctor pointed out that the high cost of pathology tests and vitamin D medications in Bangladesh. Diagnostic tests for vitamin D deficiency can range from Tk2,000 to Tk6,000 at private diagnostic centres, according to the FE market analysis.
The National Heart Foundation has the expertise to support the government in developing a strategy for fortifying edible oil with vitamin D, said Dr Choudhury.
The NHF previously collaborated with the government to set stricter regulations on trans-fat in foods, following the World Health Organization's call.
Mustak Hassan Md Iftekhar, a former chairman of the Bangladesh Food Safety Authority (BFSA), recognised sunlight as the primary source of vitamin D. However, he admitted the difficulties arising from traditional attire and climate change impacts in ensuring sufficient sun exposure in Bangladesh.
"Fortifying edible oil, widely consumed across the country, could help reduce vitamin D deficiencies," said Mr Iftekhar, who currently works as a consultant at National Heart Foundation's Large Scale Food Fortification Country Advocacy Bangladesh (LSFF).
Before implementing the fortification, he advocated for careful dosage determination.
After the fortification becomes mandatory, he said industries would require some time as a grace period to set up machinery and make preparations.
The country's Food Safety Authority is now working to develop the food fortification law, while a technical working advisory committee of the Ministry of Health is working on vitamin D fortification.
Dr Asek Mahfuz, portfolio lead for Large Scale Food Fortification and value chain at the Global Alliance for improved nutrition, said the committee will analyse prevalence rates in other countries, determine deficiency levels, and establish appropriate dosages.
They will also consider whether a new fortification law is necessary or if the existing 2013 law for vitamin A fortification can be amended. A meeting, led by the director of the Institute of Public Health, will be held mid-January to address these issues, he added.
Dr Mahfuz underscored that genetic factors in the subcontinent sometimes limit the absorption of sunlight, prompting India and Pakistan to adopt food fortification. "Our existing policy for vitamin A fortification in edible oil can be expanded to include vitamin D as well," he suggested.
The prevalence of vitamin D deficiency in Bangladesh remains high, even among coastal fishermen, according to Abu Ahmed Shamim, associate scientist at BRAC University's James P Grant School of Public Health.
He underscored the effectiveness of food fortification, a practice used for centuries in various countries to combat deficiencies like goitre, rickets and beriberi.
A study published in PLOS shows that 87.5 per cent of the edible oil purchased in Bangladesh is commercially produced and fortifiable.
Besides, individuals in both rural and urban households obtain 73 per cent and 82 per cent of their daily vitamin A requirement from fortified oil, demonstrating the potential success of vitamin D fortification.
In Bangladesh, around 72 per cent of adult women are deficient to vitamin-D (10) followed by 46 per cent school-age children and 40 per cent preschool children, a findings published in IMC journal of Medical Science.
Different food products including milk and other dairy products, margarine, oil spread, orange juice, bread are fortified in different countries. However, those foods are not wholly consumed in Bangladesh.
Study has found evidences that vitamin-D in oil is stable during normal storage conditions.
In India, Food Safety and Standard Authority of India (FSSAI) took initiative to fortify edible oil with vitamin-A and D. its incremental cost was estimated at 10 paisa per kilogram. By early 2023, about 43 per cent of the edible are fortified as per FSSAI standards.
From 2017, Pakistan engaged mills in vitamin-D and A fortification programme and provided some subsidies for initial two years (for premix). Some 95 per cent mills were adequately fortifying edible oils by January 2021 under the programme.
ABM Zubair, Executive Director of PROGGA, an advocacy organization to eradicate Vitamin-D deficiency, said it became a silent epidemic globally and Bangladesh is nothing different.
"America, Canada, England, Finland, India has taken move to fortify food and edible oil with the vitamin which Bangladesh can consider to adopt to check healh complications," he said.
According to the International Osteoporosis Foundation (IOF) estimate, more than 5- per cent of all osteoporosis fractures will occur in Asia by 2025.
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