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Offer at-risk groups vitamin D supplements

10m people’s health in England could be at risk because of low vitamin D status

Louise Prime

Thursday, 27 November 2014

The health of about 10 million people in England could be at risk because of their low vitamin D status, according to the National Institute of Health and Care Excellence. NICE’s latest public health guidance recommends better access to supplements for at-risk groups, but not routinely checking vitamin D status in asymptomatic people.

NICE points out that low levels of vitamin D can eventually lead to poor bone health and it is concerned that some people at risk are unaware of the fact. In its guidance, it is calling for better awareness of low vitamin D status, consistent information on who is at risk and better availability of supplements at the recommended dosage – 10mcg/day – to protect children from rickets, and adults from weakened bones.

Although skin can make vitamin D in sunlight, this can’t happen between mid-October and the beginning of April in the UK because the light isn’t of the correct wavelength; and in any case this is less effective in people with darker skin. People who cover their skin for cultural reasons or rarely or never go outside; children, pregnant and breastfeeding women; and those aged over 65 are also at greater risk of vitamin D deficiency (i.e. a plasma concentration of 25 hydroxyvitamin D <25nmol/l, or 10ng/ml). NICE is also concerned that many people are unaware that there are only limited food sources of vitamin D.

Its recommendations include that:

  • The Department of Health should work with manufacturers to ensure that vitamin D supplements contain the recommended daily amount for health, and it should amend existing legislation to allow Healthy Start vitamins to be more widely distributed and sold.
  • Local authorities should ensure that such supplements are widely available for all at-risk groups in local settings such as pharmacies, children’s centres, and GP reception areas and consider providing them free for at-risk groups, as well as encouraging pharmacies and supermarkets to stock the lowest cost supplements and promote them to at-risk groups. A year’s supply for an adult costs about £6.
  • Health professionals should not routinely test people’s vitamin D status unless they have symptoms of deficiency, they are considered to be at particularly high risk of deficiency, or there is a clinical reason to do so (for example, they have osteomalacia).
  • National activities should be developed to raise awareness about the importance of vitamin D among doctors, nurses, other professionals and the public.

Professor Adrian Martineau, NICE guidance developer and professor of respiratory infection and immunity at Queen Mary University of London, said: “The guideline underlines the need to help health professionals develop better awareness of the importance of vitamin D, and identifies training and continuing professional development as good opportunities for this. The guideline also advises that health professionals should recommend and record daily vitamin D supplement use to people at risk of low levels, at every available opportunity. For example this means asking people at risk during routine appointments and check-ups, child developmental checks, or when registering at a practice. The guideline recommends ensuring that computerised prompts on vitamin D are integrated into health and social care systems to support health professionals in making this a routine activity.”

As OnMedica reported in January this year, a study published in The Lancet Diabetes & Endocrinology showed that for people who are not deficient in vitamin D, there is no health benefit from supplementation – it does not reduce heart attack, stroke, cancer, and total fracture risk – and it might even be harmful.

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