Vitamin D has become a hot topic. Evidence of widespread low vitamin D status, alongside isolated reports of the re-emergence of rickets, a disease that had been largely eradicated in the UK, has raised considerable interest from all quarters including the government. Additionally, emerging research has suggested that low vitamin D status may also be associated with a number of non-skeletal disorders.
Last year, the chief medical officer for England called for a review looking at the cost effectiveness of offering free vitamins to all children below five years of age. Additionally, NICE published its guideline ‘Vitamin D: increasing supplement use among at-risk groups, including young children’. Now the Scientific Advisory Committee on Nutrition (SACN) has published its draft Vitamin D and Health report that makes new recommendations for vitamin D intakes for the UK population. A recommended (safe intake) of 8.5-10 µg vitamin D a day has been proposed for those aged below one (including exclusively breastfed infants) and 10 µg/day for those aged one year and older, an increase from the current recommendations of 7-8.5µg/day.
Why is low vitamin D status prevalent in our population and can nurses do anything to address this in the paediatric population?
If we look at where we get vitamin D from, perhaps we may understand the issue better. Vitamin D synthesised in the skin by the action of sunlight is the main source for most people; but dietary sources are important when exposure to sunlight containing the appropriate wavelength is limited, for example in the winter months. However, there are few natural dietary sources. Oily fish is the richest dietary source and the major contributor to adult intake, but contributes only 8% to vitamin D intake in young children. Other natural food sources include eggs, meat and liver. Fortified products, such as certain breakfast cereals, dairy products like fortified fromage frais, and fat spreads can also make a useful contribution to vitamin D intake.
In addition, lifestyle factors play an important role in determining vitamin D status. Less outdoor playtime, sun avoidance, cultural practices that require clothing that covers the majority of the skin and increased use of sun protection may all increase risk of inadequate vitamin D status. The problem can start in pregnancy where infants of vitamin D-deficient mothers are at high risk of vitamin D deficiency, and will be at an even higher risk if they are fed on breast milk for a prolonged period of time and not given vitamin D supplements.
If the new proposed recommendations are to become official, then attention must focus on ways to achieve them. The recommended intake may be difficult to meet from dietary sources alone, with young children currently consuming around 2µg a day from food, a far cry from the suggested new target of 10µg. So we face a challenge – particularly when the role of sunlight in preventing vitamin D deficiency may seem to conflict with sun protection messages.
The key to making inroads is the health professional. Therefore health professionals should:
· Be aware of any local supplement policies.
· Recommend free vitamin supplements under the Healthy Start scheme for low-income families (for pregnant mothers and children under 4 years of age).
· Advise women as to where they can obtain supplements.
Currently uptake of supplements is poor, possibly due to distribution and access problems, as well as low awareness and poor promotion of the scheme by health professionals. You can do something to change this.
Ayela Spiro, Helena Gibson-Moore and Sarah Coe are all nutrition scientists at The British Nutrition Foundation. All three work together to be expert bloggers in the Nursing in Practice nutrition resources centre. Individual descriptions are below:
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