Am rather concerned by the stipulation that all over 65s should have a vitamin D supplement
when the evidence is rather less clear: see Cochrane, who are also clear about risk of harms.
Ironic, given how few commercial skin products are SPF- free.
Our reference: CEM/CMO/2012/04 Gateway reference: 17193 To: General Practitioners Practice Nurses Health Visitors Community Pharmacists 2 February 2012 Dear Colleague ~~~ The Scottish Government ,DH)Department of Health VITAMIN D - ADVICE ON SUPPLEMENTS FOR AT RISK GROUPS We are aware that some of the UK population may be at risk of vitamin D deficiency. This is a concern, particularly for at-risk groups such as pregnant women and infants and young children, which is why we, the Chief Medical Officers for the United Kingdom, are writing to health professionals to increase awareness of this important issue. Last year the Chief Medical Officer for Scotland, Sir Harry Burns, wrote to health professionals in Scotland on this topic. http://www .scotland.gov. uk/Topics/Health/health/Health/EatingHealth/vitamind/CMOletter This letter is a restatement of this advice and contains important information about prescribing and recommending vitamin D supplements to those groups of the population at risk of vitamin D deficiency. The National Diet and Nutrition Survey, demonstrates that up to a quarter of people in the UK have low levels of vitamin D in their blood, which means they are at risk of the clinical consequences of vitamin D deficiency!. Although we do not have clear data on the implementation of the current advice on the use of dietary supplements containing vitamin D by 1 Data from years 1 & 2 of the National Diet and Nutrition Survey (NDNS) rolling programme. Low status is defined by the Department of Health as a plasma concentration of 25-hydroxyvitamin D (25(OH)D, the main circulating form of the vitamin) of below 25nmol/l (equal to 10 ng/ml). the at-risk groups listed below, information from the 2005 Infant Feeding Surve/ suggests that the majority of women do not take vitamin D supplements during pregnancy. Vitamin D deficiency impairs the absorption of dietary calcium and phosphorus, which can give rise to bone problems such as rickets in children, and bone pain and tenderness as a result of osteomalacia in adults. The following groups of people are at risk of vitamin D deficiency: • All pregnant and breastfeeding women, especially teenagers and young women. • Infants and young children under 5 years of age. • Older people aged 65 years and over. • People who have low or no exposure to the sun, for example those who cover their skin for cultural reasons, who are housebound or confined indoors for long periods. • People who have darker skin, for example people of African, African-Caribbean and South Asian origin, because their bodies are not able to make as much vitamin D. Recommendations All UK Health Departments recommend: • All pregnant and breastfeeding women should take a daily supplement containing 10 micrograms of vitamin D, to ensure the mother'srequirements for vitamin D are met and to build adequate fetal stores for early infancy. • All infants and young children aged 6 months to 5 years should take a daily supplement containing vitamin D in the form of vitamin drops, to help them meet the requirement set for this age group of 7-8.5 micrograms of vitamin D per day. However, those infants who are fed infant formula will not need vitamin drops until they are receiving less than 500ml of infant formula a day, as these products are fortified with vitamin D. Breastfed infants may need to receive drops containing vitamin D from one month of age if their mother has not taken vitamin D supplements throughout pregnancy. • People aged 65 years and over and people who are not exposed to much sun should also take a daily supplement containing 10 micrograms of vitamin D. Are free vitamin D supplements available? Women and children from families who are eligible for the Government's Healthy Start scheme3 can get free vitamin supplements which include vitamin D, in the form of tablets for women and drops for children. It is the statutory responsibility of PCTs, the local trust or Health Board4 to make Healthy Start vitamins available locally to women and children on the scheme. Health 2 Bolling K, Grant C, Hamlyn B, Thornton A (2007). Infant Feeding Survey 2005. The Information Centre 3 Healthy Start is a UK-wide statutory scheme providing a means-tested nutritional safety net to pregnant women and families with children under four years old in very low income and disadvantaged families. It provides vouchers for basic healthy foods and coupons for Healthy Start vitamin supplements to women and children in around 460,000 UK families. professionals should fa milia rise themselves with local distribution arrangements for Healthy Start vitamins. Uptake of the Healthy Start vitamins among families qualifying for the scheme is currently low. However, the UK Health Departments are committed to continuing to support NHS staff involved in maintaining local distribution arrangements, and those in a position to champion Healthy Start, to share and encourage good practice. It is important that women and families who may be eligible for Healthy Start know how they can apply for the scheme, and are made aware of how they can obtain vitamins locally. Women qualify for Healthy Start from the 10th week of pregnancy or if they have a child under four years old, and if she or her family receive: • Income Support, or • Income-based Jobseeker's Allowance, or • Income-related Employment and Support Allowance, or • Child Tax Credit (but not Working Tax Credit unless the family is receiving Working Tax Credit run-on only) and has an annual family income of £16,190 or less. Women who are under 18 and pregnant also qualify, even if they do not get any of the above benefits or tax credits. Further information can be found on the Healthy Start website at www.healthystart.nhs.uk NHS organisations can choose to sell the vitamins or supply them free of charge to those who are not eligible for Healthy Start, and we encourage thiss. Alternatively, vitamin D supplements are available for purchase or can be prescribed for those who are not eligible for the scheme. The National Institute for Health and Clinical Excellence (NICE) publiC health guidance on maternal and child nutrition6 (publiShed in 2008 and updated in 2011), supports the UK Health Departments' recommendations on vitamin D supplements. NICE recommend that during the booking appointment at the beginning of pregnancy, midwives should offer every woman information and advice on the benefits of taking a vitamin D supplement during pregnancy and while breastfeeding. NICE also recommend health professionals take particular care to check that women at greatest risk of deficiency are following the advice during pregnancy and while breastfeeding. This includes women from ethnic minority groups (particularly of African, South Asian or African-Caribbean origin) and women who do not get much sun (for example, women who cover their skin when outside or who spend large amounts of time indoors). 4 The Healthy Start Scheme and Welfare Food (amendment No.2) Regulations 2006 (2818). Section 7 and The Healthy Start Scheme and Day Care Food Scheme Regulations (Northern Ireland) 2006 (S.R. 2006 No. 478) Regulation 11 'Provision of Healthy Start vitamins' 5 For more information about Healthy Start vitamins including distribution case studies visit www.healthvstart.nhs. uklfor -health-professionals/vitam ins 6 NICE public health guidance (2008). PH 11 Improving the nutrition of pregnant and breastfeeding mothers and children in low-income households. It is important for public health that low levels of vitamin D are avoided. As health professionals, you can make a significant difference to people's health by making those at risk aware of how important it is to make sure they get enough vitamin D, and how they can get access to these important daily supplements. We, the Chief Medical Officers, thank you for your continued help and support with raising awareness of this issue, which in turn should raise the levels of vitamin D in those at risk, and vulnerable groups. PROFESSOR DAME SALLY C DAVIES CHIEF MEDICAL OFFICER ENGLAND CHIEF SCIENTIFIC ADVISER DR TONY JEWELL CHIEF MEDICAL OFFICER WALES DR MICHAEL McBRIDE CHIEF MEDICAL OFFICER NORTHERN IRELAND ~C~b~q~ Sir HARRY BURNS CHIEF MEDICAL OFFICER SCOTLAND