New Research: Vitamin D - A Significant Public Health Issue

Transcription

1 1) The Issue of Vitamin D New Research: Vitamin D - A Significant Public Health Issue A healthy balanced diet is considered essential to provide a good start in life. However, a recent National Diet and Nutrition Survey (2008/09 to 2010/11) 1 in the UK revealed a nutrition gap in children under 5 years. A large percentage of young children under 5, are not achieving the recommended intake (RNI) for vitamin D. Vitamin D is vital for pregnant women, breastfeeding women, babies and young children. Professor Mike Kelly, Director of the Centre for Public Health Excellence at NICE 2 has highlighted three key reasons why vitamin D is so important: 1. Vitamin D is essential for growth and development of the baby s bones, by regulating the absorption of calcium and phosphate 2. The developing infant relies on the mother s vitamin D stores during pregnancy and breastfeeding 3. If the mother s own vitamin D stores are inadequate, lack of vitamin D may adversely affect foetal bone mineralisation 2) What is the recommended intake (RNI) for vitamin D? Recommended Daily Supplement Micrograms (µg) International Units (IU) Pregnant & breastfeeding women Breastfed infants from months or from one month if the mother s nutritional status is poor Formula-fed infants who are drinking less than 500mls formula milk/day Children aged 1 to 4 years Breastfed preterm infants A vitamin supplement that includes vitamin D is usually prescribed Sources of Vitamin D Sunlight is the most important source of vitamin D o Due to a lack of clarity about safe exposure to sunlight in relation to skin cancer, a joint consensus statement has been produced, agreed and endorsed by the British Association of Dermatologists, Cancer Research UK, Diabetes UK, the Multiple Sclerosis Society, the National Heart Forum, the National Osteoporosis Society and the Primary Care Dermatology Society. The consensus statement explains the importance of vitamin D for bone health. It highlights the importance of safe exposure to sunlight without use of sunscreen. It highlights a lot of uncertainty around what levels qualify as optimal or sufficient. Please refer to website: 1 Bates (2010) 2 NICE Guidance (PH11) Maternal and Child Nutrition (2008)

2 Dietary Sources of Vitamin D Very few foods naturally contain Vitamin D. Oily fish and fish oils is a significant source Eggs and meat provide very small amounts Breast milk contains extremely small amounts, (depending on the mother s own vitamin D levels) Fortified foods such as: 1) Processed and some powdered milks 2) Evaporated milk 3) Margarine 4) Fat spreads 5) A few Breakfast cereals are fortified with vitamin D 6) Some brands of yoghurts Vitamin D content in UK foods Taken from Food Standards Agency (2002) 3 Vitamin D Food-Portion sizes for Micrograms (µg) International Units (IU) toddlers* 2-3 Tbsp Sardines canned in tomato sauce (45g) 1 Egg (60g) ½-1 slice of cooked lamb 1-2 Small slices of chicken (30g) Vitamin D Fortified Foods Micrograms (µg) International Units (IU) mls Formula milk for over one year mls Infant formula (from birth) mls of Evaporated milk Heaped tbsp. of fortified breakfast cereal (18g) 1 Tsp of margarine (5g) Food Standards Agency (2002)

3 Household spoons vary in size: tablespoons (Tbsp) are about 15ml and teaspoons (Tsp) are about 5ml As you can see there is very small amount of vitamin D in foods for an infant to meet their optimum vitamin D intake. For an infant to meet their vitamin D requirements, they would need to eat 7 eggs a day which is clearly not appropriate for a young child. 3) Consequences of Low Vitamin D Status Babies and toddlers with very low amounts of vitamin D could have fits or suffer from rickets (a disease when bones become soft and misshapen) 4 Children are more likely to develop diabetes, allergies, asthma and infectious diseases as they get older. New evidence (meta-analyses and systematic reviews) showing the possible link of low vitamin D to oesophageal, stomach and ovarian cancer. The risk of severe pre-eclampsia in pregnant women is higher in those with low levels of vitamin D 5. New evidence emerging of a link between sudden infant death syndrome and low vitamin D levels. 4) What can be done to address this issue Recommendations Vitamin D supplement of 10µg (400IU) every day is recommended during pregnancy and while breastfeeding, as infants are unlikely to get enough vitamin D from foods and sunshine alone. The Healthy Start Scheme 6 should be actively promoted to eligible families. Healthy Start for women contain Folic Acid and vitamins C and D and the Healthy Start children s vitamin drops contain vitamins A, C and D. Please refer to the Best Practice Guidance when advising women about vitamin D. This can be accessed from: july%202012_dps_v7.pdf Role of Health Professionals Raise the importance of adequate vitamin D consumption both during antenatal visits and opportunistically. Explain how to complete the Healthy Start application form. The Healthy Start resources and application forms can be accessed from the website 7 4 SACN (2007) 5 Dror (2011) and Bodnar (2007) 6 Healthy Start Website (2012)

4 Advise women to take vitamin D supplements to ensure they are getting all the nutrients they need in line with NICE Public Health Guidance Maternal and Child Nutrition (2008) guidance. Ensure information and advice is available to women from midwives during the booking appointment at the beginning of pregnancy. This should include information on the benefits of taking a vitamin D supplement of 10µg a day during pregnancy and while breastfeeding. 5) What is the Healthy Start Scheme? Healthy Start is a scheme for eligible families to apply for Healthy Start vouchers and coupons. A Healthy Start voucher entitles a family to products to the value of 3.10 per week. These vouchers can be spent on milk, plain fresh or frozen fruit and vegetables and infant formula milk from their local supermarket. The Healthy Start coupons can be exchanged for free vitamins from Children s Centres or Health Clinics. Eligible pregnant women qualify for one voucher per week worth For each baby under the age of one, families will receive two vouchers per week worth a total of For each child aged over one and under the age of 4, the family will receive one voucher per week worth The Healthy Start vitamin drops for children contain: Vitamin A for growth, vision and healthy skin. Vitamin C to help maintain healthy tissue in the body. Vitamin D for strong bones and teeth. The Healthy Start vitamin tablets for women contain: Folic acid to reduce the chances of having a baby with Spina Bifidaneural tube defect. Vitamin C to help maintain healthy tissue. Vitamin D for strong bones and teeth. 6) How can families access the Healthy Start Scheme Families can access the scheme by asking their GP, Health Visitor or Midwife for a Healthy Start application form. The health professional can help them to complete the application form and must sign Part B of the application form. If the family qualifies for the scheme, they will receive a confirmation letter from National Healthy Start that they qualify for the scheme. They will receive green Healthy Start vitamin coupons every eight weeks to exchange for free Healthy Start vitamin drops for infants and vitamin tablets for women. The vouchers will be sent in the post.

5 A list of places issuing the Healthy Start vitamins: You can access a full list of places in Kingston that are issuing Healthy Start vitamins at: *Oak Hill, Manor Drive and Hawks Road Health Centres also take payment for those who do not qualify for free vitamins. All of the Children Centres in Kingston are issuing free Healthy Start vitamins 7) Further Information To access further information about Healthy Start please contact the Healthy Lifestyle Confidential Helpline on Freephone: References 1) Bates, B. Lennox, A. and Swan G. National Diet and Nutritional Survey: Headline results from Years 1 and 2 (combined) of the Rolling Programme (2008/ /2010): London HMSO (2010) 2) NICE Guidance (PH11) Maternal & Child Nutrition (2008). Can be accessed from 3) Food Standards Agency. McCance & Widdowson s The composition of foods, Sixth summary edition. Cambridge. The Royal Society of Chemistry (2002). 4) SACN. (2007). Update on Vitamin D: Position Statement by the Scientific Advisory Committee on Nutrition. London 5) Dror, D.K. (2011). Vitamin D status during pregnancy: maternal, fetal and postnatal outcomes. Current Opinion Obstet. Gynaecology. 23, p ). 92, p. 3517e22 6) Healthy Start Website (2012). Can be accessed from: 7) Consensus Vitamin D Position Statement. (2012). Accessed from: 8) Department of Health (2011).National Diet and Nutrition Survey: Headline results from year 1 and year 2 (combined) of the rolling programme (2008/ /10)

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