Prevention of vitamin D deficiency

Prevention of vitamin D deficiency in children (1):

• vitamin D deficiency is most common in infants, toddlers and adolescents in 'at risk' ethnic minorities (e.g. Asian, African Caribbean and Middle Eastern), but breast-fed babies and children in other groups may also be at risk
  • current Department of Health (DH) advice is that all infants and children under 5 years of age should take supplements containing at least 7µg (280 IU) of vitamin D daily (available free to those eligible under the Welfare Food Scheme) (1)
  • vitamin D in pregnancy and whilst breast-feeding
    • DH recommends that all pregnant and breast-feeding women in the UK should take supplements containing 10µg (400 IU) of vitamin D daily to prevent vitamin D deficiency in themselves and their babies (1)
  • recommendations appear reasonable on current knowledge about the extent of vitamin D deficiency and on the limited clinical trial evidence available (1)

Prevention of vitamin D deficiency in adults (2) (3):

• in people with fair skin
  • sun exposure
• exposure of the hands, arms, face, or back to non-reddening doses of sunlight in the UK, from April to September, for 15 minutes two or three times a week, should result in sufficient skin synthesis of vitamin D
  • people with darker skin may need longer exposure
• NHS Choices advice on safe sun exposure include:
  • Spend time in the shade between 11.00 am and 3.00 pm.
  • Make sure you never burn
  • Aim to cover up with a T-shirt, hat and sunglasses
  • Remember to take extra care with children
  • Then use factor 15+ sunscreen
• in the UK, guidance from the Committee on Medical Aspects of Food and Nutrition Policy (COMA) states that, for adults aged 65 years or older or those at risk (e.g. women who wear clothes to cover themselves extensively), the reference nutritional intake (RNI) for vitamin D is 10µg (400 IU) daily - there is no stated RNI for adults aged 18-64 years
  • foods with a high vitamin D content (10-20µg per 100g) include herring, sprat, pilchards, sardines and rainbow trout
  • foods with moderate vitamin D content (5-10µg per 100g) include salmon, tuna, mackerel, margarine and some supplemented breakfast cereals
  • foods with low vitamin D content (1-5µg per 100g) include eggs, ghee, tinned evaporated milk, some supplemented breakfast cereals, and oysters
  • foods with trace amounts of vitamin D (below 1µg per 100g) include other shellfish, butter, milk and cheeses
• either colecalciferol or ergocalciferol can be used to prevent primary vitamin D deficiency
  • daily dose of 10µg (400 IU) is adequate to prevent simple vitamin D deficiency in otherwise healthy adults at risk of deficiency.
  • in adults at high risk of vitamin D deficiency (e.g. south Asians, people aged over 65 years and living alone) then there may be the requirement for higher doses (e.g. 20µg [800 IU] daily)
  • when taking vitamin D supplementation then require monitoring of calcium as described in the linked item

References:

1. Scientific Advisory Committee on Nutrition (SACN) 2016. Vitamin D and health
2. Pearce SH, Cheetham TD. Diagnosis and management of vitamin D deficiency. BMJ. 2010 Jan 11;340
3. NICE. Vitamin D: supplement use in specific population groups. Public health guideline [PH56]. Published: 26 November 2014 Last updated: 30 August 2017