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Vitamin D: increasing supplement use among at-risk groups

About

What is covered

This pathway aims to increase supplement use to prevent vitamin D deficiency among at-risk groups as identified in 2012 by the UK Health Departments Vitamin D – advice on supplements for at risk groups – letter from UK Chief Medical Officers, and in 2007 by the Scientific Advisory Committee on Nutrition Update on vitamin D.
Vitamin D is essential for skeletal growth and bone health. Severe deficiency can result in rickets (among children) and osteomalacia (among children and adults).
Dietary sources of vitamin D are limited. The main natural source is from the action of sunlight on skin. However, from mid-October to the beginning of April in the UK there is no ambient ultraviolet sunlight of the appropriate wavelength for skin synthesis of vitamin D. National surveys suggest that around a fifth of adults and 8 to 24% of children (depending on age and gender) may have low vitamin D status.
The risks and benefits of sunlight exposure (including exposure to prevent vitamin D deficiency) are covered in the NICE pathway on sunlight exposure: risks and benefits.

Updates

Updates to this pathway

15 December 2014 Minor maintenance update.

Supplements

For the purpose of this pathway, a supplement refers to supplements of vitamin D, either alone or contained in multi-vitamin products (including Healthy Start supplements). It includes licensed products available only on prescription or through pharmacies and (unlicensed) food supplements available from a range of pharmacies and retail outlets.

Short Text

Vitamin D: increasing supplement use among at-risk groups

What is covered

This pathway aims to increase supplement use to prevent vitamin D deficiency among at-risk groups as identified in 2012 by the UK Health Departments Vitamin D – advice on supplements for at risk groups – letter from UK Chief Medical Officers, and in 2007 by the Scientific Advisory Committee on Nutrition Update on vitamin D.
Vitamin D is essential for skeletal growth and bone health. Severe deficiency can result in rickets (among children) and osteomalacia (among children and adults).
Dietary sources of vitamin D are limited. The main natural source is from the action of sunlight on skin. However, from mid-October to the beginning of April in the UK there is no ambient ultraviolet sunlight of the appropriate wavelength for skin synthesis of vitamin D. National surveys suggest that around a fifth of adults and 8 to 24% of children (depending on age and gender) may have low vitamin D status.
The risks and benefits of sunlight exposure (including exposure to prevent vitamin D deficiency) are covered in the NICE pathway on sunlight exposure: risks and benefits.

Updates

Updates to this pathway

15 December 2014 Minor maintenance update.

Sources

NICE guidance and other sources used to create this interactive flowchart.

Quality standards

Quality statements

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
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Pathway information

Supplements

For the purpose of this pathway, a supplement refers to supplements of vitamin D, either alone or contained in multi-vitamin products (including Healthy Start supplements). It includes licensed products available only on prescription or through pharmacies and (unlicensed) food supplements available from a range of pharmacies and retail outlets.

Supporting information

Culturally appropriate interventions take account of the community's cultural or religious beliefs and language and literacy skills by:
  • Using community resources to improve awareness of, and increase access to, interventions. For example, they involve community organisations and leaders early in the development stage, use media, plan events or make use of community-specific festivals.
  • Understanding the target community and the messages that resonate with them.
  • Identifying and addressing barriers to access and participation, for example, keeping costs low to ensure affordability and taking account of working patterns and education levels.
  • Developing communication strategies that are sensitive to language use and information needs. For example, involve staff who can speak the languages used by the community, and provide information in different languages and for varying levels of literacy (for example, using colour-coded visual aids and spoken rather than written information).
  • Taking account of cultural or religious values, for example, in relation to body image, separate physical activity sessions for men and women, beliefs and practices about hospitality and food, or dates, days, settings, or timings considered unsuitable for community events or interventions.
  • Providing opportunities to discuss how interventions would work in the context of people's lives.
  • Considering how closely aligned people are to their ethnic group or religion and whether they are exposed to influences from both the mainstream and their community in relation to diet and physical activity.
Population groups at higher risk of having a low vitamin D status include:
  • All pregnant and breastfeeding women, particularly teenagers and young women
  • Infants and children under 5 years
  • People over 65
  • 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.

Glossary

foods or non-food items such as cosmetics or pharmaceuticals permitted by and prepared according to Islamic law
a UK-wide government scheme that provides a 'nutritional safety net' for pregnant women and families on benefits and tax credits. Every 8 weeks, beneficiaries get vitamin coupons to swap for Healthy Start vitamins. The vitamin tablets for mothers contain folic acid and vitamins C and D. Healthy Start vitamin drops for children contain vitamins A, C and D
food (or premises where food is sold, cooked or eaten), cosmetics and pharmaceuticals that comply with Jewish law
(sometimes called vitamin D deficiency) is defined by the Department of Health as a plasma concentration of 25-hydroxyvitamin D (the main circulating form of the vitamin) of below 25 nmol/litre (equal to 10 ng/ml)
the amount of a nutrient needed to meet the needs of around 97% of individuals in a group
people who follow a vegan diet consume only plant products. They avoid all food, drink and non-food items, such as pharmaceuticals that contain any animal products

Paths in this pathway

Pathway created: December 2014 Last updated: February 2016

© NICE 2017

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