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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Vitamin D advice issued

Public Health England has issued new advice on vitamin D based on the recommendations of the Scientific Advisory Committee on Nutrition.

The advice notes that vitamin D is made in the skin on exposure to UVB in sunlight but since this is difficult to quantify a daily dietary intake of 10 micrograms is being recommended.

It is noted that in spring and summer the majority of the population get enough vitamin D through sunlight on the skin and a healthy, balanced diet. In autumn and winter months it is difficult for people to meet the 10 microgram recommendation from consuming foods naturally containing or fortified with vitamin D so people should consider taking a daily supplement containing 10 micrograms of vitamin D.

The advice also considers people whose skin has little or no exposure to the sun, like those in institutions such as care homes, or who always cover their skin when outside and recommends that they need to take a supplement throughout the year.

Ethnic minority groups with dark skin, from African, Afro-Caribbean and South Asian backgrounds, may not get enough vitamin D from sunlight in the summer and therefore should consider taking a supplement all year round.

Recommendations are also made for children under 5. Children from birth to 1 year old who are breast feed should be given a daily supplement containing 8.5 to 10 micrograms of vitamin D. Formula fed children of this age consuming 500ml or more each day do not require a daily supplement because infant formula is fortified with vitamin D. Children aged 1 to 4 years should be given a daily supplement containing 10 micrograms of vitamin D. It is noted that low-income families can access vitamin D free of charge via Healthy Start schemes.

Action: Clinicians should be aware of this new advice. The advice consistently refers to "dietary sources" of vitamin D including foods naturally containing or fortified with vitamin D and supplements. As such prescribing of vitamin D purely for supplementation following this advice should be resisted.

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2 Comments to “Vitamin D advice issued”

  1. I would be interested in thoughts about residential/nursing home patients who are unlikely to get enough vitamin D but usually home policies are that no tablet could be taken without this being prescribed by a Dr? Even though above advice discusses to resist prescribing.

    Comment by Susan Moore — July 29, 2016 #

    1. @Susan,

      My opinion on this is that it is not a medicine, but a dietary supplement. Of course a good number of care home residents may well already be on a calcium and vitamin D supplement for a clinically sound reason and that's fine to continue. However, block starting everyone else on a vitamin D supplement would turn this public health advice about diet into a medical issue. consider it this way - if we take on prescribing for care home residents why should we not also treat other groups in the population? Until the Department of Health or NHS issue firm advice on this I believe we should maintain current practice.

      Comment by Matthew Robinson — July 29, 2016 #

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