Time for action on vitamin D

The article for the British Medical Journal (BMJ) Nutrition, Prevention & Health, written by BSMS MSc Public Health graduate Joe Williams and the university’s Principal Lecturer for Health Promotion and Public Health, Carol Williams, focused on the residential care sector and highlighted a problem in the understanding of vitamin D supplements as medicines rather than food supplements.

With residents in elderly care homes particularly at risk of vitamin D deficiency and with limited ability to make lifestyle decisions, the paper found that a gap exists between public health guidance and practice around vitamin D supplements.

Carol Williams said: “Recommendations that residents in elderly care homes should take 10mcg vitamin D each day have been around for more than 30 years. Moving into a care home should not mean an inevitable drift into vitamin D deficiency.”

Joe Williams

Carol Williams

"The study found that under the current guidance, care homes are only allowed to give residents vitamin supplements that have been prescribed. But doctors have also been advised by the NHS not to prescribe preventative vitamins because they can be bought cheaply over the counter. This means that elderly care home residents often do not get the vitamin D they require, leaving them at increased risk of falls"

Joe Williams said: “Those out of sight, including older adults in residential care settings, can often be forgotten. The coronavirus pandemic has brought the health and vulnerability of those in elderly care homes to the fore.

“The problems with vitamin D supplementation in care homes reveals both a failure to implement evidence-based recommendations and a social injustice in urgent need of public health advocacy and resolution.”

To conduct the study, interviews took place with members of care home staff, general practitioners (GPs), members of local authority public health departments and other relevant professionals in two areas of southern England.

Vitamin D is required for the regulation of calcium and phosphorus metabolism and it is also cited as heaving a potential positive role in numerous other aspects of health, including immunity, cardiovascular health, neurological conditions, respiratory infections, lung function and cancer.

Recently, there has also been interest in the possible link between the severity of COVID-19 symptoms and vitamin D deficiency.

In 2016, recommendations were made for daily vitamin D supplements to be extended to the entire UK population over the winter months and across the whole year for those living in care homes. However, deficiency in vitamin D is still widespread across Europe, Asia and the Americas.

Carol Williams said: “Vitamin D is synthesised by our skin in response to sunlight. During the winter months, the angle of the sun means that synthesis does not occur. Instead we all need to take vitamin D supplements from now until middle of -March.”

“Other commentators in the BMJ Nutrition, Prevention & Health have noted that policies and recommendations on vitamin D do not seem to be taken seriously enough. The COVID-19 pandemic has brought conditions in care homes into the public eye and on to the political agenda.

“There is an urgent need for widespread vitamin D supplementation, and in particular in care homes. “

Read the full article ‘Responsibility for vitamin D supplementation of elderly care home residents in England: falling through the gap between medicine and food’ in the BMJ Nutrition, Prevention & Health.