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Vitamin D: increasing supplement use in at-risk groups

  • This Guidelines summary includes recommendations that are relevant to the primary care setting. Please refer to the full guideline for the complete set of recommendations

Recommendation 1

Increase access to vitamin D supplements

  • The Department of Health should:
    • work with manufacturers to ensure vitamin D supplements providing the reference nutrient intake (RNI) as recommended by the Scientific Advisory Committee on Nutrition, are widely available for the following at-risk groups:
      • infants and children aged under 5
      • pregnant and breastfeeding women, particularly teenagers and young women
      • 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 with darker skin, for example, people of African, African-Caribbean or South Asian family origin
  • Suitable supplements should also be available for people with particular dietary needs (for example, people who avoid nuts, are vegan or have a halal or kosher diet). Supplements should undergo quality control checks to ensure they contain the correct dose of vitamin D

Recommendation 2

Clarify existing guidance

  • Make it clear which type of supplement most people would benefit from. Be aware that people may be more likely to take a vitamin D-only supplement than one that is combined with calcium. Supplements containing vitamin D and calcium may be harder to swallow and cause side-effects such as constipation

Recommendation 3

Develop national activities to increase awareness about vitamin D

  • Public Health England should:
    • lead development of national action to raise the population’s awareness of the importance of vitamin D. This should start as soon as existing recommendations on vitamin D have been clarified and made consistent. Awareness-raising activities should:
      • emphasise the importance of vitamin D for good health
      • emphasise the limitations of other UK sources of vitamin D (it is only contained in a few foods and sunlight is only effective from the beginning of April to mid-October)
      • emphasise the importance of a daily supplement providing the reference nutrient intake for identified at-risk groups
      • explain existing advice as clearly as possible, particularly if it may be misinterpreted. This includes making clear: what a term such as ‘low sun exposure’ means; who is covered by ‘darker skin’; which women and children are at risk (note that children aged 4 to 5 years are not usually eligible for Healthy Start supplements)
      • let people know where they can get vitamin D supplements free or as cheaply as possible
      • develop resources that are accessible and easy to adapt for local use by a range of agencies, to ensure a consistent message and to minimise duplication of effort

Recommendation 4

Ensure a consistent multiagency approach

  • Directors of public health should:
    • ensure a consistent, multiagency approach is adopted to improve the vitamin D status of local at-risk groups. This should include commissioners and senior managers in local authorities and the NHS, council leaders, elected members, public health teams and voluntary and community organisations

Recommendation 5

Increase local availability of vitamin D supplements for at-risk groups

  • Local authorities should ensure vitamin D supplements containing the recommended reference nutrient intake are widely available for all at-risk groups by:
    • establishing arrangements with a range of settings to promote and distribute them. This could include local pharmacies, children’s centres, midwifery and health visiting services and GP reception areas

Recommendation 6

Improve access to Healthy Start supplements

  • Local authorities should:
    • review current accessibility, availability and uptake of Healthy Start supplements
    • consider how accessibility, availability and uptake could be improved

Recommendation 7

Only test vitamin D status if someone has symptoms of deficiency or is at very high risk

  • Health professionals should not routinely test people’s vitamin D status unless:
    • they have symptoms of deficiency
    • they are considered to be at particularly high risk of deficiency (for example, they have very low exposure to sunlight)
    • there is a clinical reason to do so (for example, they have osteomalacia or have had a fall)

Recommendation 8

Ensure health professionals recommend vitamin D supplements

  • Local authorities, primary care, and clinical commissioning groups should:
    • ensure computerised prompts on vitamin D are integrated into health and social care systems
    • ensure health professionals recommend and record vitamin D supplement use among at-risk groups (and other family members, as appropriate) whenever possible. This could take place during registration appointments with new patients in general practice, flu, other vaccine and screening appointments. It could also take place during routine appointments and health checks including, for example:
      • NHS Health Check
      • diabetes check-ups
      • falls appointments and check-ups
      • health assessments for looked-after children
      • the first contact with someone who is pregnant
      • antenatal and postnatal appointments
      • medicine use and prescription reviews
      • health visitor appointments
      • developmental checks for infants and children
  • Developers of standardised electronic and handheld maternity notes and developers of personal child health records (the ‘red book’) should:
    • add specific questions about the use of vitamin D supplements

Recommendation 9

Raise awareness among health, social care and other relevant practitioners of the importance of vitamin D

  • Health Education England, Public Health England, clinical commissioning groups, health and wellbeing boards and local authorities should:
    • ensure health and social care practitioners receive information on the following as part of their registration and post-registration training and continuing professional development:
      • the importance of vitamin D for good health sources of vitamin D in the UK (from safe sun exposure, supplements and limited dietary sources)
      • groups at risk of low vitamin D status
      • supplement recommendations for different groups (this should address any confusion about, for example, age groups or the type of supplement to recommend)
      • how to encourage people to start and continue taking supplements (see Medicines adherence NICE guideline CG76)
  • Ensure health, social care and other relevant practitioners in contact with at-risk groups are made aware of the following:
  • local policies and procedures in relation to vitamin D
  • local sources of vitamin D supplements (including Healthy Start)
  • eligibility for Healthy Start vitamin supplements

Recommendation 10

Raise awareness of the importance of vitamin D supplements among the local population

  • Increase people’s awareness of:
    • the importance of vitamin D for good health
    • sources of vitamin D in the UK (from safe sun exposure, supplements and limited dietary sources)
    • at-risk groups and the importance of a daily vitamin D supplement for those groups
    • local sources of vitamin D supplements (including Healthy Start)
    • eligibility for Healthy Start vitamin supplements
    • sources of further information
  • Adapt any national resources for local use to minimise the risk of inconsistent advice
  • Ensure awareness-raising activities meet the needs of all at-risk groups. This includes:
    • addressing any misconceptions specific groups may have about their risk
    • working with local practitioners, role models and peers to tailor national messages for local communities to ensure information about vitamin D is culturally appropriate
  • Share vitamin D messages and information with at-risk groups using:
    • local newspapers, social media and local radio channels targeted at these groups
    • local shops and businesses
    • community workers, groups and events
    • social establishments
    • nurseries and educational institutions
    • workplaces
    • places of worship
    • local health care establishments, for example, community health facilities, hospitals urgent care centres

full guideline available from…
National Institute for Health and Care Excellence, Level 1A, City Tower, Piccadilly Plaza, Manchester, M1 4BT

National Institute for Health and Care Excellence. Vitamin D: increasing supplement use in at-risk groups. 
First included: February 2015.