Successful public health action to reduce the incidence of symptomatic vitamin D deficiency

Arch Dis Child doi:10.1136/archdischild-2012-302287
Robert John Moy 1, Eleanor McGee 2, Geoff D Debelle 3, Ian Mather 4, Nicholas J Shaw 1,5
1 School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
2 Nutrition and Dietetic Department, Birmingham Children's Hospital Foundation NHS Trust, Birmingham, UK
3 Department of General Paediatrics, Birmingham Children's Hospital Foundation NHS Trust, Birmingham, UK
4 Public Health Department, Solihull Primary Care Trust, Solihull, UK
5 Department of Endocrinology, Birmingham Children's Hospital Foundation NHS Trust, Birmingham, UK
Correspondence to
Dr Nicholas J Shaw, Department of Endocrinology, Birmingham Children's Hospital Foundation NHS Trust, Steelhouse Lane, Birmingham B4 6NH, UK; nick.shaw@bch.nhs.uk
Received 1 May 2012, Accepted 1 August 2012, Published Online First 21 August 2012

Background In response to a resurgence of symptomatic cases of vitamin D deficiency in a high-risk predominantly ethnic minority population, a programme of universal rather than targeted vitamin D supplementation was begun with a public awareness campaign about the importance of vitamin D.

Objective To evaluate the effectiveness of this programme in reducing case numbers.

Methods Cases of symptomatic vitamin D deficiency in children under 5?years resident in a primary care trust catchment area presenting at local hospitals were identified through laboratory records of low vitamin D levels which were cross-checked against medical records to confirm the diagnosis. Comparisons were made of the case incidence rate, level of public knowledge and vitamin supplement uptake rate at the onset of the programme in 2005 and 4?years later.

Results The number of cases of symptomatic vitamin D deficiency in those under 5?years fell by 59% (case incidence rate falling from 120/100?000 to 49/100?000) despite the supplement uptake rate rising only to 17%.

Public awareness of vitamin D deficiency rose to near universal levels.

Conclusions A programme of universal rather than targeted Healthy Start vitamin D supplementation for pregnant and lactating women and young children has led to a substantial decrease in cases of symptomatic vitamin D deficiency in a high-risk population.

Supplementation was also started at a younger age than in the national programme.

This approach has implications for the delivery of vitamin D supplementation programmes in similar populations.

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2011 Presentations by one of McGee (one of the authors) indicates vitamin D levels

Women 400 IU daily, Children 300 IU, infants double that: 600 IU daily

This appears to be about 10X too little for the women.

Their goal of preventing rickets in infants and children should be met by the amount given

Note: Amount of vitamin D to infants drops drastically after weaning.

See also VitaminDWiki

• Black Sudanese children 350X more likely to have rickets than other Australians – April 2012
• Turkey gave 400 IU vitamin D to needy infants and reduced Rickets by 60X - 2011 60X, not just 1.6X as for study on this page
• Wonder when the first doctor will be found liable for not providing vitamin D to a patient
• Death of Babies in UK due to vitamin D deficiency – Jan 2012
• All items in category Rickets and vitamin D 127 items
• All items in category Infants/children and vitamin D 853 items
• UK pediatricians have a lot to learn about vitamin D – May 2012 which has the following
  Identify additional groups of children who are also at high risk, not just dark skin (e.g. excess fat)
  Test for a rare allergic reaction to vitamin D before giving high doses.
  Dose size should increase with the number of high risk categories a child is in
  Also provide some cofactors, not just vitamin D
  Followup with maintenance doses after the loading dose.
• Vitamin D insufficiency in UK youths – 37X more likely if dark skin – July 2011
• 5 out of 6 UK dark skinned kids who were vitamin D deficient had no symptoms – May 2012
  Note: this article mentioned 59% decrease in SYMPTOMS: what about those with no symptoms
• What causes Rickets - 1919