Vitamin D deficiency: migrant health guide

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Letter from PHE and NHS Test and Trace to school and college leaders

Main messages

Vitamin D is needed for healthy bones and muscles. Sunlight is our main source of vitamin D.

Groups at increased risk of vitamin D deficiency are:

  • people with darker skin (including those from an African, African-Caribbean or South Asian background)
  • those who are not often outdoors
  • those who cover up most of their skin when outdoors

Everyone in the UK is advised to take a daily supplement containing 10 micrograms (400 international units) of vitamin D during the autumn and winter months (October to early March), when we cannot make vitamin D from sunlight.

Be aware of the difference between public health advice on supplementation and clinical treatment of deficiency. The latter will be at a higher dose and intended to restore optimal vitamin D levels safety but quickly.

Low income families in the UK who receive one of a range of income related benefits and tax credits may qualify for the Healthy Start scheme. Pregnant women, women with a child under 1 year of age and children aged up to 4 years can get free Healthy Start vitamin supplements which contain vitamin D.

Currently, there is not enough evidence to support taking vitamin D solely to treat or prevent COVID-19. For more information, visit the COVID-19 page of the migrant health guide.

Background

Vitamin D plays an important role in bone health by regulating calcium and phosphate metabolism.

Low vitamin D status can lead to bone problems such as rickets in children, and bone pain (due to osteomalacia) or muscle weakness in adults. This may also increase the risk of falls in older people.

Exposure of the skin to sunlight in the spring and summer months is the main source of vitamin D for most people in the UK.

In the autumn and winter months in the UK (October to early March), there is no sunlight of appropriate wavelength for synthesis of vitamin D in the skin and we rely on dietary sources. Because it is difficult to get the required amount of vitamin D through food, it’s best to take a vitamin D supplement during the autumn and winter.

Prevention

Adults (including women who are pregnant or breastfeeding), young people and children over 4 years should consider taking a daily supplement containing 10 micrograms (400 units, also called international units (IU)) of vitamin D between October and early March because people do not make enough vitamin D from sunlight in these months.

Adults, young people and children over 4 years should consider taking a daily supplement containing 10 micrograms (400 units) of vitamin D throughout the year if they have little or no sunshine exposure because they:

  • are not often outdoors, for example, if they are frail, housebound or living in a care home
  • usually wear clothes that cover up most of their skin when outdoors
  • if they have dark skin, for example, if they are of African, African-Caribbean or South Asian origin, because they may not make enough vitamin D from sunlight
  • are spending most of their time indoors because of the COVID-19 pandemic

Babies from birth to 1 year should have a daily supplement containing 8.5 micrograms (340 units) to 10 micrograms (400 units) of vitamin D throughout the year if they are:

  • breastfed
  • formula-fed and are having less than 500ml of infant formula a day (because infant formula is already fortified with vitamin D)

Children aged 1 year to 4 years should have a daily supplement containing 10 micrograms (400 units) of vitamin D throughout the year.

For more information, read the Public Health England guidance.

The NHS vitamin D page provides further information about safe upper levels of vitamin D supplementation.

The NICE guidelines for antenatal care provide further information about vitamin D recommendations during pregnancy.

Accessing vitamin D supplements

The Healthy Start scheme provides vitamin drops to children aged up to 4 years in families who qualify for the scheme. Pregnant women and women with a child under 1 year old on the scheme can also get Healthy Start women’s tablets, which contain vitamin D and folic acid.

NHS organisations may have local arrangements where they provide Healthy Start vitamins free to those not on the scheme or at a small cost.

Clinical management

NICE has published guidelines on the treatment and prevention of vitamin D deficiency in adults, including information on when to test for vitamin D deficiency. Routine testing is not recommended.

The National Osteoporosis Society has produced Vitamin D and Bone Health: A Practical Clinical Guideline for Patient Management.

Many areas of the UK also have local guidelines.

The NHS also provides information on rickets and osteomalacia.

Resources

Find out more about the vitamin D advice on the NHS website.

PHE and NICE issued a statement about vitamin D supplementation during winter.

Government advice on vitamin D is based on recommendations from the Scientific Advisory Committee on Nutrition, published in their Vitamin D and Health report.

NICE has developed guidance about:

Healthy Start provides more information on vouchers for free vitamin supplements for young children and pregnant women.



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