scholarly journals Responsibility for vitamin D supplementation of elderly care home residents in England: falling through the gap between medicine and food

2020 ◽  
pp. bmjnph-2020-000129
Author(s):  
Joseph Williams ◽  
Carol Williams
Keyword(s):  
Public Health ◽  
Vitamin D ◽  
Elderly Care ◽  
Care Home ◽  
Vitamin D Supplementation ◽  
Care Homes ◽  
Vitamin D Status ◽  
Structured Interviews ◽  
Medical Responsibility ◽  
Vitamin D Supplements

IntroductionDaily vitamin D supplements are recommended for elderly care home residents; however, they are rarely given and vitamin D deficiency in care homes is widespread. This study aimed to understand the determinants of current practice and perceived responsibility for the vitamin D status of residents.MethodsThirteen semi-structured interviews were conducted with key informants in two areas of Southern England including care home managers, general practitioners (GPs) and public health professionals. Interviews were audio recorded and transcribed verbatim.ResultsInductive thematic analysis identified four themes: framing of vitamin D supplements as medicines; professional and sector boundaries whereby GPs are perceived as responsible for the vitamin D status of residents and care home managers felt unable to administer over-the-counter vitamin tablets; low awareness of national guidance; and ethical and practical issues. This results in vitamin D supplements requiring prescription by medical professionals and few residents receiving them.ConclusionThe medical framing of vitamin D supplements in care homes is a practical barrier to implementation of longstanding nutrition guidelines. A paradigm shift is needed so that vitamin D is understood as a protective nutrient as well as a medicine, and a public health as well as a medical responsibility. Vitamin D is important for musculoskeletal health. Possible links with COVID-19 are still being investigated. The pandemic has drawn attention to conditions in care homes and there is an opportunity to revise current guidance on vitamin D supplementation which will have lasting benefit for this vulnerable group.

scholarly journals Responsibility for vitamin D supplementation of elderly care home residents in England: falling through the gap between medicine and food

2020 ◽  
Author(s):  
Joseph Williams ◽  
Carol Williams
Keyword(s):  
Public Health ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Elderly Care ◽  
Care Home ◽  
Vitamin D Supplementation ◽  
Care Homes ◽  
Vitamin D Status ◽  
Vitamin D Levels ◽  
Vitamin D Supplements

AbstractIntroductionVitamin D supplements are recommended for elderly care home residents with little sunlight exposure. However, their use in care homes is limited and vitamin D deficiency in residents is widespread. This study aimed to understand perceived responsibility for the vitamin D status of residents and the determinants of current practice around supplementation.MethodsThirteen semi-structured interviews were conducted with key informants in two areas of Southern England including care home managers, general practitioners (GPs) and public health professionals. Interviews were audio recorded and transcribed verbatim.ResultsInductive thematic analysis identified four themes – medical framing; professional and sector boundaries; awareness of national guidance; and ethical and practical issues. Vitamin D supplements were not routinely given to residents, and most participants, including the GPs, believed the vitamin D status of residents was the responsibility of the GP. Care home managers felt unable to make decisions about vitamin D and vulnerable to suggestions of wrongdoing in administering over-the-counter vitamin tablets. This results in vitamin D requiring prescription by medical professionals and few care home residents receiving vitamin D supplements.ConclusionThe medical framing of vitamin D supplements in care homes is a practical barrier to residents receiving them and is out of step with public health recommendations. Vitamin D levels in care home residents could be improved through universal supplementation. This requires a paradigm shift so that vitamin D is understood as a protective nutrient as well as a medicine, and a public health as well as a medical responsibility. The failure to ensure vitamin D adequacy of residents may emerge as a factor in the spread and severity of COVID-19 in care homes and gives increased urgency to addressing this issue.KEY MESSAGESWhat is already known about the subject?Nutrition guidelines recommend elderly care home residents take vitamin D supplements as a preventative measure. This is rarely implemented in practice and vitamin D inadequacy is widespread.What are the new findings?Medical framing of vitamin D in the care sector puts elderly residents at risk of vitamin D deficiency. Vitamin D supplements are perceived as medicines requiring an individual prescription and diagnosis by a medical professional. This is out of step with public health recommendations. The system’s failure to protect the vitamin D status of the elderly in care homes may have implications in the context of COVID-19.How might these results change the focus of research or practice?Prompt a review of current guidelines and regulations in England to establish responsibility for implementing public health recommendations on vitamin D supplementation in care homes. Further research on feasibility of implementation strategies is needed.

scholarly journals Vitamin D Supplementation in Australia: Implications for the Development of Supplementation Guidelines

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Kellie Bilinski ◽  
Peter Talbot
Keyword(s):  
Public Health ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Vitamin D Supplementation ◽  
Supplement Use ◽  
The Past ◽  
Threefold Increase ◽  
Vitamin D Supplements ◽  
Vitamin D Supplement ◽  
Potential Public Health

High rates of vitamin D deficiency and testing have been reported in Australia, yet there are few reports regarding vitamin D supplement use. Australian wholesale sales data was obtained for vitamin D supplements for the period 2000–2011. There has been a threefold increase in supplement sales over the past decade, whereby over A$94 million supplements containing vitamin D in Australia were sold during the year 2010. There were eighty-nine manufacturers that produce a variety of 195 vitamin D products. The amount of vitamin D in these products varies considerably, from 40 to 1000 IU per unit, although supplements containing only vitamin D had the highest amount of vitamin D. There was a trend for sales to increase in winter months. Given the potential public health benefits of vitamin D, there is an urgent need for a better understanding of supplementation use and for the development of supplementation.

scholarly journals Vitamin D Status and Its Seasonal Variations and Association With Parathyroid Hormone Concentration in Healthy Women in Riga

Medicina ◽  
2013 ◽  
Vol 49 (7) ◽  
pp. 51
Author(s):  
Aivars Lejnieks ◽  
Anda Slaidina ◽  
Agnis Zvaigzne ◽  
Una Soboleva ◽  
Gulsena Eivazova ◽  
...  
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Postmenopausal Women ◽  
Seasonal Variations ◽  
Threshold Level ◽  
Vitamin D Supplementation ◽  
Reproductive Age ◽  
Vitamin D Status ◽  
Healthy Women ◽  
Vitamin D Supplements

The aim of the study was to describe the vitamin D status and its seasonal variations in women living in Riga, Latvia, to examine an association between the concentrations of plasma 25-hydroxyvitamin D [25(OH)D] and parathyroid hormone (PTH), and to determine the threshold for plasma 25(OH)D above which there is no further suppression of PTH. Material and Methods. The data of 189 healthy Caucasian women were analyzed. The serum levels of 25(OH)D, PTH, and phosphorus were measured twice a year. All the participants were divided into 3 groups according to vitamin D supplementation and the reproductive status. Results. The overall mean level of 25(OH)D was 32.8 ng/mL with significantly lower levels being in winter when compared with those in summer (28.2 ng/mL vs. 37.5 ng/mL, respectively; P<0.05). PTH was negatively associated with 25(OH)D. A threshold level of plasma 25(OH)D above which no further suppression of PTH occurred was found to be 38 ng/mL. Postmenopausal women not taking vitamin D supplements and without exposure to sunlight had 25(OH)D deficiency in winter and summer (92% and 88%, respectively). The most significant seasonal fluctuations were seen in the women of the reproductive age not taking vitamin D supplements and without exposure to sunlight, of which 47% had 25(OH)D deficiency in summer and 69% in winter. Conclusions. An optimal concentration of 25(OH)D was found to be 38 ng/mL. According to this definition, 70.4% of all the healthy women were classified as vitamin D deficient in winter and 59.8% in summer. The highest proportion of vitamin D deficient individuals was found in the group representing the postmenopausal women not taking vitamin D supplements.

scholarly journals Vitamin D supplementation: are multivitamins sufficient?

2019 ◽  
Vol 105 (8) ◽  
pp. 791-793 ◽  
Author(s):  
Rebecca J Moon ◽  
Elizabeth M Curtis ◽  
Cyrus Cooper ◽  
Justin H Davies ◽  
Nicholas C Harvey
Keyword(s):  
Public Health ◽  
Vitamin D ◽  
Vitamin D Supplementation ◽  
Product Packaging ◽  
Vitamin D Supplements

BackgroundPublic Health England advises 400 IU/day vitamin D supplementation for children over 1 year. Commercially available children’s multivitamin and vitamin D supplements were surveyed to determine the vitamin D content.MethodsMultivitamins and vitamin D supplements marketed at children <12 years and sold by nine UK supermarkets and health supplement retailers were surveyed. Vitamin D content was determined from manufacturer’s websites and product packaging.Results67 multivitamins were surveyed, containing 0–800 IU/day vitamin D. Only 25%–36%, depending on the child’s age, provided ≥400 IU/day vitamin D. Supplements containing only vitamin D or labelled as for ‘healthy bones’ typically had higher vitamin D content (57%–67% contained ≥400 IU/day).ConclusionsFew multivitamin products supply the recommended 400 IU/day vitamin D. Clinicians need to be aware of this when recommending vitamin D supplementation and advise parents/carers to choose a product that contains ≥400 IU/day vitamin D.

scholarly journals ASSOCIATION BETWEEN VITAMIN D-BINDING PROTEIN (VDBP) GENE POLYMORPHISM AND VITAMIN D STATUS IN YOUNG CHILDREN

ScienceRise ◽  
2020 ◽  
pp. 51-58
Author(s):  
Mariia Romanko ◽  
Zoia Rossokha ◽  
Iryna Maydan ◽  
Maryna Mamenko ◽  
Lyudmila Kvashnina
Keyword(s):  
Vitamin D ◽  
Young Children ◽  
Gene Polymorphism ◽  
Serum Levels ◽  
Vitamin D Supplementation ◽  
Health Care Facilities ◽  
Vitamin D Status ◽  
Scientific Results ◽  
Vitamin D Supplements ◽  
Technological Product

Object of the research: VDBP gene polymorphism. Problem being addressed: the effect of existing polymorphic variants of the VDBP gene on the absorption of vitamin D in young children. The main scientific results. At the beginning of the survey, vitamin D supplementation was performed in 50.0±9.1 % (15/30) of children. The concentration of 25 (OH) D in the serum of the subjects was 32.9 ng/ml (23.2–60.0). All patients with the GG rs 7041 genotype of the VDBP gene had a concentration of 25 (OH) D in the range of 20-100 ng/ml, which is statistically more common than in children with the AA rs 4588 genotype (p=0.015), GT rs 7041 genotype (p=0.047) and genotype TT rs 7041 (p=0.033). Patients with CA rs 4588 genotypes – 23.7 ng/ml (14.8-35.8) and GT rs 7041 – 28.1 ng/ml (17.1–49) had the lowest serum levels of 25 (OH) D, the highest levels of 25 (OH) D – children with genotype AA rs 4588 – 122.6 ng/ml (23.2–124.1) and genotype TT rs 7041 – 78.6 ng/ml (23.2 –124.1). Carriers of the AA rs 4588 genotype were more likely than patients with the GG rs 7041 genotype to show dangerously high levels of 25 (OH) D (p=0.069). Patients with the AA rs 4588 genotype had lower alkaline phosphatase levels compared to the GT rs 7041 and CC rs 4588 genotypes – 185.0 U/l (147.0–212.0) versus 259.5 U/l (207.0–334.5), p=0.021 and against 251.0 U/l (222.0–346.0), p=0.016. Area of practical application of research results: The results of the study can be used by working groups to make recommendations for the prevention and treatment of vitamin D deficiency and in the practice of health care facilities. Innovative technological product: association between allelic variants of the VDBP gene and vitamin D status in young children. Scope of application of innovative technological product: pediatrics, medical genetics. Conclusions. Genetic variants of VDBP may affect the absorption of vitamin D and cause variability in 25 (OH) D levels, which complicates the development of uniform recommendations for optimal prophylactic doses of vitamin D and necessitates additional research. The highest levels of 25 (OH) D were recorded in children with genotypes AA rs 4588 and TT rs 7041 of the VDBP gene, which showed high absorption when taking vitamin D supplements at a dose of 500 IU and even excessive concentrations of 25 (OH) D with long-term supplementation in higher dose.

scholarly journals Distribution of vitamin D status in the UK: a cross-sectional analysis of UK Biobank

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e038503
Author(s):  
Liang-Yu Lin ◽  
Liam Smeeth ◽  
Sinead Langan ◽  
Charlotte Warren-Gash
Keyword(s):  
Public Health ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Serum Vitamin ◽  
Vitamin D Supplementation ◽  
Vitamin D Status ◽  
Uk Biobank ◽  
Cross Sectional ◽  
Serum Vitamin D ◽  
The Uk

ObjectiveNo recent large studies have described the distribution of vitamin D status in the UK. Understanding the epidemiology of vitamin D deficiency is important to inform targeted public health recommendations. This study aimed to investigate the distribution of factors associated with serum vitamin D status in a large national cohort.DesignA cross-sectional study.SettingThe UK Biobank, a prospective cohort study following the health and well-being of middle-aged and older adults recruited between 2006 and 2010.ParticipantsA total of 449 943 participants aged 40–69 years with measured serum vitamin D status were eligible for the analysis. Participants completed a questionnaire about sex, age, ethnic background, vitamin D supplementation, smoking, drinking and socioeconomic status.Primary and secondary outcome measuresWe investigated the distribution of serum vitamin D status and the association between demographic factors and vitamin D deficiency or insufficiency. Vitamin D deficiency was defined as a serum 25-hydroxyvitamin D level <25 nmol/L. Multivariable logistic regression was used to assess the association between demographic factors and vitamin D status.ResultsAsian (n=4297/8000, 53.7%) and black (n=2459/7046, 34.9%) participants had a higher proportion of vitamin D deficiency than white participants (n=50 920/422 907, 12%). During spring and winter, the proportion of vitamin D deficiency was higher across the UK and higher in the north than in the south. Male sex, abnormal body mass index, non-white ethnic backgrounds, smoking and being more socioeconomically deprived were associated with higher odds of vitamin D deficiency. Increasing age, taking vitamin D supplements and drinking alcohol were associated with lower odds of deficiency.ConclusionsVitamin D status varied among different ethnic groups and by season and geographical area within the UK. Taking supplements was associated with a lower risk of vitamin D deficiency. These findings support the vitamin D supplementation recommendations of Public Health England.

Vitamin D Deficiency/Insufficiency and Challenges in Developing Global Vitamin D Fortification and Supplementation Policy in Adults

2012 ◽  
Vol 82 (4) ◽  
pp. 237-259 ◽  
Author(s):  
Moshe Ben-Shoshan
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Search Strategy ◽  
Epidemiologic Studies ◽  
Vitamin D Supplementation ◽  
Vitamin D Status ◽  
Societal Burden ◽  
Time Period ◽  
New Guidelines ◽  
In Cis

This review summarizes studies discussing vitamin D status in adults and reveals that vitamin D deficiency/insufficiency is highly prevalent in adults and that current fortification and supplementation policies are inadequate. Background and aims: Studies suggest a crucial role for adequate vitamin D status in various health conditions including bone metabolism, cancer, cardiovascular diseases, and allergies. However, relatively little is known about poor vitamin D status and unmet needs in adults. This report aims to highlight the contribution of epidemiologic studies (through the identification of health effects and societal burden) to the development of vitamin D fortification and supplementation policies and reveal unmet global challenges in adults. Methods: In order to assess worldwide vitamin D status in adults, the search strategy combined the medical literature database MEDLINE (using PubMed) for the time period between January 1, 1980 and February 28, 2011, using the key words “vitamin D” “deficiency” and “insufficiency”, and included articles in which access to full text was possible and in which healthy adults were assessed according to one of four commonly used vitamin D threshold classifications. Results: This report reveals that vitamin D deficiency occurs in 4.10 % [95 % CI (confidence interval), 3.93 %, 4.27 %] to 55.05 % (54.07 %, 56.03 %) of adults, while insufficiency occurs in 26.07 % (24.82 %, 27.33 %) to 78.50 % (77.85 %, 79.16 %), depending on the classification used. However, lack of overlap in CIs and high value of I2 statistics indicate considerable heterogeneity between studies. Further, certain populations (i. e. dark-skinned individuals, immigrants, and pregnant women) may be at higher risk for poor vitamin D status. Conclusion: Current policies for vitamin D supplementation and fortification are inadequate and new guidelines are required to improve vitamin D status in adults.

scholarly journals Examining the magnitude and perception of summertime overheating in London care homes

2021 ◽  
pp. 014362442110136
Author(s):  
Rajat Gupta ◽  
Alastair Howard ◽  
Mike Davies ◽  
Anna Mavrogianni ◽  
Ioanna Tsoulou ◽  
...  
Keyword(s):  
Thermal Comfort ◽  
Care Home ◽  
Thermal Conditions ◽  
Care Homes ◽  
Structured Interviews ◽  
Night Time ◽  
Institutional Practices ◽  
Subjective Data ◽  
Hybrid Buildings ◽  
Hot Weather

This paper brings together objective and subjective data on indoor temperature and thermal comfort to examine the magnitude and perception of summertime overheating in two London-based care homes occupying modern and older buildings. Continuous monitoring of indoor and outdoor temperature, relative humidity and CO2 levels was conducted in summer 2019 along with thermal comfort surveys and semi-structured interviews with older residents and staff of the care settings. Indoor temperatures were found to be high (>30°C) with bedroom temperatures often higher at night than daytime across both care settings. Limited opening due to window restrictors constrained night-time ventilation. Overheating was prevalent with four out of the five monitored bedrooms failing all four overheating metrics investigated. While 35–42% of staff responses perceived indoor temperatures to be uncomfortably hot, only 13–19% of resident responses were found to do so, indicating that elderly residents tend to be relatively insensitive to heat, leaving them open to overheating without realising it. Residents and staff in the modern care setting were less satisfied with their thermal conditions. As hybrid buildings, care settings need to keep both residents and staff comfortable and healthy during hot weather through night-time ventilation, management of heating and supportive institutional practices. Practical application: Care home designs have focused on keeping residents warm through the winter, neglecting the risks of summertime overheating. Care homes are hybrid buildings serving as living spaces for vulnerable older residents and offices/workspaces for staff. Providing comfort to both groups during periods of hot weather is challenging. Opportunities for ventilation are limited by Health & Safety regulations that mandate up to 10 cm maximum window openings and institutional practices that result in windows routinely kept closed, particularly at night. Utilising natural and where possible cross-ventilation should be considered along with external shading. Heating should be managed to avoid unwanted heat gains in the summer.

scholarly journals Does vitamin D supplementation prevent SARS-CoV-2 infection in military personnel? Review of the evidence

2021 ◽  
pp. bmjmilitary-2020-001686
Author(s):  
Iain T Parsons ◽  
R M Gifford ◽  
M J Stacey ◽  
L E Lamb ◽  
M K O'Shea ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Supplementation ◽  
Vitamin D Status ◽  
Military Studies ◽  
Vitamin D Receptors ◽  
Area Of Interest ◽  
Military Populations ◽  
Tract Infections ◽  
Recruit Training

For most individuals residing in Northwestern Europe, maintaining replete vitamin D status throughout the year is unlikely without vitamin D supplementation and deficiency remains common. Military studies have investigated the association with vitamin D status, and subsequent supplementation, with the risk of stress fractures particularly during recruit training. The expression of nuclear vitamin D receptors and vitamin D metabolic enzymes in immune cells additionally provides a rationale for the potential role of vitamin D in maintaining immune homeostasis. One particular area of interest has been in the prevention of acute respiratory tract infections (ARTIs). The aims of this review were to consider the evidence of vitamin D supplementation in military populations in the prevention of ARTIs, including SARS-CoV-2 infection and consequent COVID-19 illness. The occupational/organisational importance of reducing transmission of SARS-CoV-2, especially where infected young adults may be asymptomatic, presymptomatic or paucisymptomatic, is also discussed.

scholarly journals Bone mineral density at age 7 years does not associate with adherence to vitamin D supplementation guidelines in infancy or vitamin D status in pregnancy and childhood: An Odense Child Cohort study

2021 ◽  
pp. 1-33
Author(s):  
Signe Monrad Nørgaard ◽  
Christine Dalgård ◽  
Malene Søborg Heidemann ◽  
Anders Jørgen Schou ◽  
Henrik Thybo Christesen
Keyword(s):  
Bone Mineral Density ◽  
Vitamin D ◽  
Bone Mineral ◽  
Vitamin D Supplementation ◽  
Vitamin D Status ◽  
Mineral Density ◽  
Mineral Concentration ◽  
High Adherence ◽  
Bone Mineralisation ◽  
In Pregnancy

Abstract Vitamin D supplementation in infancy is recommended to prevent rickets. At the population level, its effects on bone mineralisation are largely unknown. We aimed to explore whether adherence to national vitamin D supplementation guidelines (10 µg/day up to age 2 years), supplementation at ages 5 and 7 years, and serum 25-hydroxyvitamin D (s-25(OH)D) at various time points associated with bone mineral density (BMD) at age 7 years in the Odense Child Cohort, Denmark (n=1,194). High adherence was defined as supplementation with 10 µg vitamin D 6-7 times per week during ≥ 80 % of the observation time. S-25(OH)D was analysed using liquid chromatography-tandem mass spectrometry. Total-body-less-head (TBLH) BMD was measured by dual-energy X-ray absorptiometry. At median age 18.1 months, 53.9 % (n=475/881) reported high adherence. The median s-25(OH)D was 64.7, 78.8, 46.0, and 71.8 nmol/l in early pregnancy, late pregnancy, cord blood, and at 5 years, respectively. The mean (SD) TBLH BMD at median age 7.1 years was 0.613 (0.049) g/cm2 (z-score +0.363 (0.824)). In adjusted analyses, vitamin D supplementation up to 18 months, and at 5 and 7 years, was not associated with TBLH BMD. Similarly, no robust associations were found between TBLH BMD and s-25(OH)D at any time point. No associations were found for TBLH bone mineral concentration or bone area. In this population with relatively high s-25(OH)D concentrations, no consistent associations were found between adherence to vitamin D supplementation recommendations or vitamin D status in pregnancy or childhood, and bone mineralisation at age 7 years.

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