slide1 n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Addressing the supplementation needs of the under 5s PowerPoint Presentation
Download Presentation
Addressing the supplementation needs of the under 5s

Loading in 2 Seconds...

play fullscreen
1 / 33

Addressing the supplementation needs of the under 5s - PowerPoint PPT Presentation


  • 120 Views
  • Uploaded on

Addressing the supplementation needs of the under 5s. Vitamin D Briefing 19 March 2012 Royal National Orthopaedic Hospital Dr Robert Moy Retired Senior Lecturer in Child Health College of Medical and Dental Sciences University of Birmingham.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

Addressing the supplementation needs of the under 5s


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

Addressing the supplementation needs of the under 5s

Vitamin D Briefing 19 March 2012

Royal National Orthopaedic Hospital

Dr Robert Moy

Retired Senior Lecturer in Child Health

College of Medical and Dental Sciences

University of Birmingham

national diet and nutrition survey 1995

High prevalence of vitamin D deficiency in children 1.5 to 2.5 years

National Diet and Nutrition Survey 1995

Blood level of 25 hydroxyvitamin D <25 nmol/l

White children 1%

Bangladeshi children 20%

Indian children 25%

Pakistani children 34%

Lawson M. BMJ 1998;317:10-11

low vitamin d status in pregnant women
Low Vitamin D status in pregnant women

National Diet and Nutrition Survey 1995

28% females 19-24 years 25(OH)D < 25 nmol/l

50% ethnic minorities

160 non white pregnant women in South Wales 2002

50% 25(OH)D level < 20 nmol/l

198 white pregnant women in Southampton 2008

18% 25(OH)D level < 27.5 nmol/l

pregnant Asian women in Birmingham 2011

20% 25(OH)D level < 15 nmol/l

Datta S et al. Brit J Obstetrics 2002;109:905-8

Gale C et al. Eur J Clin Nutr 2008;62:68-77

caused by 1 limited sunlight exposure
Caused by: 1. Limited sunlight exposure

Pearce S Cheetham T.

Diagnosis and management of vitamin D deficiency. BMJ 2010;340:142-7

>90% of vitamin D derived from UVB light through photosynthesis of 7 dehydrocholesterol in the skin

Fair skinned persons: 20-30 minutes on face/forearms at midday in summer 2-3 times per week

Pigmented skin persons: 2-10 times exposure or frequency required

Oct to April inadequate UVB at UK latitude 50-55º north

SF15 blocks 99% of skin synthesis

2 uk diet profoundly lacking in vitamin d
2. UK diet profoundly lacking in vitamin D

SACN Update on Vitamin D 2007

Oily fish (trout, salmon, mackerel, herring, sardine, anchovy, tuna) and fish oils (5-10 µg/100g)

Egg yolk (5µg/100g)

Red meat (1µg/100g)

Breast milk (0.07µg/100ml)

Fortified sources

Fortified breakfast cereals (3-8µg/100g)

Margarine (7.5µg/100g)

Formula (1.2µg/100ml)

recent dietary evidence ndns 2008 2010
Recent dietary evidence: NDNS 2008-2010

Bates B et al. National Diet and Nutrition Survey 2008/09-2009/10

  • Reference Nutrient Intake children 1.5 to 3 years 7 µg/day
  • Average daily intake of vitamin D 1.9 µg/day (27% of RNI)
  • Only 7% toddlers taking any vitamin supplement
  • Mean dietary intake of all other vitamins above RNI
bridging the gap by vitamin d supplementation
Bridging the gap by vitamin D supplementation

“ vitamin D intake cannot be met from the diet alone (or usual sunlight exposure) and can only be guaranteed by supplementation”

BUT

“there is concern that supplementation is being overlooked or not implemented by health professionals and the general public”

SACN Update on vitamin D 2007

slide11

Promotion of vitamin D drops to the Asian community

  • posters and leaflets
  • radio and TV
  • video tapes
  • Asian newspapers
  • places of worship
  • Asian GPs
  • Community leaders
coma recommendations for vitamin d supplementation 1998
COMA recommendations for vitamin D supplementation 1998

Department of Health: Nutrition and Bone Health 1998

  • ALL pregnant women and breast feeding mothers should take a vitamin D supplement
  • ALLinfants should receive vitamin supplements unless they are having > 500 ml of fortified infant formula daily
  • Breast fed babies may delay supplements until 6 months if there mother was in “good vitamin status” during pregnancy
  • Children over 1 year should have vitamins unless their diet is “diverse and plentiful” and have exposure to sunlight
  • Children at high risk should take supplements until age 5 years eg living in north of UK, from Asian/Islamic families, poor eaters, restricted or exclusion diets, born with poor vitamin stores
nice guidance ph 11 maternal and child nutrition 2008
NICE guidance PH 11: Maternal and Child Nutrition 2008

NICE PH11 2008. Improving the nutrition of pregnant and breastfeeding mothers and children in low income households

Recommends Healthy Start vitamins for all children 6 months to 4 years and for all pregnant women eligible for the Healthy Start scheme

Recommends health professionals should promote vitamin D supplements for all those not eligible for Healthy Start, especially for pregnant women with limited sun exposure, of south Asian, African, Caribbean or Middle Eastern descent

slide14

Chief Medical Officers’ letter 2 Feb 2012

ALL pregnant and breastfeeding women require 10µg vitamin D daily

ALL infants and children aged 6 months to 5 years need 7-8.5µg daily

Breast fed infants whose mothers did not take vitamin D in pregnancy require vitamin D drops from age one month

Infants receiving > 500ml formula do NOT require additional vitamin D

65 years+ not exposed to much sun should take 10µg daily

current uk vitamin supplements for children
Current UK vitamin supplements for children

1µg vitamin D equivalent to 40 International Units

A D C B Minerals

IU µg mg

Healthy Start 700 7.5 20 - -

Abidec 1333 10 40 + -

Dalivit 5000 10 50 + -

Haliborange 200 3.25 25 + -

Well Kid 400 5 40 + ++

what is optimal vitamin d supplementation for young children
What is optimal vitamin D supplementation for young children ?

UK Reference Nutrient Intake: 7 - 8.5 µg/day up to 3 years

USA: doubled recommended minimum intake from 5 to 10µg from soon after birth (based on prevention of deficient blood level <50 nmol/l)

Canada: recommends 20µg

north of latitude 55º October-April

(3 times vitamin D content of

Healthy Start drops)

Wagner C. Pediatrics 2008;122:1142-52

importance of maternal vitamin d status
Importance of maternal vitamin D status

Maternal vitamin D status determines neonatal vitamin D status

Poor maternal vitamin D status adversely affects fetal and infant skeletal growth and bone ossification and tooth enamel formation

Inadequate vitamin D in breast milk to meet infant’s needs unless mother and infant are exposed to sunlight

Emphasises need for supplementation for pregnant and lactating women

Specker BL. Am J Clin Nutr 1994;59:S484-91

Thomas S. BMJ Open 2011;1:e000236

UNICEF UK Baby Friendly Initiative 21/12/2011

vitamin supplements for pregnant and lactating women
Vitamin supplements for pregnant and lactating women

C D Folic acid

Healthy Start 70mg 10µg 400µg

Pregnacare 70mg 10µg 400µg

is the current vitamin d supplementation dosage in pregnancy and lactation adequate
Is the current vitamin D supplementation dosage in pregnancy and lactation adequate ?

1. Conclusion of RCT of 10µg, 50µg or 100µg vitamin D supplementation from first trimester of pregnancy

100µg vitamin D is safe and most effective in achieving vitamin D sufficiency in all women (defined as 25(OH)D >80nmol/l) (ie 10 times USA/UK recommended dose )

2. Conclusion of RCT of 50µg or 100µg vitamin D supplementation of lactating women

100µg is safe and ensures adequate vitamin D status of mother and nursing infant

Current recommendations for vitamin D supplementation with 10µg:

“irrelevant”, “inconsequential” “ useless” !

Hollis B Wagner C. Am J Clin Nutr 2004;80:S175-8

Hollis B et al. J Bone and Mineral Research 2011;26:2341-57

slide21

Launched 2006

Department of Health: Scientific Review of the Welfare Food Scheme 2002

is the healthy start vitamin supplementation programme working
Is the Healthy Start vitamin supplementation programme working?

Department of Health Healthy Start unit statistics available to PCTs

Only those on benefits are eligible

Many families at risk not covered by Healthy Start

Estimated uptake of scheme: 80% of those eligible

Uptake of vitamins very low: 2.7% children

4.0% women

Significant problems with supplement supply and availability

feeding for life foundation survey of hcps
Feeding for Life Foundation survey of HCPs

The Feeding for Life Foundation survey was carried out by Opinion Health between 3rd to 13th October 2011, completed online with a sample of 155 healthcare professionals and 1001 parents

51% are either not sure or are unaware of the UK Health Departments’ supplementation recommendations

46% of those who are aware of the recommendations don’t know which vitamins are recommended daily

56% don’t discuss the importance of vitamin supplementation with all parents

feeding for life foundation survey of parents
Feeding for Life Foundation survey of parents

The Feeding for Life Foundation survey was carried out by Opinion Health between 3rd to 13th October 2011, completed online with a sample of 155 healthcare professionals and 1001 parents

74% are not aware of the UK Health Department recommendations

65 % of those aware of the recommendation do not know which vitamins are recommended daily

vitamin d deficiency in heart of birmingham pct
Vitamin D deficiency in Heart of Birmingham PCT
  • 20% Healthy Start eligibility of pregnant women
  • 75% of births to ethnic minority women with dark skin
  • increasing use of modest Islamic dress
  • no UV light at latitude 52 degrees in winter
  • frequent cases of rickets and neonatal hypocalcaemic seizures
hob pct vitamin d supplementation
HoB PCT vitamin D supplementation

FREE Healthy Start Vitamin D tablets for ALL pregnant women 2nd and 3rd trimesters

FREE Healthy Start Vitamin D tablets for one year for ALL post natal women (breast feeding or not)

FREE Healthy Start Vitamin dropsfor ALL children from 2 weeks up to 4 years

First bottle of Healthy Start drops provided by Health Visitors at Primary (New Baby) visit

Subsequent supplies from Health Centres, Sure Start, pharmacists

Universal untargeted approach

hob public awareness about vitamin d
HoB public awareness about vitamin D
  • Posters and leaflets in languages
  • Community radio
  • Shopkeepers
  • Logo on shopping bags, trolley discs
  • Baby T shirts, sun hats
hob vitamin d programme outcomes
HoB vitamin D programme outcomes

Increased public awareness:

heard of vitamin D 61% to 89%

specific knowledge 21% to 79%

Increased professional awareness:

Increased uptake of supplements:

children: 7% to 17%

women: 4% to 17 %

Decreased cases: 2006: 29 cases (incidence: 120/100,000)

2010: 12 cases (49/100,000)

what are the issues
What are the issues ?
  • In general vitamin deficiency is not really a problem for the majority of children in UK
  • EXCEPT for vitamin D especially in ethnic minority families
  • Lack of Health Care Professional awareness about supplementation
  • Poor awareness about vitamin D among parents
  • Healthy Start not covering all at risk families
  • Very limited uptake of Healthy Start vitamin supplements
  • Overly cautious approach to sunlight exposure
  • Limited vitamin D food fortification
bridging the gap in vitamin d status
Bridging the gap in vitamin D status

Advocacy for a new integrated public health policy aimed at the elimination of rickets through:

Supplementation of pregnant and lactating women and young children with an adequate dosage of vitamin D

Enhanced food fortification eg milk

Improved awareness of Health Care Professionals

Increased parental awareness

acknowledgement feeding for life foundation
Acknowledgement:Feeding for Life Foundation

An education initiative that aims to enhance knowledge and expertise in early nutrition through training, research, raising awareness and collaborative working

It’s education programme is led by a group of experts in child health and is aimed at supporting health professionals and early-years practitioners working with infants and toddlers

The Feeding for Life Foundation is supported by Cow & Gate but is a non-promotion initiative which reflects and complements their continued commitment to improving early nutrition as a way of influencing future health outcomes.