Vitamin D and Sunshine in Bradford

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Vitamin D and Sunshine in
Bradford
Ann Hobbiss : Public Health
Manager for Every Baby Matters
Zak Ansari : Public Health Dietitian
1
Incidence of vitamin D deficiency in women of
childbearing age and children remains high in
Bradford
• Between 2008 and 2010 : nearly 2,000 new
diagnoses in women aged of 16 – 44 from
primary care
• Between 2007-2010 there were 67 cases of
rickets diagnosed in children, 46 of which
were under nine years old
• Over 1,100 children were identified with vitamin
D deficiency 2007-2010
• It is likely many women and children remain
undiagnosed
2
Incidence of Vitamin D deficiency in women of
childbearing age 2008 -2010.
2008
Age
range
number
15 - 44
538
Incidence
per 1,000
women
2009
Incidence
per 1,000
women
2010
Incidence
per 1,000
women
Total
number
5.3
610
5.5
751
6.9
1958
Source: NHS Bradford & Airedale Intelligence SystmOne July 2011
3
What it is and why we need it
• Substance that is formed from the action of
sunlight falling on the skin
• Fat soluble substance
• Stored and activated in the liver
• Key Action: to enable the body to absorb and
utilise calcium for bone growth and muscle
function
• Possible additional health benefits:
prevention of multiple sclerosis and other longterm conditions
4
Obtaining Vitamin D
• Sunlight
• Supplements
• Diet – ‘top up’
5
What are the factors that contribute
to a deficiency in Bradford?
Reduced exposure to the sun through:
• Latitude – angle of UVB rays
• Weather
• Clothing
• Sun-cream (above factor 8)
6
Who is at risk?
• Those with someone else in the family with vitamin D deficiency
• People from South Asian, African, African Caribbean and Middle
Eastern backgrounds
• Those that have a low exposure to sunlight due to wearing
concealing clothing or spending time indoors
• Teenagers
• Strict sunscreen users
• People who are obese
• Pregnant or breastfeeding women
• Breastfed and some formula fed babies
• Children during periods of rapid growth such as in infancy
• Children with chronic conditions (malabsorption, juvenile idiopathic
arthritis, rheumatic conditions, chronic steroid use, diabetes,
disability and reduced mobility)
• People on medications interfering with Vit D metabolism: phenytoin,
carbamazepine, steroids, rifampicin
7
Exposure to sunlight - Angle of the
sun’s UVB rays is important
• Around noon – 11-3pm without sun
protection cream
• Summer time – April to September
• In and out of the sun - care not to redden
• Up to 15-20 minutes total
Vitamin D is manufactured during the summer months and
stored for the winter
8
Supplements for standard
dose
• Advise a preventative dose of 10 mcg or
400 IU a day
• For infants 7.5mcg or 300 IU
Healthy Start tablets and drops provide these amounts
Also: Pro D-3 and other OTC supplements (see
children’s pathway)
9
Dietary sources
• Important in winter for topping up stores
BUT only ever supplies 10% of required
amount
• Oily fish
• Fortified breakfast cereals – check label
• Fats and margarines (fortified)
• Evaporated milk
• Egg yolks
10
Achieving 10mcg(400IU)
Vitamin D through diet
Daily intake of :
•
•
•
•
•
120g of pilchards and 1 egg OR
14 bowls of fortified breakfast cereal OR
130g (13 pats) of margarine OR
1 large tin (250ml) of evaporated milk OR
12 eggs
11
Who in Bradford should be receiving free
Healthy Start vitamins?
• All mothers and children qualifying for
Healthy Start vouchers (up to age four)
• All pregnant women who book-in with a
midwife from the BRI or AGH
• All infants from first Health Visitor visit to
six months old
• All infants up to age 2 considered ‘at risk’
by the HV
12
Summary of key concepts
• Diet is not an adequate source of vitamin D –
the average intake is 10% of requirements
• Vitamin D status is dependent on exposure to
sunlight NOT diet
• To manufacture vitamin D at northern
latitudes, regular exposure of some skin
between 11-3pm during summer is needed.
• Darker skins need more time to produce
vitamin D, fairer skins need more care not to
redden. ALL skin types need to take care
not to burn.
13
Key concepts cont….
• Breast-milk will not necessarily provide sufficient vitamin D for
the infant (dependent on mother’s vitamin D status)
• All babies, including breastfed babies will be offered vitamin D
drops from first HV visit at 14 days.
• There will be some people for whom sunlight and/or standard
dose supplements is not enough, eg people with liver or renal
disease, or on particular medications and will need to see
their GP (see adult and children’s pathways for Vitamin D
insufficiency and deficiency).
• HV and MW are key professionals to ensure distribution for
mothers and young children.
• Early Years are in a key position to support families to
understand their needs and assist vulnerable families to
access vitamins.
14
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