1. Vitamin D and Sunshine in Bradford
Ann Hobbiss : Public Health Manager for Every Baby Matters
Zak Ansari : Public Health Dietitian

2. 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 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
It is likely many women and children remain undiagnosed

3. Incidence of Vitamin D deficiency in women of childbearing age 2008 -2010.
Incidence per 1,000 women
2009
2010
Total number
Age range
number
538
5.3
610
5.5
751
6.9
1958
Source: NHS Bradford & Airedale Intelligence SystmOne July 2011

4. 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 long-term conditions
Come back to these statements – angle of sunlight appears crucial
Fat soluble – hence fatty foods contain vit D – only obtain about 10% of what we need in food
Stored and activated in liver – healthy live

5. Obtaining Vitamin D
Sunlight
Supplements
Diet – ‘top up’

6. 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)
– above 52 degrees N only effective in summer months
– our hours of annual sunshine are similar to that of northern Scotland
– covering the skin will inhibit vitamin D formation
– reduced exposure through being housebound

7. 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

8. 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 minutes total
Vitamin D is manufactured during the summer months and stored for the winter

9. Supplements for standard dose
Advise a preventative dose of 10 mcg or 400 IU a day
For infants 7.5mcg or 300 IU
For people unable or unwilling to expose skin to sunlight -
Healthy Start tablets and drops provide these amounts
Also: Pro D-3 and other OTC supplements (see children’s pathway)

10. 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

11. 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

12. 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

13. 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.

14. 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.