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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     Incidence   2009   Incidence   2010   Incidence   Total
                   per 1,000          per 1,000          per 1,000   number
                   women              women              women

Age       number
range
15 - 44   538      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 long-
  term 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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