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Vitamin D: a hard to get nutrient

Vitamin D deficiency is associated with a number of different health outcomes¹. Understanding the importance of vitamin D for infants and young children and ensuring they get their daily RNI.

Introduction

Unlike most other vitamins, the main source of vitamin D is not from the diet but from synthesis in the skin by the action of sunlight. For the skin to produce vitamin D effectively it must be exposed to sunlight before sunscreen is applied. Many parents are now cautiously ‘sun-aware’ resulting in a reluctance to expose their toddler’s skin to the heat of the sun, particularly without sunscreen.

Coupled with the unpredictability of UK weather and cloud coverage, the lack of sun during the winter months and lifestyle changes that have reduced the amount of outdoor play, children in the UK may find it difficult to achieve sufficient vitamin D levels..

 

In a recent UK study 7.5% of young children (1.5-3 years) were found to be at risk of vitamin D deficiency1.

Dietary sources of vitamin D

Findings in the most recent National Diet and Nutrition Survey in the UK indicated that the average toddler is only getting 27% of their reference nutrient intake (RNI) of vitamin D3. A daily dietary intake is needed for infants and young children of this essential vitamin to protect bone and muscle health as they grow and develop.

Unfortunately, there are relatively few natural dietary sources of vitamin D. Foods that naturally contain vitamin D include:

  • Oily fish
  • Liver
  • Eggs

When you consider that many of these foods may not be very appealing to young children, it comes as little surprise that the average UK toddler diet is lacking in this hard to get nutrient.

As so few foods naturally contain vitamin D, some specific brands of foods and drinks are fortified with the nutrient:

  • Margarine
  • Breakfast cereals
  • Dairy products

Even when the above foods are included in the diet, they still need to be included every day and in unsuitably large quantities to ensure they provide enough to reach the RNI.

More recently the Scientific Advisory Committee on Nutrition (SACN) has published a report on Vitamin D and health and provided updated guidance on the amounts of vitamin D required by different groups in the UK population.

Helping parents meet the vitamin D needs of toddlers

Advice by healthcare professionals to families plays an important role in preventing vitamin D deficiency and its health implications. Since professional contact varies with a child’s age, advice on vitamin D supplementation needs to be given early and opportunistically.

Based on the latest recommendations, healthcare professionals should recommend a daily supplement containing4:

  • 10µg vitamin D for all pregnant and breastfeeding women
  • 8.5-10µg vitamin D for infants under one year
  • 10µg vitamin D for children aged one to four years

Infants who have more than 500ml (about a pint) of infant formula a day don’t need a vitamin D supplement as formula is already fortified. Just two 150ml beakers of Growing Up Milk provides 9.3µg of vitamin D.

However, given the low uptake of vitamin supplements, recommending substitution of foods specifically fortified with vitamin D can also help bring vitamin D intake to optimal levels.

  1. Scientific Advisory Committee on Nutrition (Sacn). Vitamin D and Health. Crown Copyright. 2016
  2. Annual Report of the Chief Medical Officer 2012, Our Children Deserve Better: Prevention Pays
  3. Bates B et al. (Ed) National Diet and Nutrition Survey Results from Years 1, 2, 3 and 4 (Combined) of The Rolling Programme (2008/2009 – 2011/2012). Public Health England. London. Crown Copyright. 2014
  4. NHS Choices. The New Guidelines on Vitamin D – What You Need to Know (Online). Available From: http://www.nhs.uk/news/2016/07july/pages/the-new-guidelines-on-vitamin-d-what-you-need-to-know.aspx (Accessed Nov 2016)