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Researchers call for nutritional guidelines and regulations on use of vitamin D

Vitamin D is essential for good bone health and is thought to have a role in immunity, cardiovascular health, neurological conditions, respiratory infections, lung function and cancer. @Shutterstock

Experts call for a review of the nutritional guidelines, regulations around the use of vitamin D because of the vulnerability of the elderly due to COVID-19.

Written by Jahnavi Sarma |Published : October 16, 2020 7:13 PM IST

According to a new study, the professional perception of vitamin D as a medicine, rather than as a key nutrient, is constraining practice and jeopardizing the health of elderly care home residents in England. This was published in the journal BMJ Nutrition Prevention & Health. At a time when the vulnerability of elderly care home residents is under the spotlight because of the impact of COVID-19, an urgent review is needed of the nutritional guidelines and regulations around the use of the vitamin, researchers argue. The medical framing of vitamin D supplements in care homes is a practical barrier to implementation of longstanding nutrition guidelines. A paradigm shift is needed so that vitamin D is understood as a protective nutrient as well as a medicine, and a public health as well as a medical responsibility.

Supplements essential during winter months

The main source of vitamin D is exposure to sunlight, levels of which plummet during the winter months in many countries in the northern hemisphere. With few major food sources, it's difficult to get enough vitamin D from diet alone, and vitamin D deficiency in care homes is widespread in many parts of the world, say the researchers. Vitamin D is essential for good bone health and is thought to have a role in immunity, cardiovascular health, neurological conditions, respiratory infections, lung function and cancer. Most recently, it has been linked to susceptibility to, and severity of, COVID-19.

People who spend less time outdoors, such as the elderly in residential care, or who regularly cover up their skin, or who have darker skin tones, are all at heightened risk of vitamin D deficiency. Supplements have been recommended for care home residents for nearly 30 years. In 2016, recommendations for daily vitamin D supplements were extended to the entire population in the winter months, and throughout the year for those living in care homes. National bodies from around the world have issued similar recommendations for care home residents, including Australia, Canada, France, Norway, New Zealand and the USA.

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This nutrient is often seen as medicine

In a bid to better understand thinking and practice around the use of vitamin D, the researchers conducted semi-structured interviews with 13 people involved in elderly residential care in two different areas of South East England. Participants included 4 family doctors (GPs), 4 care home managers, a dietician, a falls specialist, 2 public health practitioners/managers, and a senior doctor in elderly care. None were aware of any care home routinely prescribing vitamin D supplements to its residents. And although vitamin D supplements are regulated as foods, they were nevertheless regarded as medicines.

Interviewees considered that GPs were responsible for the vitamin D status of elderly care home residents, with prescriptions only written in response to falls or a diagnosis of vitamin D deficiency or osteoporosis rather than as maintenance or preventive treatment, which reflects current NHS guidance. Care home staff said they would feel vulnerable to malpractice allegations if they routinely provided over-the-counter vitamin D supplements to their residents: they felt this was beyond the scope of their role and expertise.

Lack of awareness makes things difficult

There was considerable ambiguity about who should provide and bear the cost of these supplements, although most felt this was GPs' responsibility as prescribers, and that any change would have financial implications for care homes or the residents and their families. What's more, NHS guidance advises against routine prescription of vitamin D because supplements can be bought easily and cheaply over the counter. Apart from the dietitian, none of the interviewees seemed familiar with the recommendation that all elderly care home residents should receive vitamin D supplements without the need for a confirmatory blood test, which itself costs more than a year's supply of supplements. And not everyone was aware that diet and sunlight can't provide adequate vitamin D levels even for the general population in the UK during winter months.

This research re-emphasizes the role of vitamin D in health, an issue that has become even more relevant, given the growing body of evidence, including research published in this journal suggesting that it may help lower the risk of COVID-19 infection and/or ease the severity of symptoms, particularly among those at highest risk.

(With inputs from Agencies)

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