Vitamin D levels for UK seniors with health problems – Dec 2017

How dietitians can help identify the prevalence of low vitamin D levels in a hospital setting

Clinical Nutrition ESPEN December 2017 Volume 22, Pages 139–140
N. Bergin, L. Nash
Department of Nutrition and Dietetics, Airedale General Hospital, Skipton Road, Steeton, Keighley, West Yorkshire, BD20 6HP, UK, OC56
DOI: http://dx.doi.org/10.1016/j.clnesp.2017.07.061

Until recently, it was assumed that, for most people, the amount of vitamin D produced by exposure to sunlight containing UVB would be sufficient to achieve serum concentrations >25 nmol/L during winter. However, it is now known that this is not the case [1]. Adult population groups at increased risk of vitamin D deficiency in the UK include those with minimal sunshine exposure e.g. frail and institutionalised people, adults aged over 65 years, and those who wear clothing that covers most of the skin while outdoors [1].

Serum 25(OH) D concentration is widely considered to be the best indicator of total vitamin D exposure because it has along half-life in the circulation (about 2–3weeks) and is not subject to tight homeostatic control [1].

National data for institutionalised adults revealed mean plasma 25(OH) D concentrations of 33.7 nmol/L in men and 32.5 nmol/L in women. Thirty-eight per cent of men and 37% of women had a plasma 25(OH) D concentration of <25 nmol/L [2].

Vitamin D levels were checked in a group of inpatients where it was anticipated vitamin D levels were going to be low by the inpatient dietetic team. 28 patients (mean age 70 years, range 18-93 years) were identified of having low vitamin D levels (Graph 1). Six patients (21%) were under the age of 65 years. The average vitamin D level was 17 nmol/L (range 1–45 nmol/L)

Graph 1. Vitamin D levels of ‘at risk’ inpatients identified by inpatient Dietitians.

19/28 patients (68%) were deficient in vitamin D (<20 nmol/L) and 9/28 (32%) were insufficient in vitamin D (<60 nmol/L). 10/28 patients (36%) were found to have vitamin D levels <10 nmol/L. All patients were then prescribed a course of vitamin D. Anecdotal reports indicate that vitamin D management throughout NHS trusts within the UK is inconsistent. This may be partly attributed to the existence of more than one guideline. A vitamin D steering group has now been established consisting of dietitians, pharmacists, and consultants, to raise awareness amongst healthcare professionals about vitamin D deficiency. A guideline to help healthcare professionals to identify and replace low levels of vitamin D is also being produced.

References

[1] Scientific Advisory Committee on Nutrition. Draft Vitamin D and Health report. Scientific consultation: 22 July to 23 September 2015, UK: SACN; 2015.
[2] Finch SA, et al. National Diet and Nutrition Survey: people aged 65 years and over, 1994–5; 1998.