Presentation on theme: "Vitamin D and Sunshine in Bradford"— Presentation transcript:
1 Vitamin D and Sunshine in Bradford Ann Hobbiss : Public Health Manager for Every Baby MattersZak 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 careBetween there were 67 cases of rickets diagnosed in children, 46 of which were under nine years oldOver 1,100 children were identified with vitamin D deficiencyIt 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 women20092010Total numberAge rangenumber5385.36105.57516.91958Source: 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 skinFat soluble substanceStored and activated in the liverKey Action: to enable the body to absorb and utilise calcium for bone growth and muscle functionPossible additional health benefits: prevention of multiple sclerosis and other long-term conditionsCome back to these statements – angle of sunlight appears crucialFat soluble – hence fatty foods contain vit D – only obtain about 10% of what we need in foodStored and activated in liver – healthy live
6 What are the factors that contribute to a deficiency in Bradford? Reduced exposure to the sun through:Latitude – angle of UVB raysWeatherClothingSun-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 deficiencyPeople from South Asian, African, African Caribbean and Middle Eastern backgroundsThose that have a low exposure to sunlight due to wearing concealing clothing or spending time indoorsTeenagersStrict sunscreen usersPeople who are obesePregnant or breastfeeding womenBreastfed and some formula fed babiesChildren during periods of rapid growth such as in infancyChildren 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 creamSummer time – April to SeptemberIn and out of the sun - care not to reddenUp to minutes totalVitamin 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 dayFor infants 7.5mcg or 300 IUFor people unable or unwilling to expose skin to sunlight -Healthy Start tablets and drops provide these amountsAlso: Pro D-3 and other OTC supplements (see children’s pathway)
10 Dietary sourcesImportant in winter for topping up stores BUT only ever supplies 10% of required amountOily fishFortified breakfast cereals – check labelFats and margarines (fortified)Evaporated milkEgg yolks
11 Achieving 10mcg(400IU) Vitamin D through diet Daily intake of :120g of pilchards and 1 egg OR14 bowls of fortified breakfast cereal OR130g (13 pats) of margarine OR1 large tin (250ml) of evaporated milk OR12 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 AGHAll infants from first Health Visitor visit to six months oldAll 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 requirementsVitamin D status is dependent on exposure to sunlight NOT dietTo 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.