GPs urged to increase vitamin D supplement prescribing

GPs should offer vitamin D supplements at 'every available opportunity' to address widespread deficiency in the UK, NICE has said.

Vitamin D supplements: balanced diet alone may be insufficient (photo: Science Photo Library)
Vitamin D supplements: balanced diet alone may be insufficient (photo: Science Photo Library)

Practice computer systems should prompt GPs to recommend supplements to at-risk people across a range of patient contacts, from new registrants to screening checks, according to preliminary guidance from the institute.

NICE said there was a lack of awareness among patients and healthcare professionals that a balanced diet alone cannot provide sufficient vitamin D.

But it also criticised the government for the lack of clarity in official guidance on which patients should receive supplements.

Around one in five adults in the UK may have low vitamin D levels, which can lead to rickets in children and osteomalacia in adults.

Its draft public health guidance - Vitamin D: implementation of existing guidance to prevent deficiency, now out for consultation - calls for better training for doctors and nurses on the harms caused by vitamin D deficiency, and a national awareness campaign to inform the public.

Dietary supplements should be made more widely available, including increased access to Healthy Start vitamins. Uptake of this scheme among pregnant and breastfeeding women and children under five is under 10%.

Current advice unclear

Local councils should consider offering supplements for free to at-risk groups and pharmacies should stock low-cost supplements.

NICE said Public Health England and the DH should make it 'much clearer which at-risk groups need a daily vitamin D supplement'.

The UK's CMOs wrote to GPs in February 2012 to advise on supplementation, and the Scientific Advisory Committee on Nutrition also published guidance in 2007.

NICE said inconsistencies in the wording of these existing recommendations needed to be addressed. It includes whether infants under six months and children aged 4-5 years should be prescribed supplements.

'Every opportunity'

The guidance said: 'Local authorities and primary and community healthcare commissioning groups should ensure computerised prompts on vitamin D are integrated into health and social care systems to recommend and record vitamin D supplement use among at-risk groups.

'This may include registration appointments with new patients in general practice, flu and other vaccine appointments, statutory health visitor appointments for infants and children, screening services, health checks, and diabetes check-ups.'

Professor Mike Kelly, director of the NICE Centre for Public Health, said: 'This draft guidance calls for better awareness of vitamin D deficiency among health professionals and the public, suggesting that a national campaign on the importance of vitamin D for good health is developed.

'Health professionals should also recommend a daily vitamin D supplement to people at risk of low levels, at every available opportunity.'

Dr Louise Warburton, GPSI and president of the Primary Care Rheumatology Society, said the guidance was 'long awaited'.

She said: 'It will certainly raise awareness of the deficiency in vulnerable groups and may make access to vitamin D testing more available.'

However, issues with access to deficiency testing and the supply of vitamin D preparations remained a concern, she added.

Men with vitamin D deficiency are more than twice as likely to develop chronic widespread pain as those with the highest levels, recent research suggests.

However, a recent study from New Zealand found that taking vitamin D supplements has little effect on the risk of falls in older people.

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