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Vitamin D

Q&A on Vitamin D Report 'Recommendations for a National Policy on Vitamin D Supplementation for Infants in Ireland'

Q. Why has this report been published?  

The recent re-emergence of rickets (a severe form of vitamin D deficiency causing deformity of the bones) amongst infants in Ireland indicated the widespread low levels of vitamin D in the Irish population. A working group was established to investigate the problem in infants and to publish recommendations based on their findings.

Q. Why has vitamin D deficiency become a problem in Ireland?  

Vitamin D deficiency was thought to have been eradicated in Ireland after the Second World War, due to better nutrition. However, over 20 cases of rickets in infants and toddlers have been reported at two Dublin hospitals in the last four to five years. Further evidence is emerging that there is widespread low levels of vitamin D in the general population in Ireland. There are several factors which have contributed to this.

  • Vitamin D is mainly produced in the body by exposure of the skin to sunlight. However, because of Ireland’s northerly latitude, in the months between November and March there is inadequate quality and quantity of sunlight to enable sufficient production of vitamin D by the body (the current recommended dietary daily amount of vitamin D is 5 µg). Even on sunny days in the winter, the sun’s rays are of the wrong type for the production of vitamin D. In addition, with more people working indoors and using sunscreen when outside, vitamin D from sunlight exposure has decreased.
  • Darker skinned people living in Ireland are particularly at risk as they require more sunlight to produce vitamin D (10 to 50 times more exposure to sunlight required). Also, some religious practices preclude any skin exposure.
  • Dietary sources of vitamin D are not consumed in sufficient quantities to counter the lack of sunlight exposure and do not form part of the weaning diet for infants. Examples of dietary sources of vitamin D include oily fish (e.g. salmon, mackerel, sardines), egg yolks and fortified foods such as milk and breakfast cereals. In addition, offal meat such as liver and kidney are a good source of Vitamin D but these foods are not suitable for infants and pregnant women because they provide too much Vitamin A.

Q. Can I get sufficient vitamin D from my diet?  

  • The foods that contain vitamin D are not commonly consumed by the Irish population, so although we rely on our diets to provide us with vitamin D in the winter months, in reality, this can be difficult to achieve.

Q. What are the dietary sources of vitamin D?  

  • Vitamin D is found in a small range of foods including oily fish, egg yolks and fortified foods such as milk, breakfast cereals and infant formula. In addition, offal meat such as liver and kidney are a good source of Vitamin D but these foods are not suitable for infants and pregnant women because they provide too much Vitamin A.

Dietary source 

Quantity 

Vitamin D (µg) 

Egg 

1 egg 

0.9 

Liver* (lamb) 

100g 

0.9 

Kidney* (Lamb) 

100g 

0.6 

Salmon 

200g 

16 

Mackrel 

200g 

18 

Sardines (canned in oil) 

100g 

5 

Supermilk 

200ml (glass) 

  4 

Kellog’s Cornflakes 

35g 

0 

Kellog’s Special K 

35g 

2.5 

Infant formula 

500 ml 

5.5 – 7.5 

Q. What is the recommended daily intake of vitamin D?  

The current healthy eating guidelines for Ireland are being revised and this will include an updated recommendation for vitamin D intake. However, recently updated dietary guidelines in North America recommend an intake of 5µg of vitamin D per day for infants and young children up to 3 years of age. In Canada, which is at a similar northerly latitude to Ireland, all babies taking less than 500ml of infant formula are supplemented with 10µg of vitamin D.

Q. What are the symptoms of vitamin D deficiency?  

Vitamin D is vital for bone health due to its role in calcium regulation. At its most extreme, vitamin D deficiency manifests itself as rickets in children and osteomalacia in adults. Less severe vitamin D deficiency contributes to osteoporosis. There is also growing evidence that low vitamin D status may contribute to a range of chronic diseases e.g. hypertension, cardiovascular disease, diabetes mellitus (type 1 diabetes), some inflammatory and autoimmune diseases and some forms of cancer.

Q. What are the FSAI recommendations regarding Vitamin D?  

The recommendations are as follows:

1. All babies living in Ireland should be given a vitamin D only supplement providing 5µg Vitamin D from birth. This is necessary because babies aged 0-12 months are at high risk of vitamin D deficiency, due to their rapid growth rates during this period.

2. Supplements that provide only vitamin D and are in a suitable form to be given to infants should be used to supplement infants in Ireland. The daily amount of vitamin D provided by such supplements should be 5µg per day. Since publication of the report three suitable vitamin D products have been placed on the Irish market. These are Abidec Vitamin D3, Baby Vit D3 by Shield Health and Baby D by Kora Healthcare.

Note: The FSAI does not approve or authorise any food products. However, by law, all food supplements marketed in Ireland must be notified to the FSAI. Of all food supplements notified, the 3 products listed about meet the criteria for supplementing babies with Vitamin D in Ireland.

3. Health professionals and parents need to be made aware that vitamin D deficiency is prevalent in Ireland, particularly among dark-skinned infants and young children.

Q. I thought breastfeeding was the best option for my baby. Am I wrong?  

No, breastfeeding is the very best way to feed your baby. Breast milk is the optimum food for infants from birth to six months. However, breast milk is low in vitamin D and breastfed babies would benefit from the use of a supplement from birth. Infant formula is developed through the addition of many nutrients that are naturally present in breast milk. However, in relation to vitamin D, infant formula has extra vitamin D added.

Q. I feed my baby infant formula. Do I need to use a supplement as well?  

Infant formula fed babies will benefit from the use of a vitamin D supplement. However, because infant formula contains vitamin A, giving your baby a vitamin D supplement that also contains vitamin A would mean that your baby receives more than the safe upper limit for vitamin A. Therefore infant formula fed babies should be given a supplement that only provides vitamin D

There are three supplements available in Ireland that provide vitamin D only. These are: - Baby Vit D3 (Shield Health ),
- Abidec Vitamin D3 drops (Chefaro) and
- Baby D (Kora Healthcare)

Note: The FSAI does not approve or authorise any food products. However, by law, all food supplements marketed in Ireland must be notified to the FSAI. Of all food supplements notified, the 3 products listed about meet the criteria for supplementing babies with Vitamin D in Ireland.

Q. If I feed my baby breast milk and infant formula, do I need to give a supplement as well?  

Yes. Your baby will need a supplement to ensure sufficient intake of vitamin D. You should give your baby a supplement every day that provides 5µg vitamin D3 only (see suitable supplements above) until s/he is 12 months old. If you are in any way unsure, you can discuss this with your public health nurse or G.P.

Q. I’ve breastfed my baby and did not give any supplement. My baby is now 14 months old. Should I give a supplement now?  

  • The recommendation for the use of a vitamin D supplement is for infants from 0-12 months as they are at the highest risk due to rapid growth during this period. While the policy specifically states that babies from birth to 12 months of age should receive a daily 5ug supplement of vitamin D, older children may also benefit from a daily supplement of vitamin D.
  • In this case, it is very important to NOT EXCEED the daily recommended dose of 5ug, using a vitamin D only supplement, for older children. Be careful not to give other supplements containing vitamin D.

Q. I am pregnant and taking a vitamin D supplement. Does this mean my baby will not need to take a supplement?  

No. Although babies are dependent on their mother’s vitamin D status, they are born with only 50-60% of their mother’s vitamin D store and therefore, will require supplementary vitamin D to ensure that they do not become deficient.

Q. Are babies the only group at risk of vitamin D deficiency?  

No. People of all ages living in Ireland have inadequate intakes of vitamin D and studies in Ireland have revealed that low vitamin D status and vitamin D deficiency are widespread in the population of Ireland. Of particular relevance to infants is the evidence that shows that women of childbearing age and adolescent girls (future potential mothers) have inadequate vitamin D intake and low vitamin D status.

Q. Should everyone be taking a vitamin D supplement?  

Studies in Ireland have revealed that low vitamin D status and vitamin D deficiency are widespread in the population of Ireland. The exact vitamin D needs of different population groups needs to be assessed before advice on supplements can be given. It is expected that the vitamin D needs of other ‘at-risk’ groups, such as pregnant women and children aged 12 months to four years will be addressed by the FSAI at a later date. In the meantime, there is information available on the best ways of getting the required amount of vitamin D from food sources (including supplements) in Ireland. This is outlined on pages 28-29 of our publication Healthy Eating and Active Living for Adults, Teenagers and Children over 5 Years  

 

 

Last reviewed: 28/10/2014

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