Vitamin D deficiency in Ireland

Information about the need for extra Vitamin D in Ireland

Vitamin D deficiency in Ireland

• Daily vitamin D supplement recommendations
  • For healthy children (5-11 years) a daily vitamin D supplement containing 10 µg (400 IU) should be taken:
    • during extended winter (end of October to March) for those of fair-skinned ethnicity
    • throughout the full year for those of darker-skinned ethnicity
  • For healthy teenagers and adults (12-65 years) a daily vitamin D supplement containing 15 µg (600 IU) should be taken:
    • during extended winter (end of October to March) for those of fair-skinned ethnicity
    • throughout the full year for those of darker-skinned ethnicity
    • throughout the full year for those who are pregnant, regardless of ethnicity.
• Recommendations for 1-5 Year-Olds
  • During the extended winter months – from Hallowe’en to St Patrick’s day, all children aged 1 to 5 years need to be given a low-dose (5 µg) vitamin D-only supplement to make up for lack of skin synthesis of this vitamin from sunlight.
• Scientific diet recommendations for older adults
  • A daily 15 µg vitamin D supplement is now recommended by the Department of Health for all older adults in Ireland. This report provides specific details on the range of dietary intake recommended for vitamin D in older adults, which vary according to ability to obtain some of this vitamin from sunlight exposure.
  • Fortified foods are a good source of B vitamins (B12, folate, B6 and riboflavin) and vitamin D; whilst unsweetened orange juice, salads, fruit and vegetables are reliable daily food sources of vitamin C. 
• Vitamin D recommendations for infants aged 0-12 months

  •    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.

  •    Exclusively breastfed infants (particularly those who are dark skinned) should be supplemented with 0.3ml of Abidec per day.  Partially breastfed infants should be supplemented with 0.3ml of Abidec per day, providing they do not receive in excess of 500ml of infant formula per day.  In all infants, this supplementation should start at birth and continue to 12 months of age.

  •    A supplement providing vitamin D only needs to be made available for use in Ireland. This new vitamin D only supplement should be given to all babies irrespective of how they are fed so that they receive a minimum of 5µg of vitamin D every day from birth to 12 months of age.

  •    Further working groups should be established to develop recommendations to improve vitamin D status in other population subgroups, with priority given to toddlers and pre-school children, pregnant women and older school children.

• 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.

  In the early 2000s, over 20 cases of rickets (a weakening of the bones caused by severe vitamin D deficiency) in infants and toddlers were reported in Ireland.

  Further evidence showed that low levels of vitamin D were widespread in the general population in Ireland.

  There are several reasons for this:

  • Vitamin D is mainly produced in the body by exposure of the skin to sunlight. Because Ireland is so far north, there is not enough sunlight, between November and March, for the body to produce the amount of vitamin D needed (the current recommended dietary daily amount of vitamin D is 5 micrograms (5 μg)). Even on sunny days in the winter, the sun’s rays are the wrong type to produce vitamin D
  • More people work indoors and use sunscreen when outside, so 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)
  • Some religious practices preclude any skin exposure
  • Natural dietary sources of vitamin D are not consumed in high enough amounts to make up for the lack of sunlight exposure. These foods also do not form part of the weaning diet for infants. Some foods are not suitable for infants and pregnant women because they provide too much vitamin A (see question What are the dietary sources of vitamin D?)
  • Since 2007, many commonly eaten foods have been fortified with vitamin D on a voluntary basis. Examples of these foods include some milks, some yoghurts and some breakfast cereals. However, only those people who consume the fortified brands of these products obtain additional vitamin D.
• Can I get sufficient vitamin D from my diet?

  The foods that contain vitamin D are not commonly consumed by the Irish population. While the range of foods fortified with vitamin D has greatly increased, this is limited to certain brands.

  Overall, this means that dietary sources of vitamin D may not provide enough vitamin D during the winter months, when no vitamin D is available from sunlight.

• 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 some milks, yoghurts, breakfast cereals and infant formula.

  Offal meats, such as liver and kidney, are a good source of vitamin D but are not suitable for infants and pregnant women because they provide too much vitamin A.

  Dietary source	Quantity	Vitamin D
  Egg	1 egg	1.6
  Liver (lamb)	100 g	0.9
  Kidney (lamb)	100 g	0.6
  Salmon (canned in brine)	200 g	27.2
  Mackerel (grilled)	200 g	17
  Sardines (canned in oil)	100 g	3.6
  Tuna (canned in brine)	200 g	2.2
  Avonmore Supermilk	100 ml (half a glass)	2
  Kellogg’s Cornflakes	35 g	2.9
  Kellogg’s Special K	35 g	2.9
  Kellogg's All-Bran	35 g	2.2
  Kellogg's Rice Krispies	35 g	2.9
  Infant formula	100 ml	1.7
  Follow-on formula	100 ml	1.7
  Drink for young children with added nutrients	100 ml	3.1
  Brennan's Wholegrain with Vitamin D	2 slices	0.8

  Please note: This is a reflection of the vitamin D content of the listed products at the time of writing (5 March 2020). Products are continually reformulated and are not required to be notified to the FSAI.

• 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 5 micrograms (5 µg) 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 500 ml of infant formula are supplemented with 10 micrograms (10 µg) of vitamin D.

• 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 (weakening of the bones) in children and osteomalacia (softening of the bones) in adults.

  Less severe vitamin D deficiency contributes to osteoporosis (bones are weaker and more likely to break).

  There is also growing evidence that low vitamin D status may contribute to a range of chronic diseases, for example, hypertension (high blood pressure), cardiovascular disease, diabetes mellitus (type 1 diabetes), some inflammatory and autoimmune diseases and some forms of cancer.

• Babies, from birth to 1 year of age, who are being breastfed

  These babies should be given a daily supplement containing 5 micrograms (5 µg) of vitamin D. This should be provided by a supplement containing vitamin D exclusively.

• Babies, from birth to 1 year of age, fed infant formula

  These babies should not be given a daily vitamin D supplement if they are having more than 300 ml (about 10 fluid ounces) of infant formula a day. This is because infant formula is fortified with vitamin D and other nutrients.

  This is a population-based recommendation for healthy term babies. Some babies who, for example, were born prematurely or who are receiving on-going medical care may have different vitamin requirements. The specific recommendation of their doctor should be sought and followed in these cases.

• 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.

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

  Babies who are consuming 300 ml (about 10 fluid ounces) of infant formula a day with breast milk will not need a supplement as they will receive enough from the formula.

• 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 birth to 12 months as they are at the highest risk due to rapid growth during this time. While the policy specifically states that babies from birth to 12 months of age should receive a daily 5 micrograms (5 μg) supplement of vitamin D, older children may also benefit from a daily supplement of vitamin D.

  In this case, it is very important not to go above the daily recommended dose of 5 micrograms (5 μg), using a vitamin D only supplement, for older children. Be careful not to give other supplements containing vitamin D.

• 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.

  This means they will require supplementary vitamin D to ensure that they do not become deficient.

• 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.

  Studies in Ireland have shown that low vitamin D status and vitamin D deficiency are widespread in the population of Ireland.

  Evidence also shows that women of childbearing age and adolescent girls (future potential mothers) have inadequate vitamin D intake and low vitamin D status.

• Should everyone be taking a vitamin D supplement?

  Studies in Ireland have shown 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 five years, will be addressed by the FSAI at a later date. 

  In the meantime, information on the best ways of getting the required amount of vitamin D from food sources (including supplements) in Ireland can be found on pages 58 to 59 of our publication Healthy Eating, Food Safety and Food Legislation.