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Vitamin D

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 a number of 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 µg). Even on sunny days in the winter, the sun’s rays are the wrong type for the production of 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 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 (µg)

Egg

1 egg

 1.6  

Liver (lamb)

100g

0.9

Kidney (Lamb)

100g

0.6

Salmon (canned in brine)

200g

 27.2

Mackrel (grilled)

200g

17  

Sardines (canned in oil)

100g

3.6  

Tuna (canned in brine)

 200g

2.2

Avonmore Supermilk

100ml (half a glass)

2

Kellog’s Cornflakes   

 35g

2.9

Kellogg’s Special K  

 35g

2.9

Kellogg's All-Bran

35g 

2.2

Kellogg's Rice Krispies 

35g

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 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.

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.

What does the FSAI recommend regarding Vitamin D?

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

These babies should be given a daily supplement containing 5 micrograms (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 300ml (about 10 fluid ounces) of infant formula a day. This is because infant formula is fortified with vitamin D and other nutrient.

This is a population based recommendation for healthy term babies. Some babies who, for example, were born prematurely or who are under 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 300ml (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 5ug 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 5ug, 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

 

 

 

Last reviewed: 11/3/2020

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