Government considering ‘mandatory’ vitamin D fortification to reduce deficiencies

The Government is consulting on measures to reduce vitamin D deficiencies, including voluntary or mandatory fortification of certain foods.

It is also considering ways to improve ‘awareness’ of vitamin D among both GPs and their patients, the Office for Health Improvement and Disparities (OHID) said.

The consultation, which will close on 15 May, applies to England only and comes as dietary UK vitamin D intake is ‘below the recommended levels in all age groups’.

Vitamin D levels among around one in six adults and almost 20% of children in the UK are ‘lower than Government recommendations’, with older people, the housebound and those from Black and South Asian communities more likely to have lower levels, OHID said.

An OHID consultation published yesterday said the Government aims to:

Improve vitamin D status through diet including ‘fortified foods and biofortification’ and through dietary supplements;
Increase ‘access to and availability of’ dietary supplements;
Raise ‘awareness’ among health and care professionals’ about vitamin D and increase ‘population awareness’ too;
Address health disparities related to accessing and consuming vitamin D.

It is ‘seeking views on improving vitamin D intake and status through diet and dietary supplements, particularly among at-risk groups’.

The consultation said: ‘Fortifying a staple food may provide a method of improving the vitamin D status of the population, and particularly for groups at higher risk of vitamin D deficiency who may not have the same access to sources of vitamin D through their usual diet, sunlight or dietary supplements.’

It asked for respondents’ ‘views on the voluntary (decided by producers) and mandatory (required by Government) fortification of food and drinks with vitamin D’ as well as views on ‘standardising’ voluntary fortification of food and drinks, such as by ‘establishing a minimum level of fortification’.

It added that the Government is ‘interested in innovative programmes and interventions to highlight or promote vitamin D in food and drinks in retail and other settings’.

Vitamin D fortification is already mandatory for milk and margarine in Canada, while in the US, various foods such as breakfast cereals, yoghurts, juices and almost all milk are fortified on a voluntary basis.

What are the current vitamin D measures and recommendations?

All margarine sold for domestic use in the UK was subject to mandatory vitamin D fortification from 1940 but the requirement was removed in 2013. Now, some foods are ‘voluntarily’ fortified with vitamin D, including some fat spreads, plant-based drinks, dried and evaporated milks and breakfast cereals. Infant formula remains mandatorily fortified with Vitamin D.

Since 2016, the current advice is for all adults and children to consider taking a daily 10 micrograms supplement of vitamin D between October and March, with some at-risk groups advised to consider taking a supplement throughout the year.

These include those who:

are not often outdoors – for example, if they are frail or housebound
are in an institution like a care home
usually wear clothes that cover up most of their skin when outdoors
have dark skin from a black African, black Caribbean, black ethnic group or south Asian background
are breastfeeding
children aged under four

However, uptake is ‘low’ with only one in six adults reporting taking a daily supplement.

During the Covid pandemic, the Government provided over 900,000 vitamin D supplements to the clinically extremely vulnerable and those in care homes who were most at risk of deficiency in England.

The consultation also suggested that there may be a need to raise awareness of vitamin D among GPs, asking whether respondents believe that ‘more awareness (or information resources) on vitamin D is needed amongst health and care professionals’.

It said: ‘For most people, their first point of contact with health services will be in primary care settings, and usually their GP.

‘Primary care settings are increasingly becoming local health hubs providing a wider range of advice and support to the communities to promote good health.’

While around seven million units of vitamin D supplements were purchased in England, Scotland and Wales as of November 2020, a ‘prescription only medicinal form of vitamin D may be provided for those with a clinical need’, it added.

Meanwhile, as well as seeking to improve awareness of fortified foods and drinks, the Government is also looking to improve awareness of the Healthy Start vitamin scheme, which funds free vitamins and healthy foods for eligible pregnant women and children aged under four.

Local authorities and NHS organisations are responsible for distributing the vitamins, such as through ‘ante-natal appointments, health visitors and health clinics’, but ‘anecdotally’ uptake is ‘low’, OHID said.

OHID said that the consultation ‘kick-starts’ a national campaign to ‘increase awareness of national guidance and dietary advice on vitamin D and associated health disparities, which will include engagement with various stakeholders and industry’.

It comes as NICE concluded that there is not enough evidence to support taking vitamin D solely to treat or prevent Covid-19, after studies found in 2020 that more than 80% of hospitalised Covid patients had vitamin D deficiency.

Meanwhile, a 2019 study showed that there has been a marked increase in vitamin D supplement prescriptions for children in the UK over the past decade.

In 2016, the Government issued new guidance on taking daily vitamin D supplements during autumn and winter, after a major Pulse investigation revealed that prescribing of vitamin D by GPs had risen 40% since 2012, with the annual cost reaching £85m.