Thursday, 14 November 2013

Vitamin supplements for all under fives – Is this the solution?

Following the release of the Chief Medical Officer’s annual report last month attention has been focussed on one area in particular. Professor Dame Sally Davies has suggested that to improve the nutrition status of children, primarily regarding the increase in rickets, all under-fives should be given free vitamin supplements. She is asking NICE to look into the cost effectiveness of this method, with the idea that prevention is cheaper than cure. However, do we really want all of our children taking synthetic compounds every day? Is this really the solution to a problem caused only by poor lifestyle and diet?

There have been mixed results from research into the benefits and safety of the use of vitamins. The concern is directed towards extra large doses, particularly when they are stored by the body. It is also generally accepted that synthetic vitamins are not metabolised as effectively as in the natural state and the absence of the context of the food they are contained in impedes their absorption. Water-soluble vitamins, for example vitamin C, are not stored in the body and so any amount over that needed per day will only be excreted –essentially, money down the drain. I have never personally been convinced of the need for vitamins taken as a day-by-day routine unless there is a medical need, for example when I was iron deficient in pregnancy. I was also uncomfortable when given multivitamin drops for my daughter when we were discharged from hospital as we had fully established breastfeeding which should naturally provide all the nutrients she required.

It is clear to see why the public might be unsettled by this ‘give them all a tablet’ solution, when the evidence for and against supplements is questionable and it may seem that only some children may need them in the first place. However, we must accept that we are society as a whole and we most definitely have a problem. The annual report informs us that up to 40% of children have vitamin D levels below the optimal level and 12% are deficient. The result of this can be rickets, hypocalcaemic convulsions and motor delay. Medical professionals have seen an increase in rickets by almost 400% in the last 9 years. I suggest that the majority of parents do not wish to cause their children harm so there needs to be improvement rather than blame and general criticism of parents by the media, public and government themselves (the report even claims that we should be “profoundly ashamed”). This is problem that may affect some groups more than others but it is a nationwide issue and it is too easy to blame immigration, moronic parents, and claim ‘it wasn’t like that in my day’ etc.  Far too little government funding is used for education and health promotion relating to diet and lifestyle. We need positivity and not shame to battle our sedentary culture.

The best way to achieve required levels of vitamin D is through safe exposure to sunshine for around 10-15minutes a day. This is easily achievable and far superior to the synthetic version found in supplements. It may be true that winter sun can be quite inadequate for achieving optimal levels of vitamin D but they can be topped up through eating oily fish and eggs. As the UK sun has not changed a huge factor coming into play in deficiency in children is the over-anxiety towards sunburn and skin cancer, resulting in children being constantly slathered in sunscreen. The obvious decrease in outdoor activity and imposition of technology into recreational time also holds responsibility.  Are we going to ignore this and allow it to worsen while hoping a quick fix supplement will work?

Free vitamins through the ‘Healthy Start’ scheme have been offered for children of low-income families with little success. Reports of poor uptake, supply and availability problems have led to an inadequate impact on deficiency-related illness. This could be evidence that in fact this method is not conducive to success. Giving children non-satisfying nutrients in this way involves commitment to a boring routine. Will offering them to all children really prove cost effective at all in that case? The theory is that in offering vitamins universally the stigma attached to hand-outs and being on benefits is therefore removed. There is also evidence of success in this approach on a smaller scale, by trial in Birmingham.

Perhaps more focus should be targeted on pregnant women taking supplements. The Department of Health recommends that all pregnant and breastfeeding women take vitamin D, however from personal experience there is little to ensure women know this or check that this is happening. A child’s vitamin D stores are established at this early stage from the mother’s own levels and so intervention at this early stage could have a measurable impact.

It makes me wonder if a universal approach is necessary when the evidence points towards greater prevalence of rickets in specific groups ie. those with darker skin or those with cultural reasons for covering up.  Is there anything wrong in checking on the nutrition status of children as a case by case matter?  Should our healthcare system not be able to detect deficiencies before they reach the disease state and intervene accordingly?

It is clear that something needs to be done to target the alarming rise in rickets in children and I suspect this is an indication of the poor nutrition status of children on the whole. The worry of how taxes are spent seems to concern people especially with expensive sounding schemes that may not bring success. However, what better to spend on than the health of future generations that will live with the consequences of a society and lifestyle that we have collectively created. Perhaps anxiety towards artificial nutrients has led to focus on this point, but should we really worry about children taking vitamins when they are already added to formula milk and fortified cereals, staples of our children’s diets. I remain unconvinced that I should be giving them to my daughter but maybe when offered universally it will be a matter of choice for parents. But would this defeat the point entirely? The debate continues...

#vitamins #children #vitaminD #vitd #rickets #vitaminsforchildren #deficiency #healthystart #annualreport #chiefmedicalofficer #underfives 


by Rachel Brophy

1 comment:

  1. Update: On further investigation and speaking to a health visitor about this I have decided that vitamin D supplementation is a good idea for myself and my daughter as I do not feel we are getting enough sunshine. Better to be safe than sorry although there is no denying, shop bought vitamins are expensive!


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