Who is at risk?

WHO IS AT RISK OF VITAMIN D DEFICIENCY?

According to a recently published public health guideline, PH 561:

  • All pregnant and breastfeeding women, particularly teenagers and young women 
  • Infants and children under 5 years 
  • People over 65 
  • People who have low or no exposure to the sun. For example, those who cover their skin for cultural reasons, who are housebound or confined indoors for long periods
  • People who have darker skin, for example, people of African, African--Caribbean and South Asian origin 

Note: Desunin is not licensed for children under 12

There are other specific groups who are at very high risk of vitamin D deficiency as a result of chronic malabsorption syndromes  such as coeliac disease, cystic fibrosis, short bowel syndrome and inflammatory bowel disease (IBD) which can increase the prevalence of vitamin D deficiency, to levels exceeding that of the general population.2 

A PubMed search identified seven key studies evaluating the prevalence of vitamin D deficiency amongst adolescents and adults with malabsorption syndromes (see Table Two).  One Canadian study showed that up to 26% of children and young people had inadequate 25(OH)D levels.3  Another study conducted on patients with acute intestinal failure, aged 3 to 22 years, showed that 39.8% had low serum vitamin D levels, indicating deficiency, and 12.5% had a low bone mineral density.4 

Amongst adults, an Irish study involving 81 patients with Crohn's disease (CD) found that 63% were vitamin D deficient using a 50 nmol/L cut-off 5  In a cross-sectional study of Iranian patients with CD there was found to be a higher frequency of low vitamin D levels amongst those with the active form of the diseases compared to those in remission (80% versus 50%).6 A pooled analysis of patients with CD and ulcerative colitis in the U.S showed that 49.8% were vitamin D deficient and 10.9% had severe deficiency.7 Finally, with regard to coeliac disease, a U.S. study identified that 25% of patients had vitamin D deficiency.8 

Overall, these studies show that vitamin D deficiency is highly prevalent amongst patients with malabsorption syndromes.  Clearly, international uniformity is needed to align biochemical cut-offs used to identify vitamin D deficiency.  On a separate note it should be considered that particular medications, such as antiresorptive medications for bone disease, antiepileptic drugs or oral glucocorticoids can also increase the need to treat vitamin D deficiency.9 

Through prevention or treatment of vitamin D deficiency, the risk of drug-induced bone damage, such as that caused by antiepileptic agents, glucocorticoids, anti-estrogens or antiretroviral drugs, can be reduced.10

REFERENCES

  1. Vitamin D: increasing supplement use among at-risk groups. NICE public health guidance 56. www.nice.org.uk guidance/ph56 (accessed 06 June 2016)
  2. Margulies SL, et al. (2015). Vitamin D deficiency in patients with intestinal malabsorption syndromes - think in and outside the gut. J Dig Dis; 16(11):617-33. 
  3. Norton L, et al. (2015). Prevalence of inadequate vitamin d status and associated factors in children with cystic fibrosis. Nutr Clin Pract.; 30(1): 111-6. 
  4. Ubesie AC, et al. (2013). Vitamin D deficiency and low bone mineral density in pediatric and young adult intestinal failure. J Pediatr Gastroenterol Nutr.; 57(3): 372-6.
  5. Suibhne TN, et al. (2012) .Vitamin D deficiency in Crohn's disease: prevalence, risk factors and supplement use in an outpatient setting. J Crohns Colitis.; 6(2): 182-8. 
  6. Torki M, et al. (2015). Vitamin D Deficiency Associated with Disease Activity in Patients with Inflammatory Bowel Diseases. Dig Dis Sci.; 60(10): 3085-91.
  7. Ulitsky A, et al. (2011) Vitamin D deficiency in patients with inflammatory bowel disease: association with disease activity and quality of life. JPEN J Parenter Enteral Nutr.; 35(3): 308-16. 
  8. Tavakkoli A, et al. (2013) Vitamin D status and concomitant autoimmunity in celiac disease. J Clin Gastroenterol.; 47(6): 515-9.
  9. National Osteoporosis Society (2016). Vitamin D and Bone Health: A Practical Clinical Guideline for Patient Management. Accessed online: www.nos.org.uk/document.doc?id=1352 (April 2016).
  10. Grober U et al. Dermatoendocrinol 2012, Apr 1, 4(2):158-168