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Vitamin D levels for UK seniors with health problems – Dec 2017

How dietitians can help identify the prevalence of low vitamin D levels in a hospital setting

Clinical Nutrition ESPEN December 2017 Volume 22, Pages 139–140
N. Bergin, L. Nash
Department of Nutrition and Dietetics, Airedale General Hospital, Skipton Road, Steeton, Keighley, West Yorkshire, BD20 6HP, UK, OC56
DOI: http://dx.doi.org/10.1016/j.clnesp.2017.07.061
Image

VitaminDWiki

Each bar represents a single senior (28 individuals)
For most countries: 75 nmol = sufficient, 100 nmol = optimal
36% of seniors tested had l <10 nmol (4 ng)

See also VitaminDWiki

Vast majority of Europeans have less than 30 ng of Vitamin D – Aug 2016
10 reasons why seniors need more vitamin D has the following

  1. Senior skin produces 3X less Vitamin D for the same sun intensity
  2. Seniors have fewer vitamin D receptors as they age
    (The effect of low Vitamin D receptor genes does not show up on vitamin D test results)
  3. Seniors are indoors more than when when they were younger
    not as agile, weaker muscles; frail, no longer enjoy hot temperatures
    (if outside, stay in the shade), however, seniors might start outdoor activities like gardening, biking, etc.
  4. Seniors wear more clothing outdoors than when younger
    fear skin cancer/wrinkles, sometimes avoid bright light after cataract surgery
  5. Seniors often take various drugs which reduce vitamin D (some would not show up on vitamin D test)
    statins, chemotherapy, anti-depressants, blood pressure, beta-blockers, etc
  6. Seniors often have one or more diseases which consume vitamin D ( osteoporosis, diabetes, MS, ...)
  7. Seniors generally put on weight at they age - and a heavier body requires more vitamin D
  8. Seniors often (40%) have fatty livers – which do not process vitamin D as well
  9. Seniors not have as much Magnesium needed to use vitamin D
    (would not show up on vitamin D test)
  10. Seniors with poorly functioning kidneys do not process vitamin D as well
    (would not show up on vitamin D test)
    2009 full text online  Also PDF 2009
  11. Vitamin D is not as bioavailable in senior digestive systems (Stomach acid or intestines?)


Until recently, it was assumed that, for most people, the amount of vitamin D produced by exposure to sunlight containing UVB would be sufficient to achieve serum concentrations >25 nmol/L during winter. However, it is now known that this is not the case [1]. Adult population groups at increased risk of vitamin D deficiency in the UK include those with minimal sunshine exposure e.g. frail and institutionalised people, adults aged over 65 years, and those who wear clothing that covers most of the skin while outdoors [1].

Serum 25(OH) D concentration is widely considered to be the best indicator of total vitamin D exposure because it has along half-life in the circulation (about 2–3weeks) and is not subject to tight homeostatic control [1].

National data for institutionalised adults revealed mean plasma 25(OH) D concentrations of 33.7 nmol/L in men and 32.5 nmol/L in women. Thirty-eight per cent of men and 37% of women had a plasma 25(OH) D concentration of <25 nmol/L [2].

Vitamin D levels were checked in a group of inpatients where it was anticipated vitamin D levels were going to be low by the inpatient dietetic team. 28 patients (mean age 70 years, range 18-93 years) were identified of having low vitamin D levels (Graph 1). Six patients (21%) were under the age of 65 years. The average vitamin D level was 17 nmol/L (range 1–45 nmol/L)

Graph 1. Vitamin D levels of ‘at risk’ inpatients identified by inpatient Dietitians.

19/28 patients (68%) were deficient in vitamin D (<20 nmol/L) and 9/28 (32%) were insufficient in vitamin D (<60 nmol/L). 10/28 patients (36%) were found to have vitamin D levels <10 nmol/L. All patients were then prescribed a course of vitamin D. Anecdotal reports indicate that vitamin D management throughout NHS trusts within the UK is inconsistent. This may be partly attributed to the existence of more than one guideline. A vitamin D steering group has now been established consisting of dietitians, pharmacists, and consultants, to raise awareness amongst healthcare professionals about vitamin D deficiency. A guideline to help healthcare professionals to identify and replace low levels of vitamin D is also being produced.

References

[1] Scientific Advisory Committee on Nutrition. Draft Vitamin D and Health report. Scientific consultation: 22 July to 23 September 2015, UK: SACN; 2015.
[2] Finch SA, et al. National Diet and Nutrition Survey: people aged 65 years and over, 1994–5; 1998.

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