Statement of support for article in Pharmaceutical Journal, January 2021, vol. 306, by Joseph Williams and Carol Williams:  Let’s make vitamin D supplements a permanent fixture for care homes

 

Across the UK and Ireland, thousands of care homes have been experiencing COVID-19 infections and deaths among residents.

A significant proportion of those elderly people show evidence of impaired nutritional status including low blood 25(OH)D concentrations, the recognised biomarker used to assess the risk of vitamin D deficiency and suboptimal intakes.  The essential micronutrients including vitamin D, vitamin A, the B vitamins (folate, vitamin B6 and vitamin B12), vitamin C and the minerals iron, copper, selenium and zinc are all known to contribute to the normal functions of the immune system.  Avoidance of deficiencies and identification of suboptimal intakes in targeted vulnerable groups such as frail elderly people in care and nursing homes are vitally important.  Common problems, such as low energy intakes, loss of appetite, age-related loss of senses of taste and smell, depression, comorbidities, digestive and cognitive impairments and some medications can all contribute towards undernutrition and malnutrition in older people.

For vulnerable people who are deprived of sunlight, dietary sources of vitamin D, including foods naturally high in vitamin D, fortified foods and food supplements, are necessary to meet nutritional requirements and to avoid vitamin D deficiency.  To ensure optimal vitamin D status, the use of vitamin D supplements is often required, as sunlight exposure and dietary intake from foods alone are usually insufficient for many elderly individuals not only in care and nursing homes but also in the community.  Recently, Griffin et al.  (2020) showed that, in Ireland, 42% of nursing home residents and 37% of hospital inpatients, respectively, had low blood 25(OH)D levels, indicating vitamin D deficiency in these vulnerable people.  Among the key findings from the UK National Diet and Nutrition Survey published by Public Health England in December 2020, less than one third of adults aged 65–74 years and over 75 years were vitamin D supplement takers, and vitamin D intakse from all sources, except for women aged 65–74 years were all well below the UK Government recommendation of 10 µg/day.

Care and nursing home residents are among the population groups who have experienced the highest mortality from COVID-19 both in Ireland and the UK.  With their demonstrably poor vitamin D status, and with the high prevalence and extent of vitamin D deficiency in these vulnerable groups, together with the immediate and grave risks posed by COVID-19, the recommendation to have food supplements as a permanent fixture for care homes is justified and is strongly supported by CRNUK.

There is general agreement from authoritative bodies that the average vitamin D intake requirement in healthy adults with minimal or no sunlight exposure is 10 µg daily and for the frail elderly it is 20 µg daily.  Supplementary amounts of vitamin D of 20–25 µg/day have been shown to reduce risk of falls and bone fractures in in adults over 70 years of age. Furthermore, clinical evidence is emerging that for optimal immune functions against viral infections, including COVID-19 and other respiratory diseases, short-term intakes of around 50 µg/day would be well within the safety profile and the tolerable upper limit for vitamin D of 100 µg/day.  This maximum level of chronic daily intake from all sources is judged by international expert scientific risk assessors to be unlikely to pose a risk of adverse health effects to humans, including all sensitive population groups.  Daily or weekly vitamin D supplementation in amounts ranging from 20 to 50 µg/day have been shown to be protective against acute respiratory infections.

In conclusion, avoidance of nutrient deficiencies, identification of target groups at high risk of suboptimal nutritional status and the use of practical, safe and effective solutions could help strengthen the resilience of people to the COVID-19 pandemic.  The role of the essential micronutrients, including vitamin D, in supporting immune functions should be one of the fundamental public health messages and be central to the development of effective strategies for good nutrition and health for the general population, but especially for people in care and nursing homes.

David Richardson

Scientific Adviser to CRN UK

1 March 2021

 

References

Calder P et al. (2020) Optimal nutritional status for a well-functioning immune system is an important factor to protect against viral infections. Nutrients 12: 1181.

Cawood AL (2020) A review of nutrition support guidelines for individuals with or recovering from COVID-19 in the community.  Nutrients 12: 3230.

Griffin TP et al. (2020) Vitamin D status of adults in the community, in outpatient clinics, in hospital and in nursing homes in the west of Ireland. J Gerentol A Biol Sci Med Sci 75: 2418-2425.

Marshall B et al. (2019) PURL:  can vitamin D prevent acute respiratory infections? J Family Practice 68(4): 230-231.

McCartney DM et al. (2020) Optimisation of vitamin D status for enhanced immunoprotection against COVID-19. Irish Med J 113(4): 58; 113(5): 80.

McKenna MJ et al. (2020) COVID-19 :  cocooning and vitamin D requirements. Irish Med J 113(5): 89.

Murphy JFA (202) COVID-19 and healthcare workers. Irish Med J 119(5): 67.

NICE/SACN/PHE Guidelines (2020) COVID-19 rapid guidelines: vitamin D.  Published 17th December 2020.

Richardson DP and Lovegrove JA (2020) Nutritional status of micronutrients as a possible and modifiable risk factor for COVID-19:  a UK perspective. Brit J Nutr 125(6): 678-684.

UK National Diet and Nutrition Survey (NDNS):  results from years 9 to 11 (combined) 2016/2017 to 2018/2019.  Published 11th December 2020.