The NHS could save millions by targeting vitamin D deficiency

Adding vitamin D to wheat flour would prevent 10 million new cases of vitamin D deficiency in England and Wales and save the NHS £65m (€70.9m~) over the next 90 years.

This is the recommendation from a team of researchers at the University of Birmingham who say that overhauling existing public health policy to combat vitamin D deficiency with the fortification of vitamin D in wheat flour would have beneficial outcomes. According to the team’s research this approach would prevent an estimated 25% of the estimated 40 million new cases in the next 90 years.

Vitamin D is vital for the healthy functioning of the body, including for skeletal growth and bone health. Vitamin D deficiency can lead to rickets, soft bones, bone pain, and muscle weakness. Previous research, also led by the University of Birmingham, has shown that in babies and children vitamin D deficiency can cause seizures or heart failure as a result of a lack of calcium.

The average daily vitamin D intake in the UK is currently far below the Reference Nutritional Intake of 400 IU per day and it is estimated that 20% of adults and up to 16% of children in the UK are deficient.

Sources of vitamin D

It can be difficult to find vitamin D in dietary sources – with the main source of the vitamin being exposure of skin to the sunlight and today there are many contributing factors to vitamin D deficiency. This includes using sunscreen to block the sunlight, air pollution, wearing long-length clothing and generally staying indoors a lot of the time.

In the UK it is also more difficult for all ethnicities to get the correct amount of vitamin D as dark skin produces far less vitamin D than white skin, and from October to April in the UK there is insufficient ambient ultraviolet sunlight to produce healthy levels. Those particularly at risk of vitamin D deficiency are older adults, pregnant women, and those of black, Asian and minority ethnic people (BAME) origin. This is not just a UK issues, however, and many countries across the globe have adopted policies to increase their population’s intake of vitamin D.

It is possible to find many foods that are fortified with vitamin D including mushrooms, cereals and milk substitutes. In the UK, multivitamin supplements are provided free-of-charge to those in low-income households and are recommended to all children aged up to four, pregnant women and breastfeeding mothers and are provided free-of-charge to those in low-income households.

Addressing vitamin D deficiency

The team of researchers suggest that, as well as fortifying wheat, offering free vitamin D supplements to targeted groups of the population would prevent an additional 8% of new cases of vitamin D deficiency in the same 90 year period. This would mean that the combination of wheat flour fortification and targeted supplementation would in total prevent 33% (13.2 million) of cases of vitamin D deficiency.

Dr Magda Aguiar, who carried out the research at the University of Birmingham, said: “While both supplements and fortified foods are important sources of vitamin D for the UK population, evidence suggests current UK supplementation polices are not working.

“Addressing vitamin D deficiency in the UK requires a multi-disciplinary approach and preventing conditions that are the consequence of deficiency would save the NHS money to the extent that it would more than compensate for the money needed to implement flour fortification at a national level.”

Dr Aguiar, now at the University of British Columbia, added: “We now hope that UK policy makers will consider a new national policy to fortify foods such as wheat flour with vitamin D to address this serious health issue. This will lead to significant benefits for the population, particularly the most vulnerable groups.”

She said that a similar national food fortification policy in Finland has reduced vitamin D deficiency from 13% to 0.6% in the population.

The price of deficiency

The researchers put forward a new strategy for implementation in the UK. This consists of adding 400IU of vitamin D per 100g of flour, whilst at the same time, offering free supplements at the same dose for children up to 18 years of age and to those over 65.

This strategy would. At an estimate, cost £250 million over 90 years – equivalent to 38p per person. Despite this long-term cost, they estimated that fortifying flour with vitamin D would save the public purse £65m (€70.9m~) by reducing demand for healthcare and treatment for the deficiency and all of its related complications.

Professor Emma Frew, of the University of Birmingham’s Institute of Applied Health Research, said: “We have provided compelling evidence that a new strategy is not only safe but would also improve vitamin D intake, which in turn would enhance the health of millions in England and Wales. Most previous research into strategies to improve population vitamin D intake have focused only on supplementation programmes, which are generally expensive and not sustainable in the long term.

“Our study showed that, even though supplements are still a viable option for those at a higher risk, food fortification strategies should be prioritized as a response to the rising prevalence of vitamin D deficiency, as it is a safe and cost-saving option.”

The study is the first to provide evidence on the health and economic impact of preventing vitamin D deficiency as well as being the first to compare a supplementation programme with flour fortification.

The research was published in the European Journal of Clinical Nutrition and was led by the University of Birmingham’s Institute of Applied Health Research and Institute of Metabolism and Systems Research.