Irish authorities recommend Vitamin D supplementation for all infants

16 May 2007 - FSAI

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The Food Safety Authority of Ireland (FSAI) today published a report recommending the implementation of a national policy of vitamin D supplementation in all infants aged 0-12 months in Ireland. This recommendation follows a review undertaken by the FSAI's Scientific Committee which highlights the re-emergence of rickets in infants in Ireland, a medical condition caused by severe vitamin D deficiency.

The report, entitled Recommendations for a National Policy of Vitamin D Supplementation for Infants in Ireland, identifies poor vitamin D status amongst infants, adults, adolescent girls and pregnant women living in Ireland. It recommends a Government policy of vitamin D supplementation for infants aged 0-12 months living in Ireland.

Infancy is a crucial period for the prevention of rickets, as it is the most rapid period of growth and development experienced by humans. The report recommends vitamin D supplementation during infancy to ensure healthy bone development and to prevent rickets.

This is particularly important for dark skinned infants who are at the highest risk of vitamin D deficiency. According to the FSAI's report, as many as 23 cases of rickets were reported in recent years at two Dublin-based paediatric hospitals. As rickets is the most extreme consequence of vitamin D deficiency, the FSAI expects the incidence of deficiency in Ireland is underestimated.

Vitamin D is involved in calcium metabolism and is necessary for good bone health. Sunlight is the primary source of vitamin D, with the body producing this vitamin as a result of the action of sunlight on the skin. However, Ireland's northerly latitude means that vitamin D production from sunlight is severely compromised particularly during the winter months of October to March.

Other countries at a similar latitude to Ireland, for example Canada and the UK, have identified this problem and have long since adopted a policy of vitamin D supplementation and/or fortification policies to tackle vitamin D inadequacy.

Vitamin D is found only in a limited number of foods such as oily fish, egg yolk and liver and as such, dietary intakes have had little impact on overall vitamin D status. This has a significant impact on infants as they must not be exposed to the sun and their diets do not contain foods rich in vitamin D. In addition, infants depend on their mothers vitamin D stores (typically inadequate in Ireland) of which they inherit 50-60% at birth.

Regardless of whether a baby is breastfed, partially breastfed or fed infant formula during the first year of life, infants are at risk of having insufficient vitamin D stores. The FSAI reiterated its advocacy of breastfeeding, as human milk uniquely protects infant health through many constituents that cannot be replicated in infant formula. Breast milk with a supplement of vitamin D provides the optimal level of nutrients required by infants in the early stages of life and is known to bestow lifelong health benefits.

The report also notes that before a policy of supplementing all infants with vitamin D can commence in Ireland, a new supplement containing only vitamin D needs to be made available. The only currently available supplement for infants in Ireland, Abidec*, also contains vitamin A, which when combined with infant formula, exceeds the safe upper limit of vitamin A. Once available, this new vitamin D supplement should be accessible to all infants aged 0-12 months.

According to Dr Mary Flynn, Chief Specialist in Public Health Nutrition, FSAI, recent studies show that most people in Ireland are not eating enough of the foods naturally rich in vitamin D or of foods fortified with the vitamin.

"It is evident that low intakes of vitamin D are prevalent among all age groups throughout Ireland and that the recommended daily intake of 5µg of vitamin D per day is not being met.

"Babies are most susceptible to developing the bone deformities associated with rickets because of the rapid growth and development that occurs during the first year of life and the likelihood of having insufficient stores of vitamin D to meet their needs. It is therefore necessary to adopt a clear, simple and safe recommendation. We conclude that all infants aged 0-12 months living in Ireland would benefit from vitamin D supplementation."

Dr Flynn added the Scientific Committee suggests that strategies should also be put in place to increase vitamin D intake in different age groups of the population in Ireland.