Second call for evidence

Vitamin D: implementation of existing guidance to prevent deficiency

Overview

NICE is issuing a second call for evidence to support the development of public health guideline on ‘Vitamin D: implementation of existing guidance to prevent deficiency’. We would like data that can contribute to any the key questions in the scope for this work, although we are particularly interested in:

• Any evidence that has been published since July 2013.
• Any unpublished, commercial or other information that was not submitted in the previous call for evidence and we would not be able to identify through a search of databases (for example, information about local interventions or processes to increase awareness and update of supplements containing vitamin D). 

We are particularly interested in any evidence that can help strengthen the recommendations in draft guideline. This includes:

• Strategies for increasing access, availability and uptake of supplements for at risk groups (see recommendation 5 in the draft guideline)
• Strategies to increase access, availability and uptake of healthy start supplements (see recommendation 6 in the draft guideline)
• Cost and benefits of vitamin D supplementation

Please do not re-submit information that was submitted to the previous call for evidence.

The closing date for submissions is the 10^th June 2014.

Background

Vitamin D is essential for skeletal growth and bone health. Dietary sources are limited. The major natural source of vitamin D is from skin synthesis following exposure to sunlight. In winter months, the UK population relies on body stores and dietary sources to maintain vitamin D levels (Scientific Advisory Committee on Nutrition 2007).

There have been reports that rickets is re-emerging in the UK (Pearce and Cheetham 2010). The national diet and nutrition survey of British adults (Ruston et al. 2004) also suggests that about a quarter of British women aged 19–24, and a sixth of those aged 25–34, are at risk of vitamin D deficiency.

Vitamin D deficiency can occur at any age but is more likely during periods of rapid growth (for example, during childhood), during pregnancy and while breastfeeding. People of South Asian, African, Caribbean and Middle Eastern descent, and those who remain covered when outside, are at particular risk. Older people are also at increased risk because their skin cannot synthesise vitamin D efficiently, they are likely to spend more time indoors and may not have enough dietary vitamin D. Limited sun exposure all year round – for example, because people are house bound or are in prison –also increases the risk (Scientific Advisory Committee on Nutrition 2007).

In 1991, the Committee on Medical Aspects of food policy (COMA) set reference nutrient intakes (RNI) for vitamin D (DH 1991). Some population groups can only achieve the RNI for vitamin D by taking a supplement.All UK health departments (Chief Medical Officers 2012) and NICE (see guidance on antenatal care and maternal and child nutrition) have issued evidence-based guidance on vitamin D supplements for various at-risk groups. They have also provided guidance on how to distribute free Healthy Start supplements (which contain vitamin D) to eligible families.

Evidence suggests implementation of these recommendations has been limited and there has been concern about how clear and consistent the recommendations are (Chief Medical Officers 2012; Feeding for Life Foundation 2012; DH: personal communication 2012). The cost effectiveness of implementing existing guidance on vitamin D also remains unclear.

Supplements containing vitamin D are available on prescription or for sale from pharmacies or shops. However, there is wide variation in the content and cost and some products may not be suitable for particular at risk groups. Healthy Start vitamins tend to be available from health clinics, children’s centres, Sure Start centres, outreach programmes or GP surgeries, although there have been local supply problems. Primary care spending on treatments for vitamin D deficiency rose from £28 million in 2004 to £76 million in 2011 (Robinson 2012; Health and Social Care Information Centre 2012).  

Introduction to call for evidence

This is the second call for evidence for this guidance. The closing date for submissions is the 10^th June 2014.  Any submitted evidence will contribute to the evidence reviews that have been commissioned as part of the development of this guidance.

• Any evidence that has been published since July 2013.
• Any unpublished, commercial or other information that was not submitted in the previous call for evidence and we would not be able to identify through a search of databases (for example, information about local interventions or processes to increase awareness and update of supplements containing vitamin D). 

We are particularly interested in any evidence that can help strengthen the recommendations in draft guideline. Additional evidence that would be particularly helpful includes:

• Strategies for increasing access, availability and uptake of supplements for at risk groups (see recommendation 5 in the draft guideline)
• Strategies to increase access, availability and uptake of healthy start supplements (see recommendation X in the draft guideline)
• Any substantial and previously-untapped data on costs (and ideally also benefits) of vitamin D supplementation within the UK. As always, the fewer assumptions that have to be made because of the lack of data in modelling, the closer the model is likely to mimic the real world.

Information of interest

We are interested in a broad range of different types of information,including local process and evaluation reports, measures of service reach and sustainability and finance reports, alongside more traditional quantitative evidence (such as pilots or observational studies) and qualitative evidence (such as those which consider participant satisfaction or reasons for drop out). We are particularly interested in evidence that may help to better promote equality of opportunity relating to age, disability, gender, gender identity, ethnicity, religion and belief sexual orientation or socio-economic status.

With finance data, we are interested in the cost to individuals, the local authority or NHS of taking part in an intervention, including discounts by volume and for longer contracts. We are unlikely to be interested in the profits or losses to a commercial company.

We are not interested in:

• Evidence published before July 2013 and considered as part of the evidence reviews for this guidance
• Evidence submitted to the previous call for evidence
• Unsubstantiated opinion / discussion pieces or promotional material.

Submitting evidence

Due to copyright restrictions please only forward the details of references for papers published in peer reviewed or other press. Please note that we are no longer able to accept paper or electronic versions of evidence if it is published in the peer reviewed or other press. However, if you give us the full citation, we will obtain our own copy. We are able to accept attachments of unpublished reports, local reports / documents.

The details and documents for this call for evidence can be found on the NICE website.

Commercially or academically sensitive information

If you wish to submit relevant commercially sensitive information, unpublished information or research, please can you highlight which sections are confidential by using a highlighter pen or the highlighter function in word. Please see Annex 1 for further information on submissions of confidential material.

Please note that we will be holding individual meetings with commercial or other organisations who which to submit commercially or academically sensitive information. If you would like to arrange an individual meeting at NICE please contact Rukshana.Begum@nice.org.uk  

Forwarding relevant evidence

Please send details via the appropriate comments form (below) to: vitaminddeficiency@nice.org.uk

Comments proforma (published material)

Comments proforma (unpublished material)

Please send any relevant evidence by 10^th June 2014.

Paper copies can be sent to:

Rukshana Begum
Co-ordinator for Centre for Public Health
National Institute for Health and Care Excellence
10 Spring Gardens
London SW1A 2BU

We look forward to receiving information on this and thank you in advance for your help.