The Department of Health has advised that adults aged 65 and older take a vitamin D supplement

The Department of Health has issued guidance advising that adults aged 65 years and older should take a vitamin D supplement to ensure they get the essential vitamin D needed for bone and muscle health. Earlier this year, the Department of Health requested the Scientific Committee of the Food Safety Authority of Ireland (FSAI) to examine the vitamin D status of this older population and provide scientific recommendations on vitamin D supplementation. The FSAI report found that older people in Ireland do not get sufficient vitamin D from their diet or the effect of sunlight on their skin.

Based on the evidence provided in the FSAI Report, the Department of Health is providing population health guidance for vitamin D supplementation for older people. The recommendation is that adults aged 65 and older take a vitamin D supplement of 15 micrograms (15μg) every day to ensure they get the essential vitamin D needed for bone and muscle health.

This vitamin D supplement can be taken in three ways: As a multivitamin supplement that contains 15 micrograms (15μg) of vitamin D; as a calcium and vitamin D supplement that contains 15 micrograms (15μg) of vitamin D; or as a vitamin D only supplement that contains 15 micrograms (15μg) of vitamin D.

People who are currently taking a vitamin D supplement that has been prescribed by a doctor or a nurse and that contains more than 15 micrograms (15μg) can continue to take the supplement prescribed.

Frailty

Speaking about the new policy recommendation, Minister for Health Stephen Donnelly TD said: “Vitamin D is essential for good bone and muscle health as we get older. In fact, there is a strong link between frailty and low vitamin D status in older adults. This link may actually lead to a cycle that sees people being frail due to low vitamin D status, which then prevents them from being mobile and going outdoors and then in turn, this further contributes to poor vitamin D intake.

The guidance issued by my Department on adequate vitamin D supplementation for those aged 65 and older will help to prevent this cycle. It is great that people are living longer and it is really important to support healthy ageing so they can continue to lead happy and full lives.”

Minister of State for Public Health and Wellbeing Frank Feighan TD commented: “This guidance represents a significant step towards helping to ensure adequate vitamin D intake over the life-course. It builds on existing Department policy on vitamin D supplementation for children up to one year of age and our recently-launched guidance on vitamin D supplementation for one-to-four year-olds.

We want to promote the development of strong bones from an early age and maintain good bone and muscle health in older people. The diets of older adults should also include regular intakes of natural sources of vitamin D, such as oily fish, eggs, meats and vitamin D-fortified foods.”

‘Evolution of evidence’

Meanwhile, a recent article from medical experts across Ireland’s leading universities outlines compelling evidence for health professionals and policy-makers to revise guidance on vitamin D supplementation amidst the ongoing Covid-19 pandemic. The position paper, published in the Irish Journal of Medical Science, urges policy-makers to recognise the protective role of vitamin D against Covid-19 infection, encouraging a vitamin D policy to be enacted in relation to this specific issue in the absence of a current cure or safe and effective vaccine.

The paper outlines how vitamin D deficiency is an easily reversible host factor that increases the risk of SARS-CoV-2 infection, after emerging evidence showed deficiency can worsen disease severity. The authors of the paper urged policy-makers to re-examine whether vitamin D supplementation can significantly lessen these risks and update its public health guidance for the Irish population.

Research shows that the ability of the skin to produce vitamin D is compromised at northerly latitudes, especially in those who are older or in those who have a darker skin pigmentation. Vitamin D deficiency is also common in those who are obese, and in older and black populations, while deficiency may also affect infection risk and severity of virus infection through its effects on immune function.

Research from the Irish Longitudinal Study on Ageing (TILDA) reports that up to 43 per cent of adults over 50 in Ireland have insufficient vitamin D levels to counteract SARS-CoV-2 in winter and spring. Ireland’s geographic location does not provide sufficient levels of vitamin D throughout the year, while previous studies have indicated that vitamin D deficiency is relatively common in Ireland and can affect all age groups.

The Covit-D Consortium also points to a number of ecological studies that found a high incidence of severe Covid-19 infection and death among groups and populations known to be at high risk of vitamin D deficiency. The paper also draws evidence from epidemiological studies that indicate a lower risk of respiratory infection and Covid-19 in those with higher vitamin D levels.

The paper calls for policy-makers and health professionals to:

▶ Recognise the importance of enhanced vitamin D status in skeletal and extra-skeletal health, particularly in the optimisation of immune response.
▶Identify more adults with vitamin D deficiency through more widespread measurement of serum 25(OH)D.
▶Develop explicit population guidance and clinical protocols for vitamin D supplementation at effective doses outlined in the paper, as part of a comprehensive policy response to combat vitamin D deficiency and enhance the immune function and overall health of the Irish population.
▶Experts recommend daily supplementation with 20-to-25μg/day (800–1,000IU/day) of vitamin D3 for most of the general adult population in Ireland for the duration of the current Covid-19 pandemic.

Prof Rose Anne Kenny, Principal Investigator at TILDA and co-author of the paper, said: “Covid-19 is continuing to put the lives of our most vulnerable at risk, particularly impacting older adults, and those living with diabetes, comorbidities, and weakened immune systems.

Following the outbreak and spread of the virus, public health bodies in England, Scotland and Wales swiftly revised vitamin D guidance, urging all adults to take a daily vitamin D supplement of at least 400IU. We are calling on the Irish Government to urgently review the evidence outlined in this paper and bring vitamin D policy in line with other European counterparts, to offer safe and effective vitamin D guidelines to benefit the health of all Irish adults.’’

The accumulation of evidence linking low vitamin D levels and Covid-19 is now considerable

Prof Daniel M McCarthy, Professor of Human Nutrition and Dietetics at TU Dublin and co-author, added: “The accumulation of evidence linking low vitamin D levels and Covid-19 is now considerable. This evidence includes studies which show an increased risk of infection in those with low vitamin D levels, and a 25-to-30-fold reduced risk of ICU admission and a roughly 90 per cent reduced risk of death in older Covid-19 patients supplemented with vitamin D.

The current pandemic has claimed over 2,000 lives in this country, and continues to pressurise our acute care system, and particularly our ICU capacity. In this context, the supplementation of adults with 20-to-25 micrograms of vitamin D per day (800-1,000IU/day) for the duration of this crisis is appropriate. This has been shown to be safe, and it is a simple and cost-effective way of mitigating the risks associated with Covid-19. Older adults, those who are obese and those with darker skin pigmentation may require higher-dose vitamin D supplements to optimise their immune function, and these should be taken under medical supervision.”

Key drivers

Dr Declan Gerard Byrne, Clinician at Saint James’s Hospital and co-author, commented: “The ongoing pandemic has resulted in over 2,000 deaths in Ireland, with roughly half of all deaths claiming the lives of vulnerable older adults. Key drivers of Ireland’s widespread vitamin D deficiency rates are due to a number of contributing factors — its geographical location, a lack of policy on mandatory food fortification, and insufficient public health guidance on safe supplementation for all adults.

The evidence linking vitamin D deficiency with increased risk of Covid-19 infection and disease severity has evolved rapidly since the outbreak of the virus. This paper outlines clear evidence for policy-makers to update vitamin D recommendations as a matter of urgency to ensure optimal vitamin D levels are met in the Irish population.”

To read the position statement from the Covit-D Consortium, ‘Vitamin D and SARS-CoV-2 infection — evolution of evidence supporting clinical practice and policy development’, visit https://doi.org/10.1007/s11845-020-02427-9.