We read with interest the results of the questionnaire survey undertaken by Metson1 highlighting the low percentage of practices in the Thames Valley and Lambeth areas that are routinely supplementing infants with vitamin D.
In Bristol, GPs have been reporting increasing numbers of adults with osteomalacia and children with rickets or vitamin D deficiency, primarily in our Somali population. This group, made up primarily of migrants seeking asylum or being granted refugee status, has rapidly grown in the city over the last 5 years. They are particularly at risk due to the combination of black skin, veiled dress in women and socioeconomic disadvantage. A recent review of cases has indicated mostly profound deficiency in those presenting with symptoms and a high prevalence of asymptomatic deficiency in the children of cases.
The poor rate of routine supplementation is not surprising considering the inconsistency between recommendations currently available from the Scientific Advisory Committee on Nutrition (SACN)2 and the National Institute for Health and Clinical Excellence.3 We understand that discussions are underway to address this inconsistency (SACN, personal communication, 2006). The low supplementation rate is compounded by the limited availability of suitable preventive preparations. Following the withdrawal of mother's and children's vitamin drops, formerly part of the Welfare Foods Scheme, there has been an absence of easily affordable over-the-counter preparations. The Welfare Foods Scheme will be replaced by Healthy Start, although the launch date and content of the new programme remain to be finalised. In the meantime, we have been preparing local treatment and prevention guidelines in which we will be recommending the prescription of vitamin D supplements for at-risk pregnant women and nursing mothers and their infants up to the age of 5 years. Initially, we will be targeting those in our Somali population and patients with a positive family history of osteomalacia or rickets.
The recommendation by Metson and colleagues for a publicity campaign to encourage vitamin D supplementation is to be supported, but only in the presence of both consistent national guidance on the population groups appropriate for supplementation, and following the provision of easily available supplement preparations.
Competing interests
The authors have stated that there are none.
REFERENCES
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