Intended for healthcare professionals


Public Health England recommends vitamin D supplements in autumn and winter

BMJ 2016; 354 doi: (Published 21 July 2016) Cite this as: BMJ 2016;354:i4061
  1. Susan Mayor
  1. London

Children and adults should take a daily supplement containing 10 micrograms of vitamin D in autumn and winter to protect bone and muscle health because it is difficult to meet this intake from dietary sources, Public Health England has recommended after the Scientific Advisory Committee on Nutrition reviewed available evidence.

The Department of Health asked the committee to update the vitamin D dietary reference values for the UK population by reviewing research evidence on the vitamin’s role in musculoskeletal health, including bone mineral density, fractures, and muscle strength, as well as in non-musculoskeletal conditions such as heart disease and cancer.

The committee found evidence showing a positive association between vitamin D supplementation and measures of bone health in adults over 50, as well as between maternal levels of the vitamin during pregnancy and bone health indices in newborns, but the effects were less clear in other age groups. They found a risk of rickets with serum levels of 25-hydroxyvitamin D (the main circulating vitamin D metabolite) below 25 nmol/L.

The review also found evidence suggesting a beneficial effect of vitamin D supplementation on muscle strength and function in adolescents and in adults of all ages. In addition, evidence showed that vitamin D supplementation reduced falls in adults over 50.

Overall, the committee found evidence showing that the risk of poor musculoskeletal health increases with levels of serum 25-hydroxyvitamin D below 25 nmol/L. They said that this represents a “population protective level,” which is the concentration of vitamin D that people should maintain throughout the year.

On the basis of the advisory committee’s findings, Public Health England recommended that all children over age 1 and UK adults of any age should consider taking a daily supplement containing 10 micrograms of vitamin D in autumn and winter, when sunlight is limited. “In spring and summer, the majority of the population get enough vitamin D through sunlight on the skin and a healthy, balanced diet,” the agency said.

It recommends that babies should have a daily 8.5-10.0 micrograms vitamin D supplement until age 1, although those consuming more than 500 mL of infant formula a day do not need supplements.

People with little or no exposure to the sun need to take a vitamin D supplement throughout the year, the advice states. And people from ethnic groups with dark skin, including those from African, African Caribbean, and South Asian backgrounds, may not get enough vitamin D from sunlight in the summer and so should also consider taking a supplement all year round.

Louis Levy, head of nutrition science at Public Health England, said, “A healthy, balanced diet and short bursts of sunshine will mean most people get all the vitamin D they need in spring and summer. However, everyone will need to consider taking a supplement in the autumn and winter if they don’t eat enough foods that naturally contain vitamin D or are fortified with it.”

He added, “Those who don’t get out in the sun or always cover their skin when they do should take a vitamin D supplement throughout the year.”


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