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Public Health England recommends vitamin D supplements in autumn and winter

BMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i4061 (Published 21 July 2016) Cite this as: BMJ 2016;354:i4061

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Re: Public Health England recommends vitamin D supplements in autumn and winter

The Scientific Advisory Committee on Nutrition (SACN) recently recommended that the Reference Nutrient Intake (RNI) for vitamin D be increased to 400IU per day throughout the year, for everyone in the UK population aged 4 years and above, and that ‘the Government considers strategies to help the population consume the recommended intakes of vitamin D’1. These recommendations were based on the committee findings that vitamin D is beneficial for musculoskeletal health, particularly rickets and osteomalacia, falls risk in older adults, and muscle strength and function in younger adults. To make their recommendation, the committee located evidence using position papers submitted by members of the working group, and assessed the evidence using the SACN Framework for evaluation of the evidence1, which does not use explicit methods to integrate certainty of evidence for an outcome from multiple studies.

This approach to collating evidence and making recommendations seems at odds to newer methods used by the wider medical profession, such as that recommended by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) group. GRADE has several advantages over older methods: separation between the quality of evidence and the strength of recommendation, transparency about judgements, and explicit acknowledgement of values and preferences underlying the recommendations2. SACN also omitted to use a fully systematic literature search strategy when compiling their evidence1. This leaves questions about the reliability of their recommendation, concerns about opacity of their decision-making, and the possibility of study selection bias informing their decisions.

I have no conflicts of interest.

References
1. Scientific Advisory Committee on Nutrition. Vitamin D and health. London: Public Health England, 2016.
2. Introduction to GRADE handbook. Handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach.: GRADE Working Group.

Competing interests: No competing interests

24 July 2016
David J Roberts
Public Health Specialty Registrar
Oxford School of Public Health, Nuffield Department of Population Health, Old Road Campus, Headington, Oxford, OX3 7LG