Intended for healthcare professionals

Infections and antibiotic prescribing might be reduced if vitamin D food fortification is introduced

Antibiotic prescribing would be reduced if susceptibility to infections could be reduced.
Providing a vitamin D deficient population with sufficient vitamin D might help reduce such susceptibility as shown by Martineau for respiratory tract infections (1). A link to increased infections in vitamin D deficient individuals has often been pointed out (2-4).

Recently, two consensus statements of a large group of researchers suggested food fortification if vitamin D deficiency exceeds 20% in a population (5,6). This might be an appropriate action for the UK, because both, the Scientific Advisory Committee on Nutrition (7) and the Scottish Food Standard Agency (8), report high prevalences of vitamin D deficiency in England and Scotland (approximately 25-40%). Finland, US, Canada are amongst other countries whose populations benefit from vitamin D food fortification.

In his editorial Alistair Hay mentioned the risk of bloodstream infections being especially high in areas of deprivation. Sepsis is reduced if better vitamin D supply is provided (10). Areas of deprivation also show the highest rate of vitamin D deficiency (7) and they would therefore benefit most from food fortification, especially as the rate of health improvements is exponentially linked to vitamin D intake (5). This might even be a (maybe not so) small step towards a reduction of health inequalities, in addition to the reduction of infections in all.

1. Martineau AR, et al. Vitamin D supplementation to prevent acute respiratory infections: individual participant data meta-analysis. Health Technol Assess 2019;23(2)
2.Prietl B, et al. Vitamin D and immune function. Nutrients. 2013 Jul 5;5(7):2502-21
3. Zhou J, et al. Preventive Effects of Vitamin D on Seasonal Influenza A in Infants: A Multicenter, Randomized, Open, Controlled Clinical Trial. Pediatr Infect Dis J. 2018 Aug;37(8):749-754
4. Jorde R, et al. Prevention of urinary tract infections with vitamin D supplementation 20,000 IU per week for five years. Results from an RCT including 511 subjects. Infect Dis (Lond). 2016 Nov-Dec;48(11-12):823-8
5. Pilz S, et al. Rationale and Plan for Vitamin D Food Fortification: A Review and Guidance Paper.
Front. Endocrinol., 17 July 2018
6. Roth DE, et al. Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low- and middle-income countries. Ann. N.Y. Acad. Sci. 2018 Oct;1430(1):44-79
7. SACN 2016 Vitamin D and health. https://www.gov.uk/government/groups/scientific-advisory-committee-on-nu...
8. Food Standards Agency in Scotland. Vitamin D status of Scottish adults: Results from the 2010 & 2011 Scottish Health Surveys . Purdon G, et al. September 2013
9. BMJ 2019;364:l780
10. Shojaei M, et al. The Correlation between Serum Level of Vitamin D and Outcome of Sepsis Patients; a Cross-Sectional Study. Arch Acad Emerg Med. 2019; 7(1): e1.

Competing interests: No competing interests

12 March 2019
Helga M Rhein
retired general practitioner
Lothian Health
Edinburgh