About this guideline
The Department of Health asked the National Institute for Health and Care Excellence (NICE) to produce a guideline on how to increase supplement use to prevent vitamin D deficiency among specific population groups. The guideline focuses on supplement use (see the scope).
This guideline is a partial update of maternal and child nutrition, NICE guideline PH11 (2008). The recommendations will replace recommendation 3 in 'Maternal and child nutrition'.
This guideline does not provide detail on the benefits and risks of sunlight exposure or management of vitamin D deficiency. (See related NICE guidance for other recommendations that may be relevant to the prevention or management of vitamin D deficiency.)
This guideline does not examine the cost effectiveness of extending the Healthy Start vitamin programme from the current targeted offering to a universal offering. NICE is working on a separate report on this issue. This will be forwarded to the Chief Medical Officer in 2015.
The absence of any recommendations on interventions that fall within the scope of this guideline is a result of lack of evidence. It should not be taken as a judgement on whether they are cost effective.
The guideline should be implemented alongside other guidance and regulations including:
Scientific Advisory Committee on Nutrition report on vitamin D (expected 2015).
The recommendations are based on the best available evidence. They were developed by the Public Health Advisory Committee (PHAC).
Members of the PHAC are listed in membership of the Public Health Advisory Committee and the NICE project team.
For information on how NICE public health guidelines are developed, see the NICE public health guidance process and methods guides.
The evidence that the PHAC considered included:
Review 1 'Vitamin D: a systematic review of effectiveness and cost-effectiveness of activities to increase awareness, uptake and provision of vitamin D supplements in at‑risk groups', was carried out by York Health Economics Consortium. The principal authors were: Anne Morgan, Danielle Varley, Mick Arber, Maria Cikalo, Victoria Burley, Anita Fitzgerald and Julie Glanville.
Review 2 'Review of systematic reviews exploring guideline uptake/ implementation' was carried out by York Health Economics Consortium. The principal authors were: Anita Fitzgerald, Anne Lethaby, Maria Cikalo, Julie Glanville and Hannah Wood.
Economic modelling 'An economic evaluation of interventions to improve the uptake of vitamin D supplements in England' was carried out by York Health Economics Consortium. The principal authors were: Alexandra Filby, Lily Lewis and Matthew Taylor.
Expert paper: 'Vitamin D intakes and status' by Gillian Swan, Public Health England.
Note: the views expressed in the expert papers above are the views of the authors and not those of NICE.
In some cases the evidence was insufficient and the PHAC has made recommendations for future research. For the research recommendations and gaps in research, see Recommendations for research and Gaps in the evidence.
The draft guideline, including the recommendations, was released for consultation in May and June 2014. At its meeting in September 2014, the PHAC amended the guideline in light of comments from stakeholders and experts and the fieldwork. The guideline was signed off by the NICE Guidance Executive in November 2014.
The guideline complements the NICE guideline on sunlight exposure and replaces recommendation 3 in the NICE guideline on maternal and child nutrition. (For further details, see Related NICE guidance).
The recommendations should be read in conjunction with existing NICE guidance unless explicitly stated otherwise. They should be implemented in light of duties set out in the Equality Act 2010.
The guideline is available on NICE's website. The recommendations are also available in a pathway for professionals whose remit includes public health and for interested members of the public.
NICE produces guidance, standards and information on commissioning and providing high‑quality healthcare, social care, and public health services. We have agreements to provide certain NICE services to Wales, Scotland and Northern Ireland. Decisions on how NICE guidance and other products apply in those countries are made by ministers in the Welsh government, Scottish government and the Northern Ireland Executive. NICE guidance or other products may include references to organisations or people responsible for commissioning or providing care that may be relevant only to England.
NICE guidance can help:
Commissioners and providers of NHS services to meet the requirements of the NHS outcomes framework 2013–14. This includes helping them to deliver against domain 1: preventing people from dying prematurely.
Local health and wellbeing boards to meet the requirements of the Health and Social Care Act (2012) and the Public health outcomes framework for England 2013–16.
Local authorities, NHS services and local organisations determine how to improve health outcomes and reduce health inequalities during the joint strategic needs assessment process.
NICE has developed tools to help organisations put this guideline into practice. Details will be available on our website after the guideline has been issued.