April 2010

János Áder calls on the EU to do more to tackle The sunshine vitamin D deficiency supplement

Vitamin D deficiency in focus

Anja Weisgerber wants to raise awareness of the importance of vitamin D

Consumers need more information on the food they eat, says Jo Leinen

In association with

Special supplement April 2010

EDITORIAL TEAM Managing editor In association with Brian Johnson Martin Banks Martha Moss Louise Tait Kevin McCann International Press Centre Boulevard Charlemagne 1 Box 2 Brussels 1041 Tel +32 (0)2 285 0828 [email protected] www.theparliament.com

VITAMIN D EDITORIAL BOARD Editor 4 Heated debate Catherine Stihler MEP János Áder is calling on the EU to make the prevention and treatment of vitamin D deficiency a top priority Editorial board Jorgo Chatzimarkakis Romana Jordan Cizelj 5 Feeling the benefit Eija-Riitta Korhola Jan Olbrycht Werner Christie says dealing with vitamin D deficiency in Europe would bring big rewards Alojz Peterle Struan Stevenson 6 All together now Inese Vaidere

Politicians and doctors should work together to raise awareness of vitamin D deficiency, writes Konstanty Radziwill PRODUCTION John Levers 7 In the loop Tel +44 (0)20 7091 7524 Jo Leinen says consumers need more information to prevent vitamin D deficiency in Europe Kazimierz Kapusniak

ADVERTISING AND 8 Pushing the agenda SPONSORSHIP SALES The time for talking is over, argues Jim Higgins, as he tells Kevin McCann about the need to act decisively on vitamin D Director Paul Sanders deficiency Tel +44 (0)20 7091 7658 Andrew Oliver 9 A call to action Tel +44 (0)1273 690 045 Anja Weisgerber talks to Martin Banks about the need to raise awareness about the importance of vitamin D Sandra Fernandez Monica Barbosa 10 The big issue Philip Beausire Tel +44 (0)20 7091 7661 The importance of vitamin D is set to move rapidly up the political agenda. Martin Banks reports Dominic Paine Tel +32 (0)2 285 0908 14 Preventing the preventable Subscriptions Sarah Kinnane Many cases of osteoporosis and other bone diseases could be prevented by ensuring an adequate vitamin D intake. Moira Tel +44 (0)20 7091 7682 O’Brien explains some of the initiatives taking place in Ireland www.theparliament.com Annual subscription price: €120

17 Upping the intake PUBLISHER & Effective dietary strategies can help prevent widespread vitamin D deficiency in Europe argues Kevin Cashman MANAGING DIRECTOR Martin Beck Dods Parliamentary 18 Sunshine and supplements Communications

An increased vitamin D intake would lead to significant benefits in fall and fracture prevention, writes Heike Bischoff-Ferrari PRINTER Corelio Printing, Brussels Tel +32 (0)2 526 01 50 www.corelioprinting.be

Dods Parliamentary Communications is widely respected for producing authoritative and independent political publications. Its policy is to accept adver- 6 8 14 17 18 tisements representing many sides of a debate from a variety of organisations. Dod’s Parliamentary Communications takes no political stance on the messages contained within advertisements but requires that all content is in strict accor- dance with the law. Dod’s Parliamentary Communications reserves the right to refuse advertisements for good reason (for example if it is libellous, defamatory, pornographic, socially unacceptable, insensitive or otherwise contrary to editorial policy.)

3 PARLIAMENTMAGAZINE April 2010 VITAMIN D DEFICIENCY

Heated debate János Áder is calling on the EU to make the prevention and treatment of vitamin D deficiency a top priority

was delighted to host the confer- multiple sclerosis and many forms of our public health systems through the ence on vitamin D deficiency in cancer. prevention and treatment of vitamin D the parliament last month. The The proper prevention and treat- deficiency, should be a top priority. presence of so many distinguished ment of vitamin D deficiency would It is rare that a health issue spans as Ispeakers, representing the scientific, clearly lead to massive health ben- wide a geographical area as vitamin D medical and patient communities, efits for Europe’s citizens, as well as deficiency does, with such measurable as well as my colleagues from the saving member states an enormous benefits for its proper treatment. The European parliament, was very encour- amount of money. According to the need for further research on the ways in aging. Vitamin D is of vital importance recent international Grant study, suf- which it can be combated is therefore to human health, and the participants ficient provision of the population with great, and the EU should do all it can in the debate have been working on vitamin D would lower health costs in to promote and fund investigation into the issue for many years, carrying out 17 European countries by an unbeliev- the subject in order to ensure the social research on its benefits and informing and economic benefits that come with people of the importance it serves in “The ‘sunshine vitamin’ is improved long-term health. our everyday lives. Vitamin D deficiency is above all a As a politician and a lawyer, it was a essential not only for specific human issue, and the human costs of pleasure to be in the company of such bone and muscle health, but inaction can be very high. While, as I say, high-level scientists, doctors, professors as a key preventative factor more research needs to be done on ways and researchers. They drew my atten- in overall human health” to treat vitamin D deficiency, we know tion to many different facts, some of the importance of an adequate intake, which were, for me, new and shocking. the consequences of not having one, At least 50 per cent of the European able €187bn, at a cost of only €10bn. As and the relative ease with which defi- population is deficient in vitamin D. this demonstrates, vitamin D deficiency ciency can be prevented. Last month’s The ‘sunshine vitamin’ is essential not is a significant opportunity for health call to action was a unique opportunity only for bone and muscle health, but promotion and prevention within the to bring together representatives of the János Áder is as a key preventative factor in overall EU. Any health issue in which 50 scientific community and policymakers a member of human health. As a growing body of per cent of the European population to highlight these facts. We are all con- parliament’s scientific research shows, vitamin D is concerned, poses a clear opportu- nected in our ambition to tackle vitamin environment, public deficiency is linked to a wide range of nity for health policy. The prevention D deficiency, and I hope parliament will health and food diseases, including osteoporosis, dis- of disease, and reduction in healthcare take the initiative to further the issue on safety committee eases of the heart, diabetes, asthma, costs as well as the economic burden on the political agenda.

4 PARLIAMENTMAGAZINE April 2010 VITAMIN D DEFICIENCY Feeling the benefit

Werner Christie says dealing with vitamin D deficiency in Europe would bring big rewards

now tells us that most populations in the standing committee of European doctors, temperate zones, and even many in the we have focused on the deficiency aspect tropics, have vitamin D blood levels far rather than new recommendations. Even below the optimal. Given what we already though numerous experts consider the know, and what an increasing amount current recommended daily intake as far of new, hard science indicates, vitamin too low, many people are still not achiev- D seems to have some incredible health ing these levels. Awareness raising and benefits related to maintaining health and education programmes urgently need to preventing infectious diseases, bone dis- be put in place. Vulnerable groups should eases, possibly cancers, and a number of so have priority for attention. called autoimmune and other diseases. We now need to assess what works and I have not, beyond tobacco control, what doesn’t. The Institute of Medicine come across any comparably promising in the US is currently conducting a review prevention opportunity with such a low of vitamin D with Canada that will no cost and low risk. In my discussions with doubt lead to a change in advice and various stakeholders it has become evident guidelines. A pan-European portal where that addressing vitamin D deficiency is interested individuals can place, access a clear healthcare obligation. This has and share information on vitamin D and the potential to improve the health and its health benefits would be helpful. With wellbeing of our population and prevent 250 million Europeans alone deficient, uring 30 years in healthcare, I serious diseases, thereby reducing pain the information task is tremendous. The have had the privilege, as well and suffering, as well as expenditure. From vitamin D conference in the European as the obligation, to search an ethical as well as public health point parliament clearly showed that there is for effective opportunities to of view, addressing vitamin D deficiency now a good momentum. We are grate- Dimprove health. There is an obvious duty thus seems an obvious and politically ful that so many stakeholders, scientists, to treat and care for a diseased person; it responsible thing to do. doctors, patients, and politicians agreed to should also be an equal responsibility to Throughout our campaign with the take action together on this issue. prevent disease. To find economical and efficient ways to reduce disease risk is As chair of PA International Foundation, I was honoured to participate in this call for action to tackle the first commandment of public health. vitamin D deficiency. PA International Foundation has made it its mission to address problems of However, the costs, risks and complexity a transborder and transcultural nature – be they in the area of humanitarian aid, environmental of many preventive programmes often protection or health – which sometimes appear to go unnoticed by others. Whilst the health benefits make them hard to implement, especially of vitamin D are a widely researched topic and the number of scientific studies is increasing on an in developing countries. almost daily basis, the issue of vitamin D deficiency has escaped the political and societal agenda. This is why – following the proposal of our board member, Werner Christie – we were keen to engage One of the most fruitful strategies of into this awareness raising campaign on vitamin D. Our curiosity was rewarded by the openness and prevention, according to a rapidly growing interest of other organisations and stakeholders. Given this unique prevention opportunity, the issue body of exciting new science, may be a very of widespread vitamin D deficiency should be taken up by the forthcoming Belgian EU presidency and Former Norwegian natural and organic substance that has fol- incorporated in its programme. I will take it personally upon myself to inform the relevant stakehold- health minister lowed human development for thousands ers and to ensure their involvement in this call for action. The EU and member states will have an Werner Christie is of generations – namely, vitamin D. We important role to play in promoting vitamin D deficiency as a public health priority. a board member synthesise it in our skin through sun of PA International Former Belgian prime minister Mark Eyskens is chair of PA international Foundation exposure in the summer, but research Foundation

April 2010 PARLIAMENTMAGAZINE 5 VITAMIN D DEFICIENCY All together now

Politicians and doctors should work together to raise awareness of vitamin D deficiency, writes Konstanty Radziwill

etter and better developed repa- ratory medicine can sometimes lead to forgetting about the important role of prevention in allB its dimensions. Individual doctors should be more and more engaged in primary prevention which avoids the development of disease, secondary pre- vention, which is aimed at early disease detection (increasing opportunities for interventions to prevent their progres- sion and the emergence of symptoms), and tertiary prevention, which reduces the impact of an existing disease by r
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to minimise disease complications and as multiple sclerosis, and immunology It is more and more obvious that there TVO patient disability. The medical profes- disorders. According to the latest data, is an urgent need for policymakers to act sion should also advise the public and there is also a higher risk of colon, pros- so as to bring the topic higher on the Konstanty Radziwill politicians on how to rationalise health tate and kidney cancer, worse asthma and agenda and to strengthen prevention is president of the expenditures and efforts. many other health problems. as the only sustainable way to decrease Standing Committee The wide prevalence of vitamin D defi- By safe and relatively cheap measures the burden of disease and of its related of European Doctors ciency – present in more than 50 per cent all these serious and expensive problems suffering.

6 PARLIAMENTMAGAZINE April 2010 VIEW FROM PARLIAMENT | VITAMIN D DEFICIENCY In the loop

Jo Leinen says consumers need more information to prevent vitamin D deficiency in Europe

revention is one of the most important building stones of health policy today. Promoting a health conscious lifestyle and advisingP the public on preventive mea- sures contributes immensely to a higher quality of life, as well as to reduced health costs. The competences of the EU in health policy mainly focus on prevention, the fight against chronic diseases and coop- eration. In this context, the concept of a healthy lifestyle plays an important role, as data show that 40 per cent of health expenditures are due to an unhealthy way of living, for example, smoking, insuffi- cient physical exercise and poor diet. How and what we eat is central to our wellbeing and is reflected in our health status. Against this background “Concerted efforts... are needed to educate people better the EU has taken several initiatives and about food and its consequences for their health” has proposed legislation to improve the information of consumers on their food nature and its deficiency is thus often due the advocacy of counteracting measures. and its safety. to an underestimation of the necessary In particular, the role of vitamin D supple- Currently, the European parliament’s daily intake, increasing body fat mass or ments needs to be assessed, as in some committee on environment, public health the scarcity of vitamin D in diets. Linked cases excessive intake even of vitamins and and food safety is working on a report to our modern lifestyles however, the most minerals can lead to adverse health effects. about food information to consumers. important lack of vitamin D stems from The European commission, in cooperation Producers have to clearly label nutrients our limited exposure to sunlight, which in with the European food safety agency, is such as fat, sugar and salt, and indicate the form of ultraviolet B radiation would currently working on defining maximum the calories contained in their products. normally penetrate our uncovered skin, amounts for vitamin D intake, consulting This enables conscious consumers to and convert the cutaneous previtamin D scientific data and stakeholders. It must be make more informed choices. However, into vitamin D. our aim to provide consumers with high the labelling of ingredients alone will Studies show that the lack of vitamin quality food supplements that contain not suffice in combating malnutrition or D is one of the greatest risks for bone nutrients at the right levels. obesity. Concerted efforts of consumer diseases and muscle weakness, rendering Parliament takes the issues of healthcare organisations and health organisations the body more susceptible to certain types and preventive measures very seriously, and of the food and the health sectors are of cancer or multiple sclerosis. Not only and will closely follow the work on setting Jo Leinen is chair needed to educate people better about food are these dreadful conditions for all those the reference intake amounts for vita- of parliament’s and its consequences for their health. concerned, it also creates high costs for mins and minerals. It is important that environment, public Vitamin D is one prominent case, as our health systems. We have to increase consumers can make informed choices health and food it is only contained in very few foods in public awareness of this issue, including about their nutrition. safety committee

April 2010 PARLIAMENTMAGAZINE 7 VITAMIN D DEFICIENCY | VIEW FROM PARLIAMENT Pushing the agenda

The time for talking is over, argues Jim Higgins, as he tells Kevin McCann about the need to act decisively on vitamin D deficiency

he EU needs to recognise the over- Vitamin D is important diabetes and certain forms of cancer, “not whelming prevalence of vitamin for all-round human to mention its osteo-significance”. D deficiency in Europe, says Jim health, including the As chair of parliament’s cross-party Higgins. More than that, it needs skeletal system interest group on arthritis, Higgins says toT act on it. The centre-right Irish deputy, that there is also an “education process” a panel speaker at the European parlia- in relation to the disease. “A lot of us ment’s conference on the subject, feels the are under the illusion that arthritis only event was “extremely successful”. occurs in northern European climates The quality of the debate, he says, where you have wet, dank weather, was very high, and reflected well on when it isn’t,” he says. “Arthritis is also those present. “It was a first venture into treatable. If it can be intercepted and this field, and it was well worthwhile. diagnosed in time, it can be treated, and What really bewildered me was not so treated very successfully.” much the number of speakers, but the The broad scope of vitamin D and qualifications. It was professor, profes- its uses needs to be fully investigated, sor, professor, all over the place,” he says. Higgins adds. While he welcomes exist- “The only problem I had was that there ing EU funding, he wants to see more was one vital component missing from money in the pot. He says, “The impor- the meeting, and that was somebody tant thing about the conference is that it from the European commission.” “There was one vital component wasn’t just a one-off event. Undoubtedly, He is unequivocal about the need missing from the meeting, and further research is needed to uncover for the EU executive to get involved. “I that was somebody from the the full extent of the properties and the think it’s a multifaceted approach. What potential of vitamin D.” Such research happened at our conference was abso- European commission” could include whether vitamin D supple- lutely brilliant – I’m only a layman, and Jim Higgins ments taken during pregnancy have a the amount of knowledge I garnered and positive effect later in life, the long term the exchange of views was excellent. But Higgins. “What came across from the effects of vitamin D intake, and whether we are talking to ourselves,” he says. “We point of view of getting the necessary sun- dietary vitamin D supplements are as had experts there from many different light stimulus is that you need 15 minutes good as exposure to sunlight. “We’re only countries, but what we need to do is every day… and that after that you have embarking on this, and even though a lot talk to the public for greater awareness. enough, providing you also have either of research has been done, there is more to That’s where the commission comes in – supplements or fortified foods.” do,” adds Higgins. for funding, and for greater publicity.” Higgins, who draws attention to the He says, “There doesn’t seem to be a Higgins highlights the role diet can “absolutely essential” need to have fatty clear definition of what kind of timeline play in reducing vitamin D deficiency, fish twice a week, says that there is a we have. I think we need to meet certainly Jim Higgins is chair while seeking to counter concerns over lot to learn about vitamin D deficiency, twice a year and preferably three times a of parliament’s conflicting advice on the need for sun including the wide scope of its beneficial year, to push the agenda forward. We’re cross-party interest exposure, and its possible link to skin properties. “I was under the impression only 25 per cent down the road. We group on rheumatic cancer. “I think what came across very that vitamin D was related just to bones need to meet more often, and we need and muscoloskeletal forcibly at the conference was that there and bone structures”, he says, mentioning to engage the commission - that’s the diseases was no conflict between the two,” says the contribution it can make to helping important thing.”

8 PARLIAMENTMAGAZINE April 2010 SCIENTIFIC VIEW | VITAMIN D DEFICIENCY A call to action Anja Weisgerber talks to Martin Banks about the need to raise awareness about the importance of vitamin D

itamin D is an important topic division of tasks. In my opinion this “What we which needs much more atten- arrangement best serves the needs of tion than it gets right now. So our citizens.” Nevertheless, she says have to do says Anja Weisgerber, co-chair there is a lot of cooperation and coordi- now is to take ofV the European parliament’s osteopo- nation taking place in the prevention of rosis interest group. Weisgerber wants epidemics, and the sponsoring of health home this to draw on her experience with osteo- research. newly gained porosis to help highlight the importance The EU is also involved in promoting of vitamin D. good health, and in providing informa- understanding “My involvement with vitamin D tion and knowledge. Weisgerber says, and build stems from my task with the interest “We should use the EU as a platform group in parliament,” she says. “We to draw attention to the importance upon it” have to limit the burden on our nation- of Vitamin D intake. We could foster Anja Weisgerber al healthcare systems, which will be awareness and knowledge through growing in the years to come.” This European-wide campaigns. What all On the European level, she says holds true not only for osteoporosis, but the participants at the workshop in that members of the interest group for many other diseases which could parliament can do is to take home the have decided to pose written questions also be prevented by a greater intake knowledge we learned from the event. on osteoporosis to the commission in of vitamin D. “There is an increas- We can for example raise the issue order to underline the importance of ing awareness of the importance of when holding a speech or a presenta- the topic. Weisgerber sees scope for osteoporosis, of its consequences and tion about European health policies. doing the same with vitamin D. Indeed, possible prevention methods,” she adds. This is what I did recently when I closing the discussion in parliament, “In our committee work we mostly deal spoke to the health working group of Weisgerber was applauded when she with proposals on directives and regu- my party in my constituency in Bavaria. said she planned to ask the commission lations. We are lawmakers. But, what The EU gives us the opportunity to what it planned to do. “Maybe we can we must not forget is that politics is work together on common challenges, hold another workshop in a year and more than law making. It is also about so let us use this platform.” see what we will have achieved by then,” promoting topics which are dear to our Weisgerber says the parliament she says. “Given the strength of feeling heart. It is about raising awareness for event, the first on vitamin D, was “very expressed at this event, I want to know issues which often do not get enough successful”, adding, “Organising and exactly how the commission intends to attention. For me, osteoporosis is such attending a conference is always a good respond to our call for action.” an issue. It is closely linked to vitamin idea. But it is only a first step.” The Weisgerber, also a member of par- D intake.” EPP deputy adds, “What we have to liament’s environment, public health She says that the EU should work do now is take home this newly gained and food safety committee, insists that on increasing people’s awareness and understanding and build upon it. We vitamin D deficiency is a “major public understanding, in an area in which the should spread the word by forming new health issue” that needs addressing at EU does not have exclusive competenc- networks and expanding existing ones. EU level. She says, “We need action, es. “Quite the contrary, the competences Most importantly, we should include and I will keep all those who par- are often very limited. Each member what we have learned in our daily work. ticipated in this event informed of state is free to decide on its own public I think we all have some homework the outcome.” She will be hoping that health policies. And I fully support this to do.” where she leads, others will follow.

April 2010 PARLIAMENTMAGAZINE 9 VITAMIN D DEFICIENCY | EUROPEAN PARLIAMENT DEBATE EUROPEAN PARLIAMENT DEBATE | VITAMIN D DEFICIENCY The big issue

The importance of vitamin D is set to move rapidly up the political agenda. Martin Banks reports

t’s a frightening statistic and one discovered in the 1930s, is essential for of vitamin D is still an unknown that most agree highlights the optimal bone health. But it is also now quantity for many, including the most need for urgent action. No less known that vitamin D influences many vulnerable in society - the elderly, than 50 per cent of the popula- other issues, including the immune young children and pregnant women. Ition is deficient in vitamin D. Many system, cell proliferation and cancer. It was against this backdrop that a of us know little about this, but it is Vitamin D deficiency is also linked to distinguished panel of experts, doctors, deemed essential to human health. a wide range of diseases, such as osteo- politicians and patient representatives The importance of vitamin D was porosis, heart disease, diabetes, asthma gathered in parliament last month in spelled out at a recent debate in the and multiple sclerosis. Extra vitamin an effort to help promote awareness European parliament, organised by D intake has, in recent times, emerged of the uses of vitamin D. Opening PA International Foundation and the as the cheap, easy and safe solution the debate, Hungarian centre-right Standing Committee of European to addressing what is a widespread MEP János Áder said the aim of the Doctors (CPME). problem. event was to emphasise the need for a The conference heard that it is “well However, despite an ever-growing “renewed vitamin D nutritional policy” known” that vitamin D, which was only body of scientific research, the role in Europe. He said, “If we prevent L-R: Konstanty Radziwill, János “There is an urgent Áder and Werner need for action” Christie Konstanty Radizwill, CPME

10 PARLIAMENTMAGAZINE April 2010 EUROPEAN PARLIAMENT DEBATE | VITAMIN D DEFICIENCY EUROPEAN PARLIAMENT DEBATE | VITAMIN D DEFICIENCY

vitamin D deficiency and with it pos- by more than 20 per cent by “simple November to May in all of Europe,” sibly diseases, we will actually prevent supplementation” of 800 to 1000 units she said. healthcare costs and reduce the eco- of vitamin D a day. “It is more and All parties involved agreed on a call nomic burden on our public health more obvious that there is an urgent for action as the only sustainable way systems. This is an important issue, and need for action towards policymak- the conference offers a unique oppor- ers to bring the topic higher on the Vitamin D in numbers tunity to bring together representatives agenda and to strengthen prevention,” who are all connected in their ambition he added. r

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April 2010 PARLIAMENTMAGAZINE 11 VITAMIN D DEFICIENCY | EUROPEAN PARLIAMENT DEBATE VITAMIN D DEFICIENCY | EUROPEAN PARLIAMENT DEBATE

to cut the burden of disease and of its related suffering. Specifically, the EU should adopt an “effective and efficient” strategy to tackle the growing problem of vitamin D deficiency. The workshop heard that the recommended level is 10 micrograms per day (10 to 15 for the elderly) but the current average is just three to four micrograms. The figures highlight the need for EU-wide action, said Kevin Cashman, of University College Cork in Ireland. One possible solution would be to “enrich certain foods” with vitamin D, although he stressed that to fortify products such as milk, dairy and fruit juices with much higher levels than currently recommended would require further research before any regula- tory go-ahead could be given. In the 1SPGFTTPS
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12 PARLIAMENTMAGAZINE April 2010 EUROPEAN PARLIAMENT DEBATE | VITAMIN D DEFICIENCY

“The conference offers a unique opportunity to bring together representatives who are all connected in their ambition to tackle vitamin D deficiency” János Áder MEP the elderly, or those with a diagnosed than half the EU average – 3.2kg per to the European commission on what it The high-level vitamin D deficiency. capita per year, compared with the EU plans to do to promote vitamin D at conference on “Vitamin D deficiency is a huge average of 10kg. He told the half-day an EU-wide level. She said education vitamin D deficiency public health issue and it is estimated hearing that the EU should consider and awareness-raising are key, not only was well-attended that 50 to 75 per cent of the adult funding research into the problem in among the population but also health- by the media, population do not take enough vitamin such countries. while the media also care professionals, in order to spread patient groups and the medical D,” he said. “We need to target the have an “important role” to play in knowledge and “ultimately enable con- profession at-risk population and take a serious raising awareness of vitamin D. sumer choice.” Closing the conference, step forward to eradicate vitamin D The MEPs present committed to she invited participants back to parlia- deficiency. This is preventable but it make the best use of parliament’s power ment in 2011 to review progress. needs an effective and efficient strategy to make it happen.” “Vitamin D deficiency is a huge Top tips to avoid vitamin D deficiency His compatriot, Professor Moira public health issue” 8IBU
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April 2010 PARLIAMENTMAGAZINE 13 VITAMIN D DEFICIENCY |AROUND EUROPE Preventing the preventable

Many cases of osteoporosis and other bone diseases could be prevented by ensuring an adequate vitamin D intake. Moira O’Brien explains some of the initiatives taking place in Ireland

ne in five men and one in two women over the age of 50 will “One in five men and one in break a bone due to osteopo- two women over the age of rosis. The disease affects all age 50 will break a bone due to Ogroups, including children. Osteoporosis osteoporosis” is the leading bone disease in the world but unfortunately it is a silent disease, which has no signs or symptoms until It is mainly thought to be linked to the fractures occur. It is preventable and menopause and elderly women. However, treatable in the majority of people; there- there are approximately 60 different risk fore by raising awareness of those at factors, with inadequate vitamin D being risk, governments could save millions. one of the strongest risk factors. Primary prevention of osteoporosis Support, information and motivation are the main aims of the BfO starts early in life, actually in utero, With a large number of local self-help groups and a nationwide lobby cam- and continues throughout life. The paign the German osteoporosis patient society, the Bundesselbsthilfeverband Irish health service executive has just für Osteoporose e.V. (BfO), is a major contact point for patients, their doctors, approved supplementation to babies up therapists and scientists. In August 1987, patients and doctors founded the to 12 months old, which is wonderful. BfO. Since then a large number of self-help groups have emerged all across However, there is a worldwide vitamin D Germany (altogether around 300 groups, 11 associations on Länder level with deficiency. Therefore a policy for all age a total of around 17,000 members). groups, male and female, should also be Support, inform and motivate are the main goals of the BfO. In 2009 the implemented in all countries. Not only to BfO founded the osteoporosis academy with the objective of patient edu- prevent osteoporosis, as vitamin D defi- cation and certification of osteoporosis consultants (training of medical ciency has also been linked with falls in experts). Through strategic lobby work, the BfO is creating a network with senior citizens, multiple forms of cancer, competent partners in order to enhance the health care situation for multiple sclerosis, ME (myoencephal- osteoporosis. opathy, or chronic fatigue syndrome), The BfO recently presented the patient version of the osteoporosis guideline tuberculosis and asthma, to name a few. to the federal government appointee for patients concerns. The guideline If governments invested in making increased the recommendations concerning daily vitamin D3 intake due physical education mandatory, this also to recent studies. would significantly decrease the amount For more information visit of people at risk for osteoporosis, obesity, www.osteoporose-deutschland.de type two diabetes, heart disease, strokes,

14 PARLIAMENTMAGAZINE April 2010 AROUND EUROPE | VITAMIN D DEFICIENCY

Greater awareness of the link between vitamin D deficiency and gastroin- testinal diseases is needed, argues UEGF The United European Gastroenterology Federation (UEGF) is a professional medical non-profit organisation comprising all of the major European societies interested in the diseases of the digestive system. Its goals are to advance science and education in digestive diseases, and to provide a suitable medium for the dissemination and discussion of the latest results in the field. UEGF is the most comprehensive organisation of this kind in the world and its affiliated societies represent over 22,000 European specialists. UEGF wishes to raise awareness for digestive diseases among the public, the political decision makers and regulatory authorities at the EU level and other stakeholders. The objective is to strategically position itself toward the EU deci- sion making bodies in order to prioritise gastroenterology issues on the EU and national policy agenda. The relationship between vitamin D deficiency and gastrointestinal diseases is well understood and clearly an issue on which greater awareness and education are necessary – especially since it is totally preventable. For more information visit www.uegf.org

KNVS hopes to create links between practitioners, scientists and policymakers in the field of fall prevention The Dutch (knowledge) network seniors fall prevention (KNVS) is a platform for professionals with a shared passion for the subject fall prevention. It is particularly targeted at those over the age of 55 and was established in 2003 under a joint initiative of EMGO Institute/VUmc (medical centre of the University of Amsterdam) and the consumer safety and the ZonMw organisations. The KNVS’ mission is to promote prevention of incidents by the creation of a link between practitioners, scientists and policymakers concerning fall prevention. Fall prevention can best be dealt with by prolonged and close cooperation between these stakeholders. On 1 April 2010 the KNVS organised a conference on the influence of vitamin D on osteoporosis and fractures caused by falling, in collaboration with the Falling, Fractures and Osteoporosis (FFO) professional association and PA International. During this interesting meeting scientific findings and practical recommendations were presented and connected. FFO unites the interest of care providers involved in fall prevention and osteoporosis with the aim of improving the quality of care. For more information visit www.kennisnetwerkvalpreventie.nl depression and more. In Ireland, physical education has been cut in many schools, yet 20 years ago, when it was a major part of a schools curriculum, obesity was rare. Now it is common place. The current cost per annum of fractures in senior citizens in Ireland is €402m; this does not include all other osteoporotic frac- tures in all other age groups. Vitamin D is essential for calcium absorption and bone

April 2010 PARLIAMENTMAGAZINE 15 VITAMIN D DEFICIENCY |AROUND EUROPE

health. It is also particularly important It is aimed at 12 to 18 year olds, and their calcium, however not all milk is for maintaining normal muscle func- consists of a DVD (which is presented fortified with vitamin D. This is why tion of the heart and nerves, and is an by teenagers), a question and answer supplementation is essential for all age essential part of preventing and treating session for the DVD, and a powerpoint groups and genders. osteoporosis. presentation. This package has been The Irish Osteoporosis Society holds short listed for an educational award. MS Society Scotland says coordinated an annual conference for physicians and The Usual Suspects TV and accompa- research across European countries would other health professionals and articles nying poster campaign highlighted that help tackle vitamin D deficiency are placed in the medical magazines. osteoporosis affects both genders and The Multiple Sclerosis Society Scotland and the As well as this, we educate the public all age groups. The youngest person in Shine on Scotland campaign are organising a through lectures, health promotions, the poster is 19 – with the bones of an vitamin D summit in April, during MS awareness articles in newspapers and magazines, 84 year old. week in the UK. Craig Wilkie, head of policy and and use radio and television interviews The major source of vitamin D is communication for the society in Scotland, to help dispel myths. from the action of sunlight on the attended the Vitamin D nutritional policy in We produce a range of leaflets on skin. However Ireland has not had a Europe meeting in the European parliament. Speaking afterwards, Wilkie said, “The meeting in bone health, exercise, nutrition, calcium traditional summer in many years and Brussels highlighted the opportunities that exist and vitamin D and fall prevention, as therefore vitamin D levels could be at for coordinated research and action on vitamin well as a campaign based on a ‘Usual dangerously low levels, increasing the D. In Scotland we are looking forward to the Suspects’-themed poster. We have an number of people at risk. Low levels of summit we are holding later this month as well educational osteoporosis pack for use in vitamin D may be due to low oestrogen as an awareness campaign on vitamin D that Moira O’Brien is secondary schools, and an osteoporosis levels (menopause), low levels of tes- the Scottish government has already pledged to president of the management class is currently being tosterone, low dietary intake, and poor initiate. Sharing policy examples and initiatives Irish Osteoporosis developed. absorption due to gastrointestinal dis- across European countries will be helpful in Society. Since osteoporosis is a disease that orders, particularly gluten intolerance. tackling vitamin D deficiency.” manifests itself in childhood, the Irish Vitamin D is rare in foods other Osteoporosis Society, with funding than oily fish, eggs, and supplemented For more information visit www.mssocietyscotland.org.uk from the health service executive, dairy products. Dairy products are one and www.shineonscotland.org.uk developed the secondary school pack. of the best ways for people to get

16 PARLIAMENTMAGAZINE April 2010 SCIENTIFIC VIEW | VITAMIN D DEFICIENCY Upping the intake

Effective dietary strategies can help prevent widespread vitamin D deficiency in Europe, argues Kevin Cashman

here is little doubt that vitamin D varying latitudes that EU citizens live deficiency across all age groups in in (35-70˚N), assuming a higher dietary “Fortification Europe is a problem, the magnitude requirement in more northerly latitudes of foods with of which ranges from significant to but not having data to base a require- pandemicT depending on which biochem- ment on. vitamin D in ical definition one uses. Most experts It has been emphasised and re-empha- the US and agree that prevention of this serious sised that there are only a limited number deficiency is a key priority, and is doable of public health strategies available to Canada has with effective dietary strategies. correct low dietary vitamin D intake. an important In humans, vitamin D is obtained pri- Improving the intake of naturally occur- marily through cutaneous biosynthesis ring vitamin D-rich foods is the least impact on the in the presence of ultraviolet blue (UVB) likely strategy to counteract low dietary mean daily sunlight in summer. During wintertime, vitamin D intake due to the fact that in latitudes greater than 35˚N, the angle there are very few food sources that are intake of of the sun is too oblique for UVB rays rich in vitamin D, and furthermore most vitamin D by to pass through ozone, so little or no of these are not frequently consumed by vitamin D is dermally synthesised. There many in the population. the average are also many reasons why summer- Supplementation is another option. adult” time sun exposure may be inadequate. This has been shown to significantly Moreover, improving vitamin D status improve vitamin D intake across a variety the US and Canada has an important by increased sun exposure will never be of age, race, ethnic and gender groups. impact on the mean daily intake of a viable public health message due to However, evidence seems to suggest that vitamin D by the average adult. Fortified the increased risk of skin cancers and the population intake of vitamin D from foods constitute the largest contributor damage associated with increased expo- supplements is quite low. This is a func- (65 to 87 per cent; and fortified milk sure. In the absence of sufficient UVB for tion mainly of the relatively low vitamin alone contributes 40 to 64 per cent) to dermal synthesis, vitamin D becomes an D content of most supplements (2.5- dietary vitamin D intake in the US pop- essential nutrient. 7.5 μg) in some countries relative to ulation. However, it has been accepted However, food sources of vitamin D requirement. Some are of the view that that the level used in fortification in the are few, and there is a significant gap while not highly effective at a population US may be too low. between typical intakes in European level, vitamin D supplementation may be From a European perspective, we need populations and the current dietary appropriate in high risk groups such as to model European food and vitamin targets. Moreover, the adequacy and cur- the elderly. D intake data to ascertain which food rency of these dietary targets have also There is also the question of vitamin vehicles and what level of vitamin D been questioned. The European dietary D fortification – this has been viewed by addition will ensure an effective but recommendation (population reference some as a feasible and effective measure safe rise in serum vitamin D status in intake) for vitamin D for adults also once applied in an evidence-based European populations. So there is a reveals considerable uncertainty about approach. In response to concerns about need to invest in such research. We need Kevin Cashman is the available evidence on which to base widespread vitamin D deficiency, many to explore vitamin D fortification as a professor of food a recommended intake, as it ranges from countries have implemented either man- means of eradicating serious vitamin D and health 0 to 10 μg/d to account not only for the datory or discretionary food fortification. deficiency in the European populations at University knowledge gaps but also for the widely Fortification of foods with vitamin D in as a matter of urgency. College Cork

April 2010 PARLIAMENTMAGAZINE 17 VITAMIN D DEFICIENCY | SCIENTIFIC VIEW

fracture prevention show that vitamin D reduces the risk of falls by 19 per cent, the risk of hip fracture by 18 per cent, and the risk of any non-vertebral frac- Sunshine and ture by 20 per cent. Notably, this benefit was dose-dependent and required an optimal intake of 800 to 1000 vitamin D IU per day. Critical for the understanding of the public health potential of vitamin D is supplements that falls and fractures are frequent and costly events with serious consequences. Some 30 per cent of seniors living at home at age 65 fall each year, the rate An increased vitamin D intake would lead to significant benefits increasing to 50 per cent among those in fall and fracture prevention, writes Heike Bischoff-Ferrari aged 80. Five to six per cent of falls lead to a fracture, nine per cent of falls trong evidence indicates that less vitamin D compared with younger require emergency medical care, and many or most adults in the US adults, and tend to avoid sunshine expo- 40 per cent of nursing home admis- and Europe would benefit from sure – the latter explaining why vitamin sions are because of falls. Hip fractures vitamin D supplements with D levels among seniors are the lowest in are the most frequent fracture among respectS to fracture and fall prevention, the Mediterranean area within Europe. those aged 75 and older, with severe and that they would possibly help meet At highest risk of vitamin D deficiency consequences occurring already in the other public health targets, including for are hip fracture patients who were found first year after the fracture: 10 per cent cardiovascular health and cancer. Simple to be vitamin D deficient in 80 to 96 per fracture their other hip, 50 per cent have strategies are urgently needed to prevent cent of cases. a permanent decline in function, 30 per chronic disease at higher ages. Ideally, cent are re-admitted to acute care for any such strategies would be effective, inex- “Simple strategies are urgently reason, 30 per cent lose their indepen- pensive, well tolerated and have a benefit needed to prevent chronic dence, and 15 to 25 per cent die. on general health. Vitamin D may be Based on evidence today, a general such a strategy. disease at higher ages” supplementation of 800 to 1000 vitamin The main source of vitamin D is sun- D IU per day could reduce the risk of shine exposure. Vitamin D deficiency As an alternative source of vitamin falls, hip and any non-vertebral fractures may be explained by less than five per D, nutritional sources of the vitamin are by 20 per cent. Given the low cost of cent of our skin being exposed to the rare, largely limited to fatty fish such as vitamin D, the frequency of these events sun, and the insufficient intensity of the salmon and mackerel. Clearly, there are and their impact on health expenditure, sun for skin production of vitamin D not enough fish in the sea to provide a benefit of supplementation would be between November and May in Europe. two portions of fatty fish per day for the enormous. Vitamin D may have further Furthermore, sunscreen, warranted for population to meet an intake of 800 to benefits based on promising data from Heike Bischoff- the prevention of skin cancer, inhibits 1000 international units (IU) of vitamin small clinical trials, large observational Ferrari works in vitamin D production in the skin to a D per day. and mechanistic studies suggesting that the department of rheumatology large extent, and contributes to vitamin We have evidence today that vitamin a higher vitamin D level is beneficial for and institute of D deficiency independent of age. Most D modulates fracture risk in two ways: cardiovascular health, cancer prevention, physical medicine at vulnerable to vitamin D deficiency by decreasing falls and increasing bone and immunity. A large clinical trial is University Hospital are adults with a dark skin tone and density. The latest, double-blind, ran- urgently needed to confirm these ben- Zurich seniors. Seniors can produce four times domised controlled trials for fall and efits in the European population.

18 PARLIAMENTMAGAZINE April 2010

The Public Advice International Foundation (PA International) is a not-for-profit Foundation. It regularly provides free advice and support when there is a clear case of need. It is the umbrella Foundation sponsored by four regional companies: PA Asia, PA Middle East, PA Europe and PA Russia. PA International is developing new approaches to trans-boundary and trans-cultural problems. For more information see: http://www.pa-international.org

The CPME - Standing Committee of European Doctors represents the National Medical Associations of 27 countries in Europe and over 1.3 million European doctors. The CPME aims to promote the highest standards of medical training and medical practice in order to achieve the highest quality of health care for all patients in Europe. The CPME is also concerned with the promotion of public health and the relationship between patients and doctors. For more information see: http://www.cpme.eu