Vitamin D in patients with intellectual and developmental disability in secure in-patient services in the North of England, UK

Abstract

Aims and methodTo assess the benefits of the introduction of routine vitamin D serum sampling for all patients admitted to a secure in-patient hospital in the North of England providing medium security, low security and rehabilitation services for offenders with intellectual and developmental disability. The vitamin D levels of 100 patients were analysed at baseline. Those with insufficient or deficient levels were offered treatment and retested after 1 year. Vitamin D levels were analysed in the context of level of security, seasonality of test and co-prescription of psychotropic medications.ResultsEighty-three per cent of patients had suboptimal vitamin D levels at initial test (41% deficient and 42% insufficient). This was seen among established patients and new admissions. Regression analysis of baseline vitamin D levels revealed no differences for levels of security, seasonality, whether patients were taking antipsychotic or anticonvulsant medication, or length of stay. Patients with deficiency or insufficiency were all offered supplementation. Those who opted in had significantly higher vitamin D levels at follow-up, compared with those who declined treatment.Clinical implicationsEstablished and newly admitted patients in our secure mental health services had substantial levels of vitamin D insufficiency. In the light of the morbidities that are associated with deficient vitamin D levels, routine screening and the offer of supplementation is advisable.Declaration of interestNone.

Prevalence of vitamin D deficiency in people with learning disability: A systematic review

“…Of the 8 studies selected, four were cross‐sectional in design (Chester, Simmons, Henriksen, & Alexander, ; Frighi et al, ; McKinnon et al, ; Wong, Lau, Lim, & Fung, ). Frighi et al () also carried out a treatment evaluation for vitamin D deficiency.…”

“…The definition of vitamin D deficiency varied between the studies. McKinnon et al (), Chester et al () and Wong et al () defined serum vitamin D of <25 nmol/L as deficient. Kilpinen‐Loisa et al () and Frighi et al () both referred to deficiency as <50 nmol/L.…”

“…Kilpinen‐Loisa et al () and Frighi et al () both referred to deficiency as <50 nmol/L. McKinnon et al () and Chester et al, () both followed criteria outlined by Pearce and Cheetham () whereby a serum vitamin D of <25 nmol/L was deficient and 25–50 nmol/L was insufficient. The Pearce and Cheetham () criteria are directly comparable to the NOS () thresholds except the term “insufficient” is utilised instead of “inadequate” [for bone health] for levels of serum vitamin D between 25 and 50 nmol/L.…”

“…Due to the wide variety of sample populations, prevalence of vitamin D deficiency was examined separately for inpatient groups and those defined as community samples. McKinnon et al () and Chester et al () examined the prevalence of vitamin D deficiency in forensic and secure inpatient facilities in the United Kingdom (UK). McKinnon et al () found that of a total study population of 100 individuals with learning disability, 41% were vitamin D deficient and 42% inadequate.…”

“…McKinnon et al () and Chester et al () examined the prevalence of vitamin D deficiency in forensic and secure inpatient facilities in the United Kingdom (UK). McKinnon et al () found that of a total study population of 100 individuals with learning disability, 41% were vitamin D deficient and 42% inadequate. Chester et al (), with a similar UK patient group ( n = 84 inpatients), measured baseline serum vitamin D levels on admission.…”