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Vitamin D in secure care for offenders with Intellectual and Developmental Disability; screening, correction of deficiency, and potential impacts on health

Lookup NU author(s): Dr Iain McKinnonORCiD


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BackgroundSuboptimal levels of vitamin D have been implicated in a number of health morbidities including musculoskeletal and cardiorespiratory diseases, diabetes and depression. Public Health England currently recommends a minimum of 10 micrograms per day for the general population aged four and above, where diet alone is insufficient. It was hypothesised that patients in secure services would have suboptimal levels of vitamin D due to less exposure to sunlight, and as a possible consequence of medications prescribed for mental disorders. ObjectivesThis study aimed to assess the benefits of introducing routine vitamin D serum sampling to all patients admitted to a secure inpatient hospital setting in the north of England. The hospital provides medium and low security as well as rehabilitation services for offenders with intellectual and developmental disability (IDD). MethodsThe vitamin D levels of 100 patients were analysed at baseline. Those with insufficient or deficient levels were offered treatment and retested after one year. Vitamin D levels were analysed in the context of level of security, seasonality of test and co-prescription of psychotropic medications.ResultsEighty-three percent of patients screened had suboptimal vitamin D levels at initial test (41% deficient and 42% insufficient). This was seen among both established patients and new admissions. Vitamin D levels were lower among patients taking antipsychotics, but not anticonvulsants. Samples taken in the winter months and from those in medium security showed slightly lower vitamin D levels, although these were not statistically significant differences. Patients with deficiency or insufficiency were all offered supplementation. Eighty-nine patients had follow up vitamin D levels analysed a year after their initial screening. Those who opted for the treatment had significantly improved vitamin D levels at follow up, compared to those who declined treatment. ConclusionsThis study shows that the vast majority of inpatients with IDD have deficiencies in vitamin D and that these are amenable to correction by oral supplementation in many cases. This raises the question as to whether all patients who are "high risk" should be offered treatment. We recommend further research in to this area including prospective studies of the longer term health sequelae.ReferencesPearce SH, Cheetham TD. Diagnosis and management of vitamin D deficiency. British Medical Journal. 2010;340:b5664.Public Health England. SACN vitamin D and health report. London, UK: The Scientific Advisory Committee on Nutrition (SACN) recommendations on vitamin D, 2016 21 July 2016. Report No.Murie J, Messow CM, Fitzpatrick B. Feasibility of screening for and treating vitamin D deficiency in forensic psychiatric inpatients. Journal of forensic and legal medicine. 2012;19(8):457-64.Kilpinen-Loisa P, Arvio M, Ilvesmaki V, Makitie O. Vitamin D status and optimal supplementation in institutionalized adults with intellectual disability. Journal of intellectual disability research : JIDR. 2009;53(12):1014-23.Autier P, Gandini S. Vitamin D supplementation and total mortality - A meta-analysis of randomized controlled trials. Archives of Internal Medicine. 2007;167(16):1730-7.

Publication metadata

Author(s): Thorp J, Lewis T, Mehta N, Imrit S, Ince C, McKinnon I

Publication type: Conference Proceedings (inc. Abstract)

Publication status: Published

Conference Name: 16th International Conference on the Care and Treatment of Offenders with an Intellectual or Developmental Disability

Year of Conference: 2017

Acceptance date: 01/02/2017

Publisher: The National Autistic Society