Let's just recommend that people take supplements for everything and stop
eating, then the obesity epidemic would end, we wouldn't have all those
lorries on the roads, Tescos would be a nice small place selling nail files,
shampoo and socks and not gigantic packs of yuck and the world would be a
better place.

I do not like the sinister way that pregnant and lactating women are grouped
together with children and babies in a flock of brainless beasts that need
to be herded together and pushed around by professors and governmental
committees. For goodness sake the population is better fed than it has been
for years - too much in fact. If these experts would stop medicalising
things and producing pill-based solutions and concentrated on diet and
exercise it would do all of us a lot of good. But that would harm both the
food industry and the drug industry wouldn't it?

Harrumph!

And before you unleash a cacophony of whines about the top-posting I've done
it so that you can refer to the whole of the original posting below.
--
Fay


----- Original Message -----
From: "Graham Balin" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, January 23, 2004 12:10 PM
Subject: Re: Vitamin supplements for babies - Follow up


Graham Balin wrote:
> ALL children over the age of 1year should take a multivitamin
> supplement. ALL BREASTFED BABIES and high-risk babies ....
> should start
> the supplement
> before 6m.
> ALL pregnant and lactating women should take Vit D supplements.


This is the reply I got from Prof H. Is anyone going to change their
practice?


>
Professor David Hall
Storrs House Farm
Storrs Lane
Sheffield
56 6GY

Tel: +44 (0) 114 255 3177
Fox: .144 (0) 114 255 4054
Mobile: 07836 799918
E-mail: [log in to unmask]

19 January 2004

Dear Dr Balin

Thanks for your letter. I have consulted my expert adviser, and his reply
follows:


The recommendation is still active and it applies to breastfed infants from
6-months (or earlier if in a high-risk group); bottle fed babies form
12-months.

There is plenty of evidence to support the practice, particularly in the
case of vitamin D (see recent Lancet review by Brian Wharton and Nick
Bishop). Essentially the justification lies in the DRV handbook "Dietary
Reference Values for food energy and nutrients in the United Kingdom", Rep.
Hlth Soc Sub] 1991: 41. This sets out briefly the reason that a Reference
Nutrient Intake is set for any nutrient, and specifically why these amounts
of vitamin A, D and C.

There is a perception that eating a "healthy' diet supplies enough vitamins,
but a). this is untrue in the case of vitamin D and 1,). we know that many
toddlers do not eat "healthy" diets but drink large amounts of cow's milk
and snack on processed foods, crisps etc!. The prevalence of vitamin D
deficiency is still an acknowledged problem.

Where vitamin A is concerned the National Diet and Nutrition Surveys for
children 1 1/2 - 4 1/2 and 4 1/2 - IS show that some 8-10~/o consume less
than the LRINI of vitamin A (amount which can be expected to prevent
deficiency in <3% of the population). Of course we don't see night blindness
or keratomalacia(!), but marginal status could impact upon such things as
immunity - and status is very difficult to measure (retinal levels being a
very poor indicator).

In the case of vitamin C the same sources (NDNS surveys) suggest an inverse
gradient of plasma concentration with social class. The recommendation about
vitamin supplements is a population measure intended to provide a "safety
net" though it is clearly one which is full of holes.

In many aspects of nutrition looking for the RCT will be fruitless - but
evidence of a different kind is there. You may have noticed that NICE has
fallen into the same trap
in their review of antenatal care by saying that on the basis of Cochrane
Reviews of two studies (one positive - Oliver Brooke's and one negative)
there is no evidence to support the use of vitamin D supplements in
pregnancy! If that is so, one has to ask why in a recent study from South
Wales in BJOG almost half the women from some ethnic groups had 25-OH D
levels indicative of deficiency. NICE did not consult (I understand) with DH
and FSA, and I think they may have to recant.

Thanks for reminding me that we have nothing on the website - I will rectify
this Yours sincerely



David Hall-Professor of Community Paediatrics, University of Sheffield.

--
Cheerio,

Graham