Vitamin D deficiency in British South Asians, a persistent but avoidable problem associated with many health risks (including rickets, T2DM, CVD, COVID-19 and pregnancy complications): the case for correcting this deficiency

Abstract

High vitamin D deficiency rates, with rickets and osteomalacia, have been common in South Asians (SAs) arriving in Britain since the 1950s with pre ventable infant deaths from hypocalcaemic status-epilepticus and cardiomyopathy. Vitamin D deficiency increases common SA disorders (type 2 diabetes and cardiovascular disease ), recent trials and non-linear Mendelian randomisation studies having shown deficiency t o be causal for both disorders. Ethnic minority, obesity, diabetes and social depriv ation are recognised COVID- 19 risk factors, but vitamin D deficiency is not, despite convin cing mechanistic evidence of it. Adjusting analyses for obesity/ethnicity abolishes vitam in D deficiency in COVID-19 risk prediction, but both factors lower serum 25(OH)D specifical ly. Social deprivation inadequately explains increased ethnic minority COVID-19 risks. SA vitamin D deficiency remains uncorrected after 70 years, official bodies using ‘educat ion’, ‘assimilation’ and ‘diet’ as ‘proxies’ for ethnic differences and increasing pressu res to assimilate. Meanwhile, English rickets was abolished from ~1940 by free ‘welfare foods ’ (meat, milk, eggs, cod liver oil), for all pregnant/nursing mothers and young children (<5 years old). Cod liver oil was withdrawn from antenatal clinics in 1994 (for excessive vitamin A teratogenicity), without alternative provision. The take-up of the 2006 ‘Healthy -Start’ scheme of food-vouchers for low-income families with young children (<3 years old) has been poor, being inaccessible and poorly publicised. COVID-19 pandemic advice fo r UK adults in ‘lockdown’ was ‘400 IU vitamin D/day’, inadequate for correcting the defici ency seen winter/summer at 17.5%/5.9% in White, 38.5%/30% in Black and 57.2%/50.8% in SA p eople in representative UK Biobank subjects when recruited ~14 years ago and remaining similar in 2018. Vitamin D inadequacy worsens many non-skeletal health risks. No t providing vitamin D for preventing SA rickets and osteomalacia continues to be unac ceptable, as deficiency-related health risks increase ethnic health disparities, while abolishing vitamin D deficiency would be easier and more cost-effective than correcting any othe r factor worsening ethnic minority health in Britain.

Keywords

• vitamin d deficiency
• uk south asians
• long-standing
• correction
• justification