Endocrine Abstracts

Introduction: Nutritional rickets is a growing public health concern in at-risk populations despite existing prevention programs and health policies.

Aims: To compare infant and childhood vitamin D supplementation policies and strategies across Europe and explore factors influencing adherence.

Methods: Representatives of the ESPE bone and growth plate working group and other experts in the field of infant vitamin D supplementation across Europe were asked to complete a questionnaire relating to their national health policy and child care programs, societal factors, and details on strategy implementation. Kendall’s tau-b correlation coefficient was used to assess the effect of individual factors and the total number of factors (n=11) on estimated country-specific adherence rates.

Results: Responses were received from 28 European countries, of which 27 (96%) had a national vitamin D policy in place (96%). Fifty % (14/28) of countries commence supplements on day 1–5, 46% (13/28) on day 7–21, and only one country (the UK) starts supplements not before 6 months of life. There was a wide variation in the recommended duration of vitamin D supplements (1–4 years, to lifelong in at risk populations). Five countries (18.5%) reported adherence rates from national statistics; others were estimates of experts working in the field. Good (≥80%), moderate (50–79%) and poor adherence (<50%) was reported by 59% (16/27), 30% (8/27) and 11% (3/27) of countries, respectively. The UK reported the lowest adherence rate of all European countries (20%). Specific factors significantly associated with good adherence were: 1) supplementation of both breast and bottle fed infants (P=0.02); currently recommended by 81% of countries. 2) Availability of family financial support (P=0.04); currently practised in 89% of countries. 3) Checking adherence to supplementation at routine child care visits (P=0.001); currently practised by 59% of countries. Adherence was also positively associated with the total number of factors (P<0.001).

Conclusions: Good adherence to vitamin D supplementation is associated with relatively simple factors such as offering universal supplementation and checking adherence at routine childcare visits. Supplementation should be adopted independent of the mode of feeding. Interestingly, financial family support and not free vitamin D supplies enhanced compliance.