PDF(Pubmed)
Abstract：
High vitamin D deficiency rates, with rickets and osteomalacia, have been common in South Asians (SAs) arriving in Britain since the 1950s with preventable 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 to be causal for both disorders. Ethnic minority, obesity, diabetes and social deprivation are recognised COVID-19 risk factors, but vitamin D deficiency is not, despite convincing mechanistic evidence of it. Adjusting analyses for obesity/ethnicity abolishes vitamin D deficiency in COVID-19 risk prediction, but both factors lower serum 25(OH)D specifically. Social deprivation inadequately explains increased ethnic minority COVID-19 risks. SA vitamin D deficiency remains uncorrected after 70 years, official bodies using \'education\', \'assimilation\' and \'diet\' as \'proxies\' for ethnic differences and increasing pressures 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 Cod liver oil was withdrawn from antenatal clinics in 1994 (for excessive vitamin A teratogenicity), without alternative provision.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 for UK adults in \'lockdown\' was \'400 IU vitamin D/day\', inadequate for correcting the deficiency seen winter/summer at 17.5%/5.9% in White, 38.5%/30% in Black and 57.2%/50.8% in SA people in representative UK Biobank subjects when recruited ~14 years ago and remaining similar in 2018. Vitamin D inadequacy worsens many non-skeletal health risks. Not providing vitamin D for preventing SA rickets and osteomalacia continues to be unacceptable, as deficiency-related health risks increase ethnic health disparities, while abolishing vitamin D deficiency would be easier and more cost-effective than correcting any other factor worsening ethnic minority health in Britain.
摘要：
维生素D缺乏率高,病和骨软化症,自1950年代以来，在南亚人（SA）到达英国的情况很普遍，可预防的婴儿死于低钙血症状态-癫痫持续和心肌病。维生素D缺乏增加常见的SA疾病（2型糖尿病和心血管疾病），最近的试验和非线性孟德尔随机研究表明，缺陷是两种疾病的原因。少数民族,肥胖，糖尿病和社会剥夺是公认的COVID-19危险因素，但维生素D缺乏不是，尽管有令人信服的机械证据。对肥胖/种族的调整分析消除了COVID-19风险预测中的维生素D缺乏，但这两个因素都特别降低了血清25(OH)D。社会剥夺不足以解释少数民族COVID-19风险增加的原因。SA维生素D缺乏在70年后仍未得到纠正，官方机构使用“教育”，\'同化\'和\'饮食\'作为\'代表种族差异和越来越大的同化压力。同时,从1940年起，英国的病被免费的“福利食品”废除了(肉，牛奶，鸡蛋,鱼肝油)，适用于所有怀孕/哺乳母亲和幼儿（<5岁）。从1994年开始从产前诊所撤出鱼肝油（因为维生素A过度致畸），没有替代条款。2006年为有幼儿（<3岁）的低收入家庭提供的“健康开始”计划食品券的使用率很低，无法访问和宣传不力。COVID-19在“封锁”中对英国成年人的大流行建议是“每天400IU维生素D”，不足以纠正白色冬季/夏季为17.5%/5.9%的不足，在约14年前招募时，黑人占38.5％/30％，在代表英国生物银行受试者中的SA人中占57.2％/50.8％，在2018年保持相似。维生素D不足会使许多非骨骼健康风险恶化。不提供维生素D来预防SA病和骨软化症仍然是不可接受的，由于与缺乏相关的健康风险增加了种族健康差异，而消除维生素D缺乏症将比纠正任何其他因素更容易和更具成本效益恶化的少数民族健康在英国。
