By: Daniel Raederstorff, principal scientist at DSM Nutritional Products
Could higher vitamin D intake in childhood help end the global diabetes epidemic?
The number of people living with diabetes worldwide is rapidly rising, with an estimated 422 million adults affected in 2014 compared with 108 million in 1980.1 A serious issue on its own, diabetes can also lead to a wide range of additional health concerns such as sight loss. It is also closely linked to heart health, contributing to high blood pressure and cholesterol, both of which are risk factors for heart attacks.2 Approximately 90-95% of cases are type 2, which can be prevented and/or managed through lifestyle changes. Type 1 diabetes, where the body does not create any insulin, is an autoimmune disease meaning the causes are much harder to determine.3
For many years, researchers have investigated the risk factors behind type 1 diabetes. Genetics are thought to play a part in its development, with first degree relatives significantly more likely to be diagnosed with the condition than unrelated individuals.4 Additionally, cow’s milk, viral infection and low blood levels of vitamin D have all been suggested as potential triggers.5
A recent observational study examined the effect of vitamin D on children who had been identified as having an increased genetic risk.6 Over 8,000 individuals were observed in the research, which took place over six sites in the United States and Europe. The results revealed a higher vitamin D status in childhood was associated with a with a lower risk of developing type 1 diabetes in children.
This adds to a large pool of existing scientific evidence supporting the role of vitamin D, particularly in supplement form, in protecting young people against diabetes.7,8 The EURODIAB Substudy 2 Study Group, for example, was a study that collected data from 820 patients and 2,335 control subjects across Europe. The findings consistently highlighted that vitamin D supplementation may have a protective effect in infancy, and activated vitamin D might contribute to immune modulation in susceptible people.9
There is also research that indicates vitamin D may have a place in the treatment of health complications associated with type 1 diabetes, such as endothelial (the inner lining of blood vessels) dysfunction. A recent study examined the effects of vitamin D supplementation in adolescents already diagnosed with type 1 diabetes and found that treatment with the nutrient was linked to an improvement in endothelial function, as well as reduced expression of urinary inflammatory markers, with no apparent negative effects.10
It is important that individuals understand the best ways to increase their vitamin D levels. Although a healthy, balanced diet can provide a large proportion of the daily recommended intake for many nutrients, vitamin D does not naturally occur in many foods. Often referred to as the ‘sunshine vitamin’, it is synthesized in the skin after exposure to the sun. However, for people who spend a lot of time indoors or covered up, and especially for those who live in areas with limited sun exposure, deficiency is more likely.
It is important that individuals understand the best ways to increase their vitamin D levels. Although a healthy, balanced diet can provide a large proportion of the daily recommended intake for many nutrients, vitamin D does not naturally occur in many foods. Often referred to as the ‘sunshine vitamin’, it is synthesized in the skin after exposure to the sun. However, for people who spend a lot of time indoors or covered up, and especially for those who live in areas with limited sun exposure, deficiency is more likely. For these groups, fortified food or supplements can offer a simple, safe and effective method of increasing vitamin D intake. A DSM study set out to discover how nutritional supplements are perceived by healthcare professionals in Europe and found that vitamin D is the most recommended supplement to patients, particularly by GPs.11 While this is positive, it is not specifically related to diabetes prevention and the recommendations are unlikely to reach those without existing health issues that have led them to seek medical advice. Additional education, particularly for parents of young at-risk children, is key to increasing intakes of vitamin D globally to protect against diabetes. Pregnant women with type 1 diabetes may also benefit from receiving advice on vitamin D supplementation, with new research indicating an association between insufficient intake and an increased chance of preterm delivery.12
To find out more about the role of nutritional solutions in preventing diabetes and improving heart health, read our whitepaper, ‘The role of nutrients in supporting cardiovascular health’.
 World Health Organisation, ‘Global report on diabetes’, 2016. Available at: http://apps.who.int/iris/bitstream/10665/204871/1/9789241565257_eng.pdf. Accessed on: 6 November 2017.
 Diabetes.co.uk, ‘How does diabetes affect the body?’, 2017. Available at: http://www.diabetes.co.uk/how-does-diabetes-affect-the-body.html. Accessed on: 7 November 2017.
 Centers for Disease Control and Prevention, ‘At a glance 2016: Diabetes’, 2016. Available at: https://www.cdc.gov/chronicdisease/resources/publications/aag/diabetes.htm. Accessed on: 6 November 2017.
 World Health Organisation, ‘Genetics and diabetes’, nd. Available at: www.who.int/genomics/about.Accessed on 9 November 2017.
 M. Knip et al, ‘Environmental triggers and determinants of type 1 diabetes’, Diabetes, Vl 54, 2005.
 J. Norris et al., ‘Plasma 25-Hydroxyvitamin D Concentration and Risk of Islet Autoimmunity’, Diabetes, Vol 66, Issue 11.
 C. Zipitis, ‘Vitamin D supplementation in early childhood and risk of type 1 diabetes: a systematic review and meta-analysis’, Disease in Childhood, Vol. 93, issue 6, 2008.
 E. Hyppönen, ‘Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study’, The Lancet, Vol 358, Issue 9292, 2001, p 1500-03.
 The EURODIAB Substudy 2 Study Group, ‘Vitamin D supplement in early childhood and risk for type I (insulin-dependent) diabetes mellitus’, Diabetologia, vol 42, Issue 1, 1999, p 51–54.
 L. Deda, ‘Improvements in peripheral vascular function with vitamin D treatment in deficient adolescents with type 1 diabetes’, Pediatr Diabetes, 2017. Available at: http://onlinelibrary.wiley.com/doi/10.1111/pedi.12595/abstract Accessed on: 15 November 2017.
 DSM, ‘Perception of nutritional supplements’, 2017.
 M.Vestgaard et al., ‘Vitamin D insufficiency, preterm delivery and preeclampsia in women with type 1 diabetes – an observational study’, Acta Obstet Gynecol Scand, vol 96, issue 10, 2017, p 1197-1204.