Adherence to Vitamin D Intake Guidelines in the United States

Pediatrics. 2020 Jun;145(6):e20193574. doi: 10.1542/peds.2019-3574. Epub 2020 May 18.


Background: The American Academy of Pediatrics (AAP) revised its infant vitamin D intake guidelines in 2008. We aimed to examine previously unexplored trends in meeting vitamin D intake guidelines among US infants since 2009 and whether there were differences across demographic subgroups.

Methods: We analyzed dietary recall data for infants 0 to 11 months in the 2009-2016 NHANES. We estimated the percentage meeting 2008 AAP vitamin D guidelines, defined as consuming ≥1 L of infant formula and/or receiving a vitamin D supplement of ≥400 IU. We used Poisson regressions to assess trends over time and differences across demographic subgroups.

Results: Overall, 27.1% (95% confidence interval [CI]: 24.3%-29.8%) of US infants in 2009-2016 met vitamin D intake guidelines, with nonbreastfeeding infants (31.1% [95% CI: 27.6%-34.5%]) more likely to meet guidelines than breastfeeding infants (20.5% [95% CI: 15.4%-25.5%]; P < .01). From 2009-2010 to 2015-2016, overall and for both breastfeeding and nonbreastfeeding infants, there were no significant changes over time in the percentage of infants who met the guidelines (P > .05). Among breastfeeding infants, those with a family income ≥400% of the federal poverty level, with a college graduate head of household, and with private insurance were more likely to meet guidelines.

Conclusions: Among US infants, we observed no increase in meeting AAP vitamin D intake guidelines since 2009. Less than 40% of infants met guidelines in nearly all demographic subgroups. These findings suggest renewed consideration of how to best meet vitamin D intake guidelines.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Breast Feeding / methods
  • Breast Feeding / trends
  • Cross-Sectional Studies
  • Dietary Supplements*
  • Female
  • Humans
  • Infant
  • Infant Nutritional Physiological Phenomena / drug effects*
  • Infant Nutritional Physiological Phenomena / physiology
  • Infant, Newborn
  • Male
  • Medication Adherence*
  • Nutrition Policy / trends*
  • Nutrition Surveys / methods
  • Nutrition Surveys / trends
  • United States / epidemiology
  • Vitamin D / administration & dosage*
  • Vitamin D Deficiency / epidemiology
  • Vitamin D Deficiency / prevention & control


  • Vitamin D