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Adherence to Vitamin D Intake Guidelines in the United States
Alan E Simon1, Katherine A Ahrens2
1Environmental Influences on Child Health Outcomes Program, Office of the Director, National Institutes of Health, Rockville, Maryland; and alan.simon@nih.gov.
Insights
Most US infants do not meet vitamin D guidelines. Since 2009, there has been no improvement in infant vitamin D intake, with less than 40% meeting recommendations.
Area of Science:
- Pediatrics
- Nutrition Science
- Public Health
Background:
- The American Academy of Pediatrics (AAP) updated infant vitamin D guidelines in 2008.
- Trends in adherence to these guidelines among US infants since 2009 remain largely unexamined.
- Investigating demographic differences in guideline adherence is crucial.
Purpose of the Study:
- To analyze trends in meeting 2008 AAP infant vitamin D intake guidelines from 2009 to 2016.
- To identify disparities in guideline adherence across various demographic subgroups of US infants.
Main Methods:
- Analysis of dietary recall data from the 2009-2016 National Health and Nutrition Examination Survey (NHANES).
- Estimation of the percentage of infants (0-11 months) meeting guidelines (≥1 L formula and/or ≥400 IU vitamin D supplement).
- Utilization of Poisson regressions to assess temporal trends and demographic differences.
Main Results:
- Overall, 27.1% of US infants met vitamin D guidelines between 2009-2016.
- Nonbreastfeeding infants (31.1%) were more likely to meet guidelines than breastfeeding infants (20.5%).
- No significant changes in guideline adherence were observed over time for any subgroup (P > .05).
Conclusions:
- US infants have not shown increased adherence to AAP vitamin D guidelines since 2009.
- Fewer than 40% of infants met recommended vitamin D intake across most demographic groups.
- Findings highlight a need to re-evaluate strategies for improving infant vitamin D sufficiency.
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.
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