Demographic Differences and Trends of Vitamin D Insufficiency in the US Population, 1988-2004 | Nutrition | JAMA Internal Medicine | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Hess  AFUnger  LF The cure of infantile rickets by sunlight.  JAMA 1921;77 (1) 39- 41Google Scholar
Chalmers  JConacher  WDHGarnder  DLScott  PJ Osteomalacia: a common disease in elderly women.  J Bone Joint Surg Br 1967;49 (3) 403- 423PubMedGoogle Scholar
Poole  KELoveridge  NBarker  PJ  et al.  Reduced vitamin D in acute stroke.  Stroke 2006;37 (1) 243- 245PubMedGoogle ScholarCrossref
Giovannucci  ELiu  YHollis  BWRimm  EB 25-hydroxyvitamin D and risk of myocardial infarction in men.  Arch Intern Med 2008;168 (11) 1174- 1180PubMedGoogle ScholarCrossref
Dobnig  HPilz  SScharnagl  H  et al.  Independent association of low serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels with all-cause and cardiovascular mortality.  Arch Intern Med 2008;168 (12) 1340- 1349PubMedGoogle ScholarCrossref
Garland  CFComstock  GWGarland  FCHelsing  KJShaw  EKGorham  ED Serum 25-hydroxyvitamin D and colon cancer.  Lancet 1989;2 (8673) 1176- 1178PubMedGoogle ScholarCrossref
Giovannucci  ELiu  YRimm  EB  et al.  Prospective study of predictors of vitamin D status and cancer incidence and mortality in men.  J Natl Cancer Inst 2006;98 (7) 451- 459PubMedGoogle ScholarCrossref
Garland  CFGarland  FCGorham  ED  et al.  The role of vitamin D in cancer prevention.  Am J Public Health 2006;96 (2) 252- 261PubMedGoogle ScholarCrossref
Lin  JManson  JELee  IMCook  NRBuring  JEZhang  SM Intakes of calcium and vitamin D and breast cancer risk in women.  Arch Intern Med 2007;167 (10) 1050- 1059PubMedGoogle ScholarCrossref
Wilkinson  RJLlewelyn  MToossi  Z  et al.  Influence of vitamin D deficiency and vitamin D receptor polymorphisms on tuberculosis among Gujarati Asians in west London: a case-control study.  Lancet 2000;355 (9204) 618- 621PubMedGoogle ScholarCrossref
Cannell  JJVieth  RUmhau  JC  et al.  Epidemic influenza and vitamin D.  Epidemiol Infect 2006;134 (6) 1129- 1140PubMedGoogle ScholarCrossref
Laaksi  IRuohola  JPTuohimaa  P  et al.  An association of serum vitamin D concentrations <40 nmol/L with acute respiratory tract infection in young Finnish men.  Am J Clin Nutr 2007;86 (3) 714- 717PubMedGoogle Scholar
Camargo  CA  JrIngham  TWickens  K  et al.  Cord blood 25-hydroxyvitamin D levels and risk of childhood wheeze in New Zealand [abstract].  Am J Respir Crit Care Med 2008;177 ((suppl)) A993Google Scholar
Lappe  JMTravers-Gustafson  DDavies  KMRecker  RRHeaney  RP Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial.  Am J Clin Nutr 2007;85 (6) 1586- 1591PubMedGoogle Scholar
Autier  PGandini  S Vitamin D supplementation and total mortality: a meta-analysis of randomized controlled trials.  Arch Intern Med 2007;167 (16) 1730- 1737PubMedGoogle ScholarCrossref
Avenell  ACook  JAMaclennan  GSMacpherson  GC Vitamin D supplementation to prevent infections.  Age Ageing 2007;36 (5) 574- 577PubMedGoogle ScholarCrossref
Martineau  ARWilkinson  RJWilkinson  KA  et al.  A single dose of vitamin D enhances immunity to mycobacteria.  Am J Respir Crit Care Med 2007;176 (2) 208- 213PubMedGoogle ScholarCrossref
Standing Committee on the Scientific Evaluation of Dietary Reference Intakes Food and Nutrition Board, Institute of Medicine, Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride.  Washington, DC National Academy Press1999;250- 287
Scragg  RJackson  RHoldaway  IMLim  TBeaglehole  R Myocardial infarction is inversely associated with plasma 25-hydroxyvitamin D3 levels: a community-based study.  Int J Epidemiol 1990;19 (3) 559- 563PubMedGoogle ScholarCrossref
Scragg  RSowers  MBell  CThird National Health and Nutrition Examination Survey, Serum 25-hydroxyvitamin D, diabetes, and ethnicity in the Third National Health and Nutrition Examination Survey.  Diabetes Care 2004;27 (12) 2813- 2818PubMedGoogle ScholarCrossref
Black  PNScragg  R Relationship between serum 25-hydroxyvitamin D and pulmonary function in the Third National Health and Nutrition Examination Survey.  Chest 2005;128 (6) 3792- 3798PubMedGoogle ScholarCrossref
Bischoff-Ferrari  HAGiovannucci  EWillett  WCDietrich  TDawson-Hughes  B Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes [published corrections appear in Am J Clin Nutr. 2006;84(5):1253 and Am J Clin Nutr. 2007;86(3):809].  Am J Clin Nutr 2006;84 (1) 18- 28PubMedGoogle Scholar
Forman  JPGiovannucci  EHolmes  MD  et al.  Plasma 25-hydroxyvitamin D levels and risk of incident hypertension.  Hypertension 2007;49 (5) 1063- 1069PubMedGoogle ScholarCrossref
Gorham  EDGarland  CFGarland  FC  et al.  Optimal vitamin D status for colorectal cancer prevention.  Am J Prev Med 2007;32 (3) 210- 216PubMedGoogle ScholarCrossref
Garland  CFGorham  EDMohr  SB  et al.  Vitamin D and prevention of breast cancer: pooled analysis.  J Steroid Biochem Mol Biol 2007;103 (3-5) 708- 711PubMedGoogle ScholarCrossref
Holick  MF Vitamin D deficiency.  N Engl J Med 2007;357 (3) 266- 281PubMedGoogle ScholarCrossref
Vieth  RBischoff-Ferrari  HBoucher  BJ  et al.  The urgent need to recommend an intake of vitamin D that is effective.  Am J Clin Nutr 2007;85 (3) 649- 650PubMedGoogle Scholar
Holick  MFChen  TC Vitamin D deficiency: a worldwide problem with health consequences.  Am J Clin Nutr 2008;87 (4) 1080S- 1086SPubMedGoogle Scholar
Holick  MF Resurrection of vitamin D deficiency and rickets.  J Clin Invest 2006;116 (8) 2062- 2072PubMedGoogle ScholarCrossref
Scragg  RCamargo  CA  Jr Frequency of leisure time physical activity and serum 25-hydroxyvitamin D levels in the US population: results from the Third National Health and Nutrition Examination Survey.  Am J Epidemiol 2008;168 (6) 577- 586PubMedGoogle ScholarCrossref
Looker  ACDawson-Hughes  BCalvo  MSGunter  EWSahyoun  NR Serum 25-hydroxyvitamin D status of adolescents and adults in two seasonal subpopulations from NHANES III.  Bone 2002;30 (5) 771- 777PubMedGoogle ScholarCrossref
Zadshir  ATareen  NPan  DNorris  KMartins  D The prevalence of hypovitaminosis D among US adults: data from the NHANES III.  Ethn Dis 2005;15 (4) ((suppl 5)) S5-97- S5-101PubMedGoogle Scholar
Centers for Disease Control and Prevention (CDC); National Center for Health Statistics (NCHS), National Health and Nutrition Examination Survey Data  Hyattsville, MD US Dept of Health and Human Services. Accessed June 26, 2008
US Department of Health and Human Services, Healthy People 2010: With Understanding and Improving Health and Objectives for Improving Health: Section 3: Cancer. 2nd ed. Washington, DC US Dept of Health and Human Services November2000;
Matsuoka  LYIde  LWortsman  JMacLaughlin  JAHolick  MF Sunscreens suppress cutaneous vitamin D3 synthesis.  J Clin Endocrinol Metab 1987;64 (6) 1165- 1168PubMedGoogle ScholarCrossref
Wortsman  JMatsuoka  LYChen  TCLu  ZHolick  MF Decreased bioavailability of vitamin D in obesity.  Am J Clin Nutr 2000;72 (3) 690- 693PubMedGoogle Scholar
Ogden  CLCarroll  MDCurtin  LR McDowell  MATabak  CJFlegal  KM Prevalence of overweight and obesity in the United States, 1999-2004.  JAMA 2006;295 (13) 1549- 1555PubMedGoogle ScholarCrossref
Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Institute of Medicine, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.  Washington, DC National Academy Press2002;
Wolf  MBetancourt  JChang  Y  et al.  Impact of activated vitamin D and race on survival among hemodialysis patients.  J Am Soc Nephrol 2008;19 (7) 1379- 1388PubMedGoogle ScholarCrossref
Barger-Lux  MJHeaney  RPDowell  SChen  TCHolick  MF Vitamin D and its major metabolites.  Osteoporos Int 1998;8 (3) 222- 230PubMedGoogle ScholarCrossref
Original Investigation
March 23, 2009

Demographic Differences and Trends of Vitamin D Insufficiency in the US Population, 1988-2004

Author Affiliations

Author Affiliations: Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora (Dr Ginde); Divisions of Pulmonary and Critical Care Medicine and Allergy and Clinical Immunology, The Johns Hopkins University School of Medicine; Baltimore, Maryland (Dr Liu); and Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Dr Camargo).

Arch Intern Med. 2009;169(6):626-632. doi:10.1001/archinternmed.2008.604

Background  Vitamin D insufficiency is associated with suboptimal health. The prevalence of vitamin D insufficiency may be rising, but population-based trends are uncertain. We sought to evaluate US population trends in vitamin D insufficiency.

Methods  We compared serum 25-hydroxyvitamin D (25[OH]D) levels from the Third National Health and Nutrition Examination Survey (NHANES III), collected during 1988 through 1994, with NHANES data collected from 2001 through 2004 (NHANES 2001-2004). Complete data were available for 18 883 participants in NHANES III and 13 369 participants in NHANES 2001-2004.

Results  The mean serum 25(OH)D level was 30 (95% confidence interval [CI], 29-30) ng/mL during NHANES III and decreased to 24 (23-25) ng/mL during NHANES 2001-2004. Accordingly, the prevalence of 25(OH)D levels of less than 10 ng/mL increased from 2% (95% CI, 2%-2%) to 6% (5%-8%), and 25(OH)D levels of 30 ng/mL or more decreased from 45% (43%-47%) to 23% (20%-26%). The prevalence of 25(OH)D levels of less than 10 ng/mL in non-Hispanic blacks rose from 9% during NHANES III to 29% during NHANES 2001-2004, with a corresponding decrease in the prevalence of levels of 30 ng/mL or more from 12% to 3%. Differences by age strata (mean serum 25[OH]D levels ranging from 28-32 ng/mL) and sex (28 ng/mL for women and 32 ng/mL for men) during NHANES III equalized during NHANES 2001-2004 (24 vs 24 ng/mL for age and 24 vs 24 ng/mL for sex).

Conclusions  National data demonstrate a marked decrease in serum 25(OH)D levels from the 1988-1994 to the 2001-2004 NHANES data collections. Racial/ethnic differences have persisted and may have important implications for known health disparities. Current recommendations for vitamin D supplementation are inadequate to address the growing epidemic of vitamin D insufficiency.