Calcium and Vitamin D Disparities Are Related to Gender, Age, Race, Household Income Level, and Weight Classification but Not Vegetarian Status in the United States: Analysis of the NHANES 2001–2008 Data Set

Abstract Objective: Adequate calcium and vitamin D intakes are critical during all life cycle stages. This study aimed to characterize usual intakes of calcium and vitamin D from food and dietary supplements in specific subpopulations of Americans so that fortification/enrichment and supplementation efforts may be targeted toward populations who are truly in need. Methods: The National Cancer Institute method was used to estimate usual intakes of calcium and vitamin D by source and compared usual intakes to the established Dietary Reference Intakes for U.S. residents aged ≥4 years using National Health and Nutrition Examination Survey 2001–2002, 2003–2004, 2005–2006, and 2007–2008 data sets. Results: These results showed for the first time that low-income, overweight, and/or obese minority populations may be at greater risk of calcium and vitamin D insufficiency. Children aged 4–8 years were more likely to obtain recommended dairy intakes compared with older children and adults of all ages. Food intakes of calcium decreased with age in adults. Adults who used supplemental calcium showed a lower prevalence of insufficiency. Calcium and vitamin D intakes from food and dietary supplements were not related to vegetarian status. Excessive intakes of calcium and vitamin D above the tolerable upper intake level were low among all studied populations and “overnutrification” was not widely present across these analyses. Conclusions: Age- and gender-specific supplementation and modest use of fortification with calcium and vitamin D may be warranted for targeting certain subpopulations, particularly older adults, teenagers, minorities, and those who are low income and overweight and/or obese. Practical Application: This study aimed to characterize usual intakes of calcium and vitamin D from food and dietary supplements in specific subpopulations of Americans so that fortification/enrichment and supplementation efforts may be better targeted. Low-income, overweight, and/or obese minority populations may be at a greater risk of calcium and vitamin D insufficiency. Key words: calciumvitamin DNHANESDRI valuessubpopulation ACKNOWLEDGMENT The authors thank Pharmavite, LLC, for their financial support in developing this database. T.C. Wallace is currently employed by the Council for Responsible Nutrition. C. Reider is currently employed by Pharmavite, LLC. Abbreviations: AI = adequate intake, BMI = body mass index, CDC = US Centers for Disease Control and Prevention, DGA = Dietary Guidelines for Americans, DRI = Dietary Reference Intakes, EAR = estimated average requirements, IOM = Institute of Medicine, NCHS = National Center for Health Statistics, NCI = National Cancer Institute, NHANES = National Health and Nutrition Examination Survey, RDA = recommended dietary allowances, UL = tolerable upper intake level, USDA = US Department of Agriculture.