NCHS Data Brief No.

59 March 2011
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
National Center for Health Statistics
Vitamin D Status: United States, 20012006
Anne C. Looker, Ph.D.; Clifford L. Johnson, M.P.H.; David A. Lacher, M.D.; Christine M. Pfeiffer, Ph.D.;
Rosemary L. Schleicher, Ph.D.; and Christopher T. Sempos, Ph.D.
TheInstituteofMedicine(IOM)recentlyreleasednewdietaryreference
intakesforcalciumandvitaminD(1).TheIOMdefnedfourcategoriesof
vitaminDstatusbasedonserum25-hydroxyvitaminD(25OHD):(i)risk
ofdefciency,(ii)riskofinadequacy,(iii)suffciency,and(iv)abovewhich
theremaybereasonforconcern(1).Thisbriefpresentsthemostrecent
nationaldataonvitaminDstatusintheU.S.populationbasedontheseIOM
categories.Resultsarepresentedbyage,sex,raceandethnicity,and,for
women,bypregnancyandlactationstatus.
Keywords: serum 25-hydroxyvitamin D prevalence defciency inadequacy
In 20012006, what was the vitamin D status of the U.S.
population based on the IOM thresholds for serum 25OHD?
In20012006,two-thirds(67%)ofpersonsaged1yearandoverhadserum
25OHDvaluesconsideredsuffcient(Figure1).Roughlyonequarterofthe
populationhadserum25OHDvaluesthatputthematriskofinadequacy.
Eightpercentwereatriskofdefciency,and1%hadahighserum25OHD
valuethatmaypossiblybeharmful.Serum25OHDpercentilevalues,which
provideamoredetaileddescriptionoftheserum25OHDdistributioninthe
U.S.population,areshownintheTable.
Key fndings
Data from the National
Health and Nutrition
Examination Surveys
(NHANES)
In20012006,two-thirdsof
thepopulationhadsuffcient
vitaminD,defnedbythe
InstituteofMedicineasa
serum25-hydroxyvitaminD
(25OHD)valueof50125
nmol/L.Aboutone-quarter
wereatriskofvitaminD
inadequacy(serum25OHD
3049nmol/L),and8%were
atriskofvitaminDdefciency
(serum25OHDlessthan30
nmol/L).
TheriskofvitaminD
defciencydifferedbyage,
sex,andraceandethnicity.
Theprevalencewaslowerin
personswhowereyounger,
male,ornon-Hispanic
white.Amongwomen,the
prevalenceatriskwasalso
lowerinpregnantorlactating
women.
TheriskofvitaminD
defciencyincreasedbetween
19881994and20012002in
bothsexesbutdidnotchange
between20012002and
20052006.
NOTES: 25OHD is 25-hydroxyvitamin D. To convert nmol/L to ng/mL, divide by 2.5.
SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey (NHANES); data for ages 15 years from NHANES
20032006.
Figure 1. Serum 25OHD status of persons aged 1 year and over: United States, 20012006
Possibly harmful
(>125 nmol/L)
1%
Sufficient
(50125 nmol/L)
67%
At risk of
inadequacy
(3049 nmol/L)
24%
At risk of deficiency
(<30 nmol/L)
8%
The data in Figures 4 and 5 have been corrected.
NCHS Data Brief No. 59 March 2011
2
Table. Selected percentile values for serum 25-hydroxyvitamin D (25OHD), by sex and age, and by pregnancy
and lactation status in females: United States, 20012006
Serum 25OHD (nmol/L) percentile
Characteristic n 5th 10th 25th 50th 75th 90th 95th
Male
Age (years)
13 581 40.7 48.3 58.2 69.5 84.4 94.7 101.0
48 970 42.6 47.8 58.0 67.3 78.8 92.0 99.9
913 1,473 32.5 40.4 49.9 62.1 74.5 87.4 98.5
1418 1,978 25.3 33.0 45.7 58.5 71.2 84.9 95.7
1930 1,611 23.0 29.4 41.9 55.3 68.7 83.6 94.3
3150 2,244 25.1 31.3 44.2 57.4 71.5 84.5 94.3
5170 1,853 25.6 32.7 44.1 58.1 71.3 83.7 91.8
Over 70 1,217 25.4 31.7 44.6 57.2 69.7 82.7 90.1
Female
Age (years)
13 584 43.3 49.8 58.5 68.3 79.4 89.2 94.9
48 989 38.4 44.2 54.5 67.2 80.0 93.4 101.0
913 1,515 27.7 34.6 46.3 57.6 68.4 80.9 87.5
1418 1,823 20.8 27.2 41.1 57.2 71.6 87.1 104.0
1930 1,346 18.5 25.4 40.0 55.9 76.2 95.6 111.0
3150 2,097 19.2 25.3 38.9 55.3 71.0 87.6 101.0
5170 1,866 21.2 27.0 39.7 54.7 69.7 85.4 93.4
Over 70 1,197 22.6 27.1 40.5 55.5 69.6 84.1 93.6
Pregnant or
lactating
1,067 24.5 31.4 44.5 62.4 78.2 94.7 109.0
SOURCE:CDC/NCHS,NationalHealthandNutritionExaminationSurvey(NHANES),20012006;dataforages15yearsfromNHANES20032006.
What is the prevalence of serum 25OHD values indicating risk of defciency,
by age and sex?
Theseason-adjustedprevalenceatriskofdefciencybyagerangedfrom1%to8%inmalesand
1%to12%infemales(Figure2).Inbothsexes,theprevalencewaslowestinchildrenaged18
years.Riskofdefciencyincreasedsignifcantlywithageuntilage30inmalesandage18in
females,afterwhichitdidnotchangesignifcantlywithage.
NCHS Data Brief No. 59 March 2011
3
Figure 2. Prevalence at risk of deficiency, by age and sex: United States, 20012006
P
e
r
c
e
n
t
0
5
10
15
20
Over
70
5170 3150 1930 1418 913 18 Over
70
5170 3150 1930 1418 913 18
Age group (years)
1
*2
*7
*8
7 7
6
12
11 11 11
*10
1
*5
0DOH
)HPDOH
* S < 0.05 compared with preceding age group within sex.
NOTES: At risk of deficiency is defined as serum 25OHD (25-hydroxyvitamin D) less than 30 nmol/L. Serum 25OHD values have been adjusted for season.
Significant trend by age within sex, S < 0.05.
SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey (NHANES); data for ages 15 years from NHANES 20032006.
What is the prevalence of serum 25OHD values indicating risk of
inadequacy, by age and sex?
Theseason-adjustedprevalenceatriskofinadequacybyagerangedfrom9%to28%inmales
and11%to28%infemales(Figure3).Inbothsexes,theprevalencewaslowestinchildrenaged
18years.Riskofinadequacyincreasedsignifcantlywithageuntilage30inmales,afterwhich
itdidnotchangefurtherwithage.Riskofinadequacyincreasedsignifcantlywithageuntilage
14yearsinfemales.Afterage14,riskofinadequacyamongfemalesremainedconstantuntil
age51,whenitincreasedsignifcantly.Aftertheincreaseatage51,riskofinadequacyremained
stableinfemales.
* S < 0.05 compared with preceding age group within sex.
NOTES: At risk of inadequacy is defined as serum 25OHD (25-hydroxyvitamin D) of 3049 nmol/L. Serum 25OHD values have been adjusted for season.
Significant trend by age within sex, S < 0.05.
SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey (NHANES); data for ages 15 years from NHANES 20032006.
Figure 3. Prevalence at risk of inadequacy, by age and sex: United States, 20012006
P
e
r
c
e
n
t
0
5
10
15
20
25
30
Over
70
5170 3150 1930 1418 913 18 Over
70
5170 3150 1930 1418 913 18
Age group (years)
9
*19
*22
*28
24
25
24
11
*22
24
26
24
*28
27
0DOH )HPDOH
NCHS Data Brief No. 59 March 2011
4
Does the prevalence of serum 25OHD values indicating risk of defciency
and inadequacy differ by sex or race and ethnicity? Among women of
childbearing age, does this prevalence differ by pregnancy and lactation
status?
Males were less likely to be at risk of defciency than females, after adjusting for age and
season (Figure 4). The age- and season-adjusted prevalence at risk of inadequacy did not differ
by sex. Non-Hispanic white persons were less likely to be at risk of defciency or at risk of
inadequacy than non-Hispanic black or Mexican American persons, after adjusting for age and
season. According to IOM (1), interpretation of serum 25OHD thresholds for risk of defciency
or inadequacy in nonwhite persons is uncertain because many nonwhite groups have better
skeletal status than white persons despite having lower serum 25OHD values. Among women of
childbearing age, those who were pregnant or lactating were less likely to be at risk of defciency
than women who were not pregnant or lactating, after adjusting for age and season. The age- and
season-adjusted prevalence at risk of inadequacy did not differ by pregnancy and lactation status
in women of childbearing age.
1
S< 0.05 compared with males.
2
S< 0.05 compared with non-Hispanic white persons.
3
S< 0.05 compared with pregnant or lactating women.
SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey (NHANES); data for ages 15 years from NHANES 20032006.
Figure 4. Age- and season-adjusted prevalence at risk of deficiency and inadequacy among persons aged 1 year and
over: United States, 20012006
P
e
r
c
e
n
t
At risk of inadequacy
(3049 nmol/L)
At risk of deficiency
(<30 nmol/L)
0
20
40
60
80
100
No Yes Mexican Black White Female Male
23
24
18

41

32

33

9
21
7

12
10
6
25
Non-Hispanic
Pregnant or lactating
(females aged
1244 years)
3
NCHS Data Brief No. 59 March 2011
5
Has the prevalence at risk of defciency and inadequacy changed since
the 1990s?
In 19881994, 3% of males aged 12 years and over had serum 25OHD values that put them at
risk of defciency, after adjusting for age and season; in comparison, the age- and season-adjusted
prevalence at risk of defciency in 20012002 increased to 7% (Figure 5). The corresponding
fgures for those at risk of inadequacy were 20% and 24%, respectively. The age- and season-
adjusted prevalence at risk of defciency or inadequacy did not change between 20012002 and
20052006 in adolescent and adult men.
The age- and season-adjusted prevalence at risk of defciency also increased between 19881994
and 20012002 among females aged 12 years and over (Figure 5). In 19881994, 7% of females
aged 12 and over were at risk of defciency, after adjusting for age and season, compared with
11% in 20012002. However, the age- and season-adjusted prevalence of adolescent and adult
women at risk of inadequacy decreased from 29% in 19881994 to 26% in 20012002. The
age- and season-adjusted prevalence at risk of defciency or inadequacy did not change between
20012002 and 20052006 in adolescent and adult women.
Figure 5. Age- and season-adjusted prevalence at risk of deficiency and inadequacy among persons aged 12 years and
over: United States, 19881994 through 20052006
* Adjusted for assay difference between NHANES and NHANES 20012006.
| S < 0.05 compared with preceding time period within sex.
NOTE: Significant overall trend in risk of deficiency and risk of inadequacy by survey period within sex, S < 0.05.
SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey (NHANES).
P
e
r
c
e
n
t
)HPDOH 0DOH
0
10
20
30
40
50
At risk of inadequacy
At risk of deficiency
2005
2006
2003
2004
2001
2002
1988
1994*
0
10
20
30
40
50
At risk of inadequacy
At risk of deficiency
2005
2006
2003
2004
2001
2002
1988
1994*
NCHS Data Brief No. 59 March 2011
6
Summary
MostpersonsintheUnitedStatesaresuffcientinvitaminD,basedonserum25OHDthresholds
proposedbyIOM.Roughlyone-quarterwereatriskofinadequacyand8%wereatriskof
defciency.Theprevalenceatriskofdefciencyorinadequacydifferedbyage,sex,andrace
andethnicity.Groupsatlowerriskincludedchildren,males,non-Hispanicwhitepersons,
andpregnantorlactatingwomen.Between19881994and20012002,theprevalenceatrisk
ofdefciencyincreasedinadolescentsandadultsofbothsexes,buttheprevalenceatriskof
defciencyorinadequacydidnotchangebetween20012002and20052006.
Defnitions
AtriskofvitaminDdefciency:Serum25OHDlessthan30nmol/L(12ng/mL)(1).
AtriskofvitaminDinadequacy:Serum25OHD3049nmol/L(1219ng/mL)(1).
SuffcientinvitaminD:Serum25OHD50125nmol/L(2050ng/mL)(1).
PossiblyharmfulvitaminD:Serum25OHDgreaterthan125nmol/L(50ng/mL)(1).
Season:Twocategories,basedonmonthofblooddraw:NovemberMarchandAprilOctober.
Seasonisimportanttoconsiderfortworeasons:(i)vitaminDisproducedintheskinbysunlight
exposure,soitvariesbyseason;and(ii)forpracticalreasons,dataarecollectedinNHANESin
theSouthduringthewinterandNorthduringthesummer.
NHANESIII(19881994)serum25OHDadjustment:Theassaymethodusedtomeasureserum
25OHDinNHANESIIIdifferedfromthemethodusedinNHANES20012006.Astatistical
adjustmentwasappliedtotheNHANESIIIserum25OHDsothatthedatacouldbevalidly
comparedwithserum25OHDfromNHANES20012006.Detailsabouttheadjustmenthave
beenpublishedelsewhere(2).
Data source and methods
NHANESdatawereusedfortheseanalyses.NHANESisacross-sectionalsurveydesignedto
monitorthehealthandnutritionalstatusoftheciviliannoninstitutionalizedU.S.population(3).
Thesurveyconsistsofinterviewsconductedinparticipantshomesandstandardizedphysical
examinationsthatincludelaboratorytestsutilizingbloodandurinespecimensprovidedby
participantsduringtheexamination.
TheNHANESsampleisselectedthroughacomplex,multistagedesignthatincludesselectionof
primarysamplingunits(counties),householdsegmentswithinthecounties,andfnallysample
personsfromselectedhouseholds.Thesampledesignincludesoversamplingtoobtainreliable
estimatesofhealthandnutritionalmeasuresforpopulationsubgroups.In19881994and2001
2006,non-HispanicblackandMexican-Americanpersonswereoversampled.In1999,NHANES
becameacontinuoussurvey,feldedonanongoingbasis.Eachyearofdatacollectionisbasedon
arepresentativesamplecoveringallagesoftheciviliannoninstitutionalizedpopulation.Public-
usedataflesarereleasedin2-yearcycles.
NCHS Data Brief No. 59 March 2011
7
Sampleweights,whichaccountforthedifferentialprobabilitiesofselection,nonresponse,
andnoncoverage,wereincorporatedintotheestimationprocess.Thestandarderrorsofthe
percentageswereestimatedusingTaylorserieslinearization,amethodthatincorporatesthe
sampleweightsandsampledesign.Prevalenceestimateswerestatisticallyadjustedforage
whenmakingcomparisonsbysex,raceandethnicity,andpregnancyorlactationstatus.Serum
25OHDdatawerestatisticallyadjustedforseasonwhenmakingcomparisonsbyage,sex,
raceandethnicity,andpregnancyorlactationstatus,tocontrolfordifferencesinthetimeof
yearwhenbloodwasdrawnindifferentgroups.Differencesbetweengroupswereevaluated
usingatstatisticatthep<0.05signifcancelevel.Testsoftrendsweredoneusingthep<
0.05signifcancelevel.Allresultspresentedhavearelativestandarderrorlessthan30%.All
differencesreportedarestatisticallysignifcantunlessotherwiseindicated.Statisticalanalyses
wereconductedusingtheSASSystemforWindows(release9.2;SASInstitute,Cary,NC)and
SUDAAN(release10.0;ResearchTriangleInstitute,ResearchTrianglePark,NC).
About the authors
AnneC.Looker,CliffordL.Johnson,andDavidA.LacherarewiththeCentersforDisease
ControlandPreventions(CDC)NationalCenterforHealthStatistics,DivisionofHealthand
NutritionExaminationSurveys.ChristineM.PfeifferandRosemaryL.Schleicherarewith
CDCsNationalCenterforEnvironmentalHealth,DivisionofLaboratorySciences.Christopher
T.SemposiswiththeNationalInstitutesofHealth,OffceofDietarySupplements.
References
1. InstituteofMedicine.DietaryreferenceintakesforcalciumandvitaminD.Washington,DC:
NationalAcademiesPress.2010.
2. LookerAC,PfeifferCM,LacherDA,SchleicherRL,PiccianoMF,YetleyEA.Serum25-
hydroxyvitaminDstatusoftheU.S.population:19881994comparedwith20002004.AmJ
ClinNutr88(6):151927.2008.
3. NationalCenterforHealthStatistics.NationalHealthandNutritionExaminationSurvey,
20012006.Availablefrom:http://www.cdc.gov/nchs/nhanes/nhanes_questionnaires.htm.
AccessedFebruary25,2011.
NCHS Data Brief No. 59 March 2011
Suggested citation
LookerAC,JohnsonCL,LacherDA,etal.
VitaminDstatus:UnitedStates,20012006.
NCHSdatabrief,no59.Hyattsville,MD:
NationalCenterforHealthStatistics.2011.
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National Center for Health
Statistics
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JenniferH.Madans,Ph.D.,Associate
Director for Science
Division of Health and Nutrition
Examination Surveys
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