Skip to main content Accessibility help

Vitamin D in adolescence: evidence-based dietary requirements and implications for public health policy

  • Taryn J. Smith (a1), Laura Tripkovic (a1), Susan A. Lanham-New (a1) and Kathryn H. Hart (a1)


Vitamin D is a unique nutrient. First, it acts as a pro-hormone and secondly, the requirement for vitamin D can be met by both endogenous synthesis from sunlight and by dietary sources. This complicates the determination of dietary requirements for vitamin D, which along with the definition of optimal vitamin D status, have been highly controversial and much debated over recent years. Adolescents are a population group at high risk of low vitamin D status, which is concerning given the important role of vitamin D, and calcium, in promoting normal bone mineralisation and attainment of peak bone mass during this rapid growth phase. Dietary vitamin D recommendations are important from a public health perspective in helping to avoid deficiency and optimise vitamin D status for health. However limited experimental data from winter-based dose–response randomised trials in adolescents has hindered the development of evidence-based dietary requirements for vitamin D in this population group. This review will highlight how specifically designed randomised trials and the approach adopted for estimating such requirements can lead to improved recommendations. Such data indicate that vitamin D intakes of between 10 and about 30 µg/d may be required to avoid deficiency and ensure adequacy in adolescents, considerably greater than the current recommendations of 10–15 µg/d. Finally this review will consider the implications of this on public health policy, in terms of future refinements of vitamin D requirement recommendations and prioritisation of public health strategies to help prevent vitamin D deficiency.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Vitamin D in adolescence: evidence-based dietary requirements and implications for public health policy
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Vitamin D in adolescence: evidence-based dietary requirements and implications for public health policy
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Vitamin D in adolescence: evidence-based dietary requirements and implications for public health policy
      Available formats


Corresponding author

*Corresponding author: T. J. Smith, email


Hide All
1.Holick, MF (2007) Vitamin D deficiency. New Engl J Med 357, 266281.
2.Kiely, M & Black, LJ (2012) Dietary strategies to maintain adequacy of circulating 25-hydroxyvitamin D concentrations. Scand J Clin Lab Invest 72, 1423.
3.Bates, B, Lennox, A, Prentice, A et al. (2014) National Diet and Nutrition Survey: Results from Years 1, 2, 3 and 4 (combined) of the Rolling Programme (2008/2009–2011/2012). London: Public Health England. Available at (accessed August 2017).
4.Webb, AR (2006) Who, what, where and when—influences on cutaneous vitamin D synthesis. Prog Biophys Mol Biol 92, 1725.
5.Darling, AL, Hart, KH, Macdonald, HM et al. (2013) Vitamin D deficiency in UK South Asian women of childbearing age: a comparative longitudinal investigation with UK Caucasian women. Osteoporos Int 24, 477488.
6.Klingberg, E, Oleröd, G, Konar, J et al. (2015) Seasonal variations in serum 25-hydroxy vitamin D levels in a Swedish cohort. Endocrine 49, 800808.
7.DeLuca, HF (2004) Overview of general physiologic features and functions of vitamin D. Am J Clin Nutr 80, 1689S1696S.
8.Weaver, CM, Gordon, CM, Janz, KF et al. (2016) The National Osteoporosis Foundation's position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. Osteoporos Int 27, 12811386.
9.Bailey, DA, McKay, HA, Mirwald, RL et al. (1999) A six-year longitudinal study of the relationship of physical activity to bone mineral accrual in growing children: the University of Saskatchewan Bone Mineral Accrual Study. J Bone Miner Res 14, 16721679.
10.Henry, YM, Fatayerji, D & Eastell, R (2004) Attainment of peak bone mass at the lumbar spine, femoral neck and radius in men and women: relative contributions of bone size and volumetric bone mineral density. Osteoporos Int 15, 263273.
11.Norman, AW (2008) From vitamin D to hormone D: fundamentals of the vitamin D endocrine system essential for good health. Am J Clin Nutr 88, 491S499S.
12.Bouillon, R, Schoor, NMV, Gielen, E et al. (2013) Optimal vitamin D status: a critical analysis on the basis of evidence-based medicine. J Clin Endocrinol Metab 98, E1283E1304.
13.Makariou, S, Liberopoulos, EN, Elisaf, M et al. (2011) Novel roles of vitamin D in disease: what is new in 2011? Eur J Intern Med 22, 355362.
14.Martineau, AR, Jolliffe, DA, Hooper, RL et al. (2017) Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ 356, i6583.
15.Institute of Medicine, Food and Nutrition Board (2011) Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academies Press.
16.European Food Safety Authority Panel on Dietetic Products, Nutrition and Allergies (2016) Dietary reference values for vitamin D. EFSA J 14, 4547.
17.Braegger, C, Campoy, C, Colomb, V et al. (2013) Vitamin D in the healthy European paediatric population. J Pediatr Gastroenterol Nutr 56, 692701.
18.Wagner, CL & Greer, FR (2008) Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics 122, 11421152.
19.Society for Adolescent Health and Medicine (2013) Recommended vitamin D intake and management of low vitamin D status in adolescents: a position statement of the society for adolescent health and medicine. J Adolesc Health 52, 801803.
20.Holick, MF, Binkley, NC, Bischoff-Ferrari, HA et al. (2011) Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 96, 19111930.
21.Scientific Advisory Committee on Nutrition (2016) Vitamin D and Health. Available at: (accessed July 2016).
22.Smith, TJ, Lanham-New, SA & Hart, KH (2017) Vitamin D in adolescents: are current recommendations enough? J Steroid Biochem Mol Biol 173, 265272.
23.Ganji, V, Zhang, X & Tangpricha, V (2012) Serum 25-hydroxyvitamin D concentrations and prevalence estimates of hypovitaminosis D in the U.S. population based on assay-adjusted data. J Nutr 142, 498507.
24.Weng, FL, Shults, J, Leonard, MB et al. (2007) Risk factors for low serum 25-hydroxyvitamin D concentrations in otherwise healthy children and adolescents. Am J Clin Nutr 86, 150158.
25.Harkness, LS & Cromer, BA (2005) Vitamin D deficiency in adolescent females. J Adolesc Health 37, 75.
26.Whiting, SJ, Langlois, KA, Vatanparast, H et al. (2011) The vitamin D status of Canadians relative to the 2011 dietary reference intakes: an examination in children and adults with and without supplement use. Am J Clin Nutr 94, 128135.
27.González-Gross, M, Valtueña, J, Breidenassel, C et al. (2012) Vitamin D status among adolescents in Europe: the healthy lifestyle in Europe by nutrition in adolescence study. Br J Nutr 107, 755764.
28.Andersen, R, Mølgaard, C, Skovgaard, LT et al. (2005) Teenage girls and elderly women living in northern Europe have low winter vitamin D status. Eur J Clin Nutr 59, 533541.
29.Outila, TA, Kärkkäinen, MU & Lamberg-Allardt, CJ (2001) Vitamin D status affects serum parathyroid hormone concentrations during winter in female adolescents: associations with forearm bone mineral density. Am J Clin Nutr 74, 206210.
30.Cheng, S, Tylavsky, F, Kröger, H et al. (2003) Association of low 25-hydroxyvitamin D concentrations with elevated parathyroid hormone concentrations and low cortical bone density in early pubertal and prepubertal Finnish girls. Am J Clin Nutr 78, 485492.
31.Öberg, J, Jorde, R, Almås, B et al. (2014) Vitamin D deficiency and lifestyle risk factors in a Norwegian adolescent population. Scand J Public Health 42, 593602.
32.Kim, SH, Oh, MK, Namgung, R et al. (2014) Prevalence of 25-hydroxyvitamin D deficiency in Korean adolescents: association with age, season and parental vitamin D status. Public Health Nutr 17, 122130.
33.Puri, S, Marwaha, RK, Agarwal, N et al. (2008) Vitamin D status of apparently healthy schoolgirls from two different socioeconomic strata in Delhi: relation to nutrition and lifestyle. Br J Nutr 99, 876882.
34.Foo, LH, Zhang, Q, Zhu, K et al. (2009) Relationship between vitamin D status, body composition and physical exercise of adolescent girls in Beijing. Osteoporos Int 20, 417425.
35.Siddiqui, AM & Kamfar, HZ (2007) Prevalence of vitamin D deficiency rickets in adolescent school girls in Western region, Saudi Arabia. Saudi Med J 28, 441444.
36.Fraser, WD & Milan, AM (2013) Vitamin D assays: past and present debates, difficulties and developments. Calcif Tissue Int 92, 118127.
37.Cashman, KD, Dowling, KG, Škrabáková, Z et al. (2016) Vitamin D deficiency in Europe: pandemic? Am J Clin Nutr 103, 10331044.
38.El-Hajj Fuleihan, G, Nabulsi, M, Choucair, M et al. (2001) Hypovitaminosis D in healthy schoolchildren. Pediatrics 107, e53.
39.Ginty, F, Cavadini, C, Michaud, PA et al. (2004) Effects of usual nutrient intake and vitamin D status on markers of bone turnover in Swiss adolescents. Eur J Clin Nutr 58, 12571265.
40.Abrams, SA, Hicks, PD & Hawthorne, KM (2009) Higher serum 25-hydroxyvitamin D levels in school-age children are inconsistently associated with increased calcium absorption. J Clin Endocrinol Metab 94, 24212427.
41.Absoud, M, Cummins, C, Lim, MJ et al. (2011) Prevalence and predictors of vitamin D insufficiency in children: a Great Britain population based study. PLoS ONE 6, e22179.
42.Aksnes, L & Aarskog, D (1982) Plasma concentrations of vitamin D metabolites in puberty: effect of sexual maturation and implications for growth. J Clin Endocrinol Metab 55, 94101.
43.Lehtonen-Veromaa, M, Möttönen, T, Irjala, K et al. (1999) Vitamin D intake is low and hypovitaminosis D common in healthy 9- to 15-year-old Finnish girls. Eur J Clin Nutr 53, 746751.
44.Krabbe, S, Christiansen, C & Hummer, L (1986) Serum vitamin D metabolites are not related to growth rate, bone mineral content, or serum alkaline phosphatase in male puberty. Calcif Tissue Int 38, 127129.
45.Pettifor, JM (2004) Nutritional rickets: deficiency of vitamin D, calcium, or both? Am J Clin Nutr 80, 1725S1729S.
46.Wahl, DA, Cooper, C, Ebeling, PR et al. (2012) A global representation of vitamin D status in healthy populations. Arch Osteoporos 7, 155172.
47.Cashman, KD, Hill, TR, Cotter, AA et al. (2008) Low vitamin D status adversely affects bone health parameters in adolescents. Am J Clin Nutr 87, 10391044.
48.Foo, LH, Zhang, Q, Zhu, K et al. (2009) Low vitamin D status has an adverse influence on bone mass, bone turnover, and muscle strength in Chinese adolescent girls. J Nutr 139, 10021007.
49.Kristinsson, , Valdimarsson, Ö, Sigurdsson, G et al. (1998) Serum 25-hydroxyvitamin D levels and bone mineral density in 16–20 years-old girls: lack of association. J Intern Med 243, 381388.
50.Marwaha, RK, Tandon, N, Reddy, DRH et al. (2005) Vitamin D and bone mineral density status of healthy schoolchildren in northern India. Am J Clin Nutr 82, 477482.
51.Lehtonen-Veromaa, MK, Möttönen, TT, Nuotio, IO et al. (2002) Vitamin D and attainment of peak bone mass among peripubertal Finnish girls: a 3-y prospective study. Am J Clin Nutr 76, 14461453.
52.Winzenberg, TM, Powell, S, Shaw, KA et al. (2010) Vitamin D supplementation for improving bone mineral density in children. Cochrane Database Syst Rev 10, CDoo6944.
53.Holick, MF (2006) Resurrection of vitamin D deficiency and rickets. J Clin Investig 116, 20622072.
54.Petersen, RA, Dalskov, S-M, Sørensen, LB et al. (2015) Vitamin D status is associated with cardiometabolic markers in 8–11-year-old children, independently of body fat and physical activity. Br J Nutr 114, 16471655.
55.Cabral, M, Araújo, J, Teixeira, J et al. (2016) Vitamin D levels and cardiometabolic risk factors in Portuguese adolescents. Int J Cardiol 220, 501507.
56.Reis, JP, von Mühlen, D, Miller, ER et al. (2009) Vitamin D status and cardiometabolic risk factors in the US adolescent population. Pediatrics 124, e371e379.
57.Johnson, MD, Nader, NS, Weaver, AL et al. (2010) Relationships between 25-hydroxyvitamin D levels and plasma glucose and lipid levels in pediatric outpatients. J Pediatr 156, 444449.
58.Ganji, V, Zhang, X, Shaikh, N et al. (2011) Serum 25-hydroxyvitamin D concentrations are associated with prevalence of metabolic syndrome and various cardiometabolic risk factors in US children and adolescents based on assay-adjusted serum 25-hydroxyvitamin D data from NHANES 2001–2006. Am J Clin Nutr 94, 225233.
59.Williams, DM, Fraser, A & Lawlor, DA (2011) Associations of vitamin D, parathyroid hormone and calcium with cardiovascular risk factors in US adolescents. Heart 97, 315320.
60.Nam, GE, Kim, DH, Cho, KH et al. (2014) 25-Hydroxyvitamin D insufficiency is associated with cardiometabolic risk in Korean adolescents: the 2008–2009 Korea National Health and Nutrition Examination Survey (KNHANES). Public Health Nutr 17, 186194.
61.Black, LJ, Burrows, S, Lucas, RM et al. (2016) Serum 25-hydroxyvitamin D concentrations and cardiometabolic risk factors in adolescents and young adults. Br J Nutr 115, 19942002.
62.Dolinsky, DH, Armstrong, S, Mangarelli, C et al. (2013) The association between vitamin D and cardiometabolic risk factors in children: a systematic review. Clin Pediatr 52, 210223.
63.Department of Health (1998) Nutrition and Bone Health: With Particular Reference to Calcium and Vitamin D. London: The Stationery Office.
64.Nordic Council of Ministers (2014) Nordic Nutrition Recommendations 2012. Integrating Nutrition and Physical Activity. Copenhagen, Denmark: NORDEN.
65.Health Council of the Netherlands (2012) Evaluation of the Dietary Reference Values for Vitamin D. The Hague: Publication no. 2012/15E: Health Council of the Netherlands.
66.German Nutrition Society (2012) New reference values for vitamin D. Ann Nutr Metab 60, 241246.
67.World Health Organization and Food and Agriculture Organization of the United Nations (2004) Vitamin and Mineral Requirements in Human Nutrition. Report of a joint WHO/FAO expert consultation, 2nd ed., Geneva: World Health Organization.
68.Department of Health (1991) Dietary Reference Values for Food Energy and Nutrients for the United Kingdom. London: Stationery Office Books.
69.Scientific Advisory Committee on Nutrition (2007) Update on Vitamin D: Position Statement by the Scientific Committee on Nutrition. London: The Stationery Office.
70.Cashman, KD & Kiely, M (2011) Towards prevention of vitamin D deficiency and beyond: knowledge gaps and research needs in vitamin D nutrition and public health. Br J Nutr 106, 16171627.
71.Cashman, KD & Kiely, M (2013) EURRECA – estimating vitamin D requirements for deriving dietary reference values. Crit Rev Food Sci Nutr 53, 10971109.
72.Vale, CL, Rydzewska, LHM, Rovers, MM et al. (2015) Uptake of systematic reviews and meta-analyses based on individual participant data in clinical practice guidelines: descriptive study. BMJ 350, h1088.
73.Cashman, KD, Ritz, C & Kiely, M (2017) Improved dietary guidelines for vitamin D: application of Individual Participant Data (IPD)-level meta-regression analyses. Nutrients 9, 469.
74.Cashman, KD, Fitzgerald, AP, Kiely, M et al. (2011) A systematic review and meta-regression analysis of the vitamin D intake–serum 25-hydroxyvitamin D relationship to inform European recommendations. Br J Nutr 106, 16381648.
75.Cashman, KD (2015) Vitamin D: dietary requirements and food fortification as a means of helping achieve adequate vitamin D status. J Steroid Biochem Mol Biol 148, 1926.
76.Cashman, KD, FitzGerald, AP, Viljakainen, HT et al. (2011) Estimation of the dietary requirement for vitamin D in healthy adolescent white girls. Am J Clin Nutr 93, 549555.
77.Cashman, KD, Hill, TR, Lucey, AJ et al. (2008) Estimation of the dietary requirement for vitamin D in healthy adults. Am J Clin Nutr 88, 15351542.
78.Cashman, KD, Wallace, JM, Horigan, G et al. (2009) Estimation of the dietary requirement for vitamin D in free-living adults ≥64 y of age. Am J Clin Nutr 89, 13661374.
79.Schou, AJ, Heuck, C & Wolthers, OD (2003) A randomized, controlled lower leg growth study of vitamin D supplementation to healthy children during the winter season. Ann Hum Biol 30, 214219.
80.Ala-Houhala, M, Koskinen, T, Koskinen, M et al. (1988) Double blind study on the need for vitamin D supplementation in prepubertal children. Acta Paediatr Scand 77, 8993.
81.Kiely, M & Cashman, KD (2015) The ODIN project: development of food-based approaches for prevention of vitamin D deficiency throughout life. Nutr Bull 40, 235246.
82.Smith, TJ, Tripkovic, L, Damsgaard, CT et al. (2016) Estimation of the dietary requirement for vitamin D in adolescents aged 14–18 y: a dose-response, double-blind, randomized placebo-controlled trial. Am J Clin Nutr 104, 13011309.
83.Rajakumar, K, Moore, CG, Yabes, J et al. (2015) Effect of vitamin D3 supplementation in black and in white children: a randomized, placebo-controlled trial. J Clin Endocrinol Metab 100, 31833192.
84.Öhlund, I, Lind, T, Hernell, O et al. (2017) Increased vitamin D intake differentiated according to skin color is needed to meet requirements in young Swedish children during winter: a double-blind randomized clinical trial. Am J Clin Nutr 106, 105112.
85.Smith, TJ & Hart, KH (2017) Vitamin D during childhood and adolescence: evidence-based dietary requirements for adequacy and implications for bone health. Nutr Bull 42, 5560.
86.Fulgoni, VL, Keast, DR, Bailey, RL et al. (2011) Foods, Fortificants, and supplements: where do Americans get their nutrients? J Nutr 141, 18471854.
87.Lehtonen-Veromaa, M, Möttönen, T, Leino, A et al. (2008) Prospective study on food fortification with vitamin D among adolescent females in Finland: minor effects. Br J Nutr 100, 418423.
88.Laaksi, IT, Ruohola, JPS, Ylikomi, TJ et al. (2006) Vitamin D fortification as public health policy: significant improvement in vitamin D status in young Finnish men. Eur J Clin Nutr 60, 10351038.
89.Jääskeläinen, T, Itkonen, ST, Lundqvist, A et al. (2017) The positive impact of general vitamin D food fortification policy on vitamin D status in a representative adult Finnish population: evidence from an 11-y follow-up based on standardized 25-hydroxyvitamin D data. Am J Clin Nutr 105, 15121520.
90.Piirainen, T, Laitinen, K & Isolauri, E (2007) Impact of national fortification of fluid milks and margarines with vitamin D on dietary intake and serum 25-hydroxyvitamin D concentration in 4-year-old children. Eur J Clin Nutr 61, 123128.
91.Soininen, S, Eloranta, A-M, Lindi, V et al. (2016) Determinants of serum 25-hydroxyvitamin D concentration in Finnish children: the Physical Activity and Nutrition in Children (PANIC) study. Br J Nutr 115, 10801091.
92.Van Horn, LV, Bausermann, R, Affenito, S et al. (2011) Ethnic differences in food sources of vitamin D in adolescent American girls: the National Heart, Lung, and Blood Institute Growth and Health Study. Nutr Res 31, 579585.


Related content

Powered by UNSILO

Vitamin D in adolescence: evidence-based dietary requirements and implications for public health policy

  • Taryn J. Smith (a1), Laura Tripkovic (a1), Susan A. Lanham-New (a1) and Kathryn H. Hart (a1)


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.