Micronutrient Inadequacies

Although progress has been made in certain areas, subgroups of children and adolescents still experience micronutrient inadequacies that may adversely affect their health, particularly insufficient intakes of vitamins A, E, B6, and folate as well as calcium, iron, potassium, zinc, and magnesium (DHHS and USDA, 2004; Ganji et al., 2003; IOM, 2005c).

Inadequate dietary calcium intake combined with physical inactivity during childhood, adolescence, and early adulthood compromises peak bone mass and contributes to bone resorption and bone diseases, including osteomalacia and osteoporosis in later adulthood (NIH, 2001). Young adults who do not reach a normal peak bone mass by 20 years of age have the greatest risk of developing osteoporosis in later years (Beck and Shoemaker, 2000). Osteoporosis is a serious health problem for today’s youth that has been associated with a decline in calcium intake (NIH, 2001), attributed in part to increased consumption of sweetened beverages (such as carbonated soft drinks, fruit drinks, and sweetened teas) and reduced consumption of milk—the primary source of calcium in U.S. children’s and adolescents’ diets (AAP, 2004; Fisher et al., 2004; Mrdjenovic and Levitsky, 2003). Studies suggest that a higher consumption of carbonated beverages in adolescent girls may be associated with incidence of bone fracture (Wyshak, 2000). Moreover, rickets among infants is attributed to inadequate vitamin D intake and reduced exposure to sunlight, and remains a problem in the United States. For example, reemergence of nutritional rickets has been reported in some African American infants3 (Weisberg et al., 2004).

Dental Caries

Diets high in added sugars also predispose to dental caries. Although the prevalence of dental caries has decreased in the United States, in particular due to topical and water supply fluoridation, lack of access to care has contributed to declines in dental visits and increased rates of untreated dental caries for children and adolescents (DHHS, 2000b; Gift et al., 1996). More than one-half of low-income children without health insurance had no preventive dental care visits (Kenney et al., 2005). The Surgeon General’s


The American Academy of Pediatrics (AAP) recommends that all infants, including those who are exclusively breastfed, receive a minimum intake of 200 international units (IU) of vitamin D daily beginning during the first 2 months of life. Additionally, the AAP recommends that an intake of 200 IU of vitamin D be continued throughout childhood and adolescence because adequate sunlight exposure is not easily determined for an individual (Gartner et al., 2003). Daily sunlight exposure to skin allows the human body to convert vitamin D to a biologically active form that is absorbed by the lower intestine and metabolized with dietary calcium to prevent rickets (IOM, 1997).

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