Finding: Mean sodium intake of children and youth has increased over the past 35 years, and the majority of children and adolescents are consuming sodium in greater amounts than recommended levels.

Although essential nutrients can be obtained from a balanced diet, many individuals take dietary supplements. NHANES III (1988–1994) collected data on supplement use for all individuals including children (ages 2 months–11 years) and adolescents (ages 12–19 years). About 40 percent of children and 25 percent of adolescents took some type of supplement (Ervin et al., 2004). Of those taken, multivitamins plus vitamin C (47 percent) was the leading supplement reported for children, followed by multivitamins/multiminerals (13 percent), multivitamins plus iron (10 percent), vitamin C (7 percent), and multivitamins plus fluoride (6 percent). The supplements reported by adolescent boys included vitamin C (24 percent); multivitamins/multiminerals (21 percent); multivitamins plus vitamin C (17 percent); supplements such as herbs, botanicals, and sport drinks (8 percent); and all other supplements such as single vitamins or minerals (29 percent). Those reported by adolescent girls included multivitamins/multiminerals (23 percent), multivitamins plus vitamin C (20 percent), vitamin C (16 percent), iron (6 percent), vitamin E (5 percent), and a mixture of assorted other supplements (30 percent). The contribution of dietary supplements usually is not included in past assessments of nutrient intakes from dietary survey data.

Children’s and adolescents’ nutrient intakes reflect their food and beverage choices, which have changed substantially over time. In general, there have been increases in consumption of sweetened carbonated soft drinks, noncitrus juices/nectars, and fruit drinks/ades; grain mixtures such as pasta with sauces, rice dishes, and pizza; salty snacks; fried potatoes; candy; low-fat and skim milk; and cheese. Intakes have decreased for total milk and whole milk; yeast breads and rolls; green beans, corn, peas, and lima beans; and beef and pork (Enns et al., 2002, 2003). For younger children (ages 2–5 years) between 1977 and 1998, the percentage of total calories from added sugars increased during the same time period (Kranz et al., 2004). There has been a small improvement in dietary quality since 1977. Preschoolers had an increased number of servings of grains, dairy products, juice, and fruits and vegetables, although the types of fruits and vegetables