600 IU)/100 g; Atlantic herring contain up to as much as 40 µg (1,600 IU)/100 g (USDA, 1991).

After vitamin D was recognized as being critically important for the prevention of rickets, the United States, Canada, and many other countries instituted a policy of fortifying some foods with vitamin D (Steenbock and Black, 1924). Milk was chosen as the principal dietary component to be fortified with either vitamin D2 or vitamin D3. In other countries, some cereals, margarine, and breads also have small quantities of added vitamin D (Lips et al., 1996). In the United States and Canada, all milk, irrespective of its fat content, is fortified with 10 µg (400 IU)/quart and 9.6 µg (385 IU)/liter, respectively, of vitamin D. However, during the past decade, three surveys in which the vitamin D content in milk was analyzed revealed that up to 70 percent of milk sampled throughout the United States and Canada did not contain vitamin D in the range of 8 to 12 µg (320 to 480 IU)/quart (the 20 percent variation allowed by current labeling standards). Furthermore, 62 percent of 42 various milk samples contained less than 8 µg (320 IU)/quart of vitamin D, and 14 percent of skim milk samples had no detectable vitamin D (Chen et al., 1993; Holick et al., 1992; Tanner et al., 1988). All proprietary infant formulas must also contain vitamin D in the amount of 10 µg (400 IU)/liter. However, these products have also been found to have wide variability in their vitamin D content (Holick et al., 1992).

Intake from Dietary Supplements

In the one available study of dietary supplement intake in the United States, use of vitamin D supplements in the previous 2 weeks in 1986 was reported for over one-third of the children 2 to 6 years of age, over one-fourth of the women, and almost 20 percent of the men (Moss et al., 1989). For supplement users, the median dose was the same for men, women, and children: 10 µg (400 IU)/day. However, the ninety-fifth percentile was the same as the median for the children (still 10 µg [400 IU]/day), indicating little variation in the upper range for young children, while the ninety-fifth percentile for adults was considerably higher: 20 µg (800 IU)/day for men and 17.2 µg (686 IU)/day for women.

Effects of Vitamin D Deficiency

Vitamin D deficiency is characterized by inadequate mineralization or demineralization of the skeleton. In children, vitamin



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