High proportion of young children are vitamin D sufficient after expansion of Sweden’s mandatory fortification but dairy products also contribute to a high climate impact

Summary

This cross-sectional analysis of the Swedish Riksmaten Young Children survey (2021–24) found that vitamin D fortification expansion has been effective: 93–96% of young children now achieve sufficient status (≥50 nmol/l 25OHD), though 16% of 18-month-olds and 61% of 4-year-olds fall below the average requirement when dietary intake alone is considered. The study identifies dairy products as the dominant dietary source of vitamin D but also as a significant contributor to diet-related climate impact (10–16% of total GHGEs), whereas plant-based alternatives and fortified fat spreads provide vitamin D more efficiently per unit of greenhouse gas emissions.

Regional applicability

This study applies directly to United Kingdom policy and practice, as vitamin D fortification and childhood micronutrient sufficiency are relevant to UK public health. The UK currently does not mandate universal fortification to the same extent as Sweden, though voluntary fortification of some foods and universal vitamin D supplementation schemes (e.g., Healthy Start vitamins) operate. The finding that fortified plant-based alternatives achieve high vitamin D density with lower climate cost may inform UK dietary guidance and climate-conscious food policy.

Key measures

Serum 25-hydroxyvitamin D concentrations (25OHD, nmol/l); dietary vitamin D intake (µg/d) from 24-hour food records; vitamin D from supplements/drops; greenhouse gas emissions (CO₂ eq) per food source using life cycle assessment

Outcomes reported

The study assessed vitamin D status (serum 25-hydroxyvitamin D concentrations) and dietary vitamin D intake in 18-month-old and 4-year-old Swedish children following expanded mandatory fortification in 2018, and quantified the climate impact (greenhouse gas emissions) of major vitamin D food sources.

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