Contribution of WIC-Eligible Foods to the Overall Diet of 13- and 24-Month-Old Toddlers in the WIC Infant and Toddler Feeding Practices Study-2

Background

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) provides supplemental foods to assist participants in meeting their dietary needs. Few studies have described the extent to which WIC-eligible foods contribute to the overall diet of children who were enrolled in WIC prenatally or in early infancy.

Federal Food Program Participation and Beverage Intake Among Families With Low Household Income

ObjectiveExamine beverage intake among families with low income by household participation in federal food assistance programs.DesignCross-sectional study conducted in fall/winter 2020 via an online survey.ParticipantsMothers of young children insured by Medicaid at the time of the child's birth (N = 493).Variables MeasuredMothers reported household federal food assistance program participation, later categorized as Supplementation Nutrition Program for Women, Infants, and Children (WIC) only, Supplemental Nutrition Assistance Program-Education (SNAP) only, both WIC and SNAP, and neither. Mothers reported beverage intake for themselves and their children aged 1–4 years.AnalysisNegative binomial and ordinal logistic regression.ResultsAfter accounting for sociodemographic differences between groups, mothers from households participating in WIC and SNAP consumed sugar-sweetened beverages (incidence rate ratio, 1.63; 95% confidence interval [CI], 1.14–2.30; P = 0.007) and bottled water (odds ratio, 1.76; 95% CI, 1.05–2.96; P = 0.03) more frequently than mothers from households in neither program. Children from households participating in WIC and SNAP also consumed soda (incidence rate ratio, 6.07; 95% CI, 1.80–20.45; P = 0.004) more frequently than children in either program. Few differences in intake were observed for mothers or children participating in only WIC or SNAP vs both programs or neither program.Conclusion and ImplicationsHouseholds participating in both WIC and SNAP may benefit from additional policy and programmatic interventions to limit sugar-sweetened beverage intake and reduce spending on bottled water.     

Food Security Status,WIC Participation,and Early Childhood Caries in a Nationally Representative Sample of Children

BackgroundDespite the potential role of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in mitigating the adverse effects of food insecurity on oral health, to our knowledge, no study has examined whether WIC participation could modify the association between food insecurity with caries in young children.ObjectiveOur aim was to investigate the impact of WIC participation in modifying the association between food insecurity and early childhood caries.DesignThis was a cross-sectional study.Participants/settingUsing 2011-2018 National Health and Nutrition Examination Survey data, children aged 2 through 5 years; with household income ≤185% of the Federal Poverty Level; and with data on WIC participation, food security, and dental examinations were included (n = 1,921).Study exposuresFood-security status and WIC participation were the study exposures.Main outcome measuresTotal and untreated dental caries were the main outcome measures.Statistical analysesLogistic regression examined associations of food security (household-level and child-level) and WIC participation with odds of caries. Interactions between food security and WIC participation were examined using multiplicative interaction terms.ResultsMarginal child food security was significantly related to higher odds of total caries in income-eligible WIC nonparticipants (odds ratio 1.92; 95% CI 1.07 to 3.46); however, this relationship was not observed in WIC participants. Furthermore, food insecurity was significantly associated with greater odds of untreated caries only among income-eligible WIC nonparticipants (odds ratio 1.79; 95% CI 1.12 to 2.85).ConclusionsIn this sample of preschool-aged children, the relationship of food insecurity with caries differed by WIC participation status. Findings suggest that WIC participation could improve the oral health of income-eligible children with lower levels of food security.     

Effect of income and WIC on the dietary intake of preschoolers: results of a preliminary study

Dietary composition of energy and four nutrients targeted by the Supplemental Food Program for Women, Infants, and Children (WIC) were assessed among a random sample of 106 children aged 1 to 5 years. Fifty-one percent of children were from households with incomes above WIC eligibility levels. Of the 49% of children from households eligible for WIC by income, 42% participated in WIC. Children from low-income households were significantly more likely to have low dietary intakes of energy, vitamin C, and iron than children from higher-income households. Low-income children participating in WIC were significantly less likely to have low iron intakes than children who were eligible by income level but not participating in WIC. The percentage of children with low intakes of vitamin A and calcium did not significantly vary by household income level or by participation in WIC. Data from this preliminary study indicate that low-income children in the sample surveyed are at higher risk for consuming diets low in energy and two of four nutrients targeted by the WIC program than are children from higher-income households and that participation in WIC improves the iron intake of low-income children.     

The Contribution of Discrete Vegetables,Mixed Dishes,and Other Foods to Total Vegetable Consumption: US Ages 2 Years and Over, 2017-2018

BackgroundThe 2020-2025 Dietary Guidelines for Americans recommend intake of a variety of vegetables, including dark green, red, and orange vegetables and starchy and other vegetables.ObjectivesThis study aims to describe sociodemographic differences in the contribution of different categories of vegetables and the form in which they are consumed (ie, discrete vegetables, mixed dishes, and other foods such as savory snacks to total vegetable intake on a given day).DesignThis is a cross-sectional, secondary analysis of the 2017-2018 National Health and Nutrition Examination Survey.Participants/settingThis study included the data of 7122 persons aged 2 years with reliable day 1 24-hour dietary recalls.Main outcome measuresServing equivalents of vegetables from 20 discrete categories of vegetables and from mixed dishes and other foods as a percentage of total vegetables.Statistical analysesPairwise differences by age, sex, race, Hispanic origin, and family income were examined using univariate t statistics, and trends by age and income were examined using orthogonal polynomials.ResultsMean serving equivalents of vegetables was 1.4 cups. The serving equivalents increased with age among youth, was higher among non-Hispanic Asian (NHA) persons than other subgroups, and increased with increasing family income. Overall, discrete vegetables contributed 55.2% of total vegetable intake, and the contribution increased with age in adults and with increasing family income. The top 5 discrete vegetable contributors were other vegetables and combinations, french fries and other fried white potatoes, lettuce and lettuce salads, mashed potatoes and white potato mixtures, and baked or boiled white potatoes. Nonstarchy discrete vegetables contributed more to total vegetables for adults (37.6%) than youth (28.0%), and the contribution increased with increasing family income. On the other hand, the contribution of mixed dishes and other foods decreased with increasing family income.ConclusionsDiscrete vegetables only contributed 55.2% of total vegetable intake, and the top sources were not varied. Three of them potato based, which may explain the reported low vegetable intake, relative to the 2020-2025 Dietary Guidelines for Americans. More than one-third of vegetables consumed were nonstarchy discrete vegetables, many of which are high in vitamins. Nonstarchy discrete vegetable intake was higher in adults than youth and increased with family income.     

Positive influence of the revised Special Supplemental Nutrition Program for Women, Infants, and Children food packages on access to healthy foods

BackgroundThe Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has important potential for preventing diet-related disease in low-income children. WIC food packages were recently revised to offer foods that better reflect dietary recommendations for Americans.ObjectiveThis article reports on how implementation of the new healthier WIC food packages affected access of low-income populations to healthy foods (eg, whole grains, fruit and vegetables, and lower-fat milk).DesignA pre–post store inventory was completed using a standardized instrument to assess availability, variety, quality and prices of WIC-approved foods (65 food items). Stores were assessed before (spring 2009) and shortly after the new WIC package implementation (spring 2010).Participants/settingAll convenience stores and nonchain grocery stores located in five towns of Connecticut (N=252), including 33 WIC-authorized stores and 219 non-WIC stores.Statistical analyses performedThe healthy food supply score was constructed to summarize postrevision changes in availability, variety, prices of healthy foods, and produce quality. The effect of the WIC food package revisions was measured by differential changes in the scores for stores authorized to accept WIC benefits and stores not participating in WIC, including differences by neighborhood income. Multivariate multilevel regression models were estimated.ResultsThe 2009 introduction of the revised WIC food packages has significantly improved availability and variety of healthy foods in WIC-authorized and (to a smaller degree) non-WIC convenience and grocery stores. The increase in the composite score of healthy food supply varied from 16% in WIC convenience and grocery stores in higher-income neighborhoods to 39% in lower-income areas. Improved availability and variety of whole-grain products were responsible for most of the increase in the composite score of healthy food supply.ConclusionsDesigned as cost-neutral changes, the WIC food package revisions have improved access to healthy foods for WIC participants and society at large.     

Prenatal and Postnatal Fruit and Vegetable Intake Among US Women: Associations with WIC Participation

Objective Evaluate variation in fruit and vegetable intake by Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation and poverty status among pregnant, and postpartum women participating in the Infant Feeding Practice Study II (IFPSII). Methods IFPSII (2005–2007) followed US women from third trimester through 1 year postpartum through mailed questionnaires measuring income, WIC participation, breastfeeding; and dietary history questionnaires (DHQ) assessing prenatal/postnatal fruit and vegetable consumption. Poverty measurements used U.S. Census Bureau Federal Poverty thresholds to calculate percent of poverty index ratio (PIR) corresponding to WIC’s financial eligibility (≤185 % PIR). Comparison groups: WIC recipients; WIC eligible (≤185 % PIR), but non-recipients; and women not financially WIC eligible (>185 % PIR). IFPSII participants who completed at least one DHQ were included. Intake variation among WIC/poverty groups was assessed by Kruskal–Wallis tests and between groups by Mann–Whitney Wilcoxon tests and logistic regression. Mann–Whitney Wilcoxon tests examined postnatal intake by breastfeeding. Results Prenatal vegetable intake significantly varied by WIC/poverty groups (p = 0.04) with WIC recipients reporting significantly higher intake than women not financially WIC eligible (p = 0.02); association remained significant adjusting for confounders [odds ratio 0.66 (95 % confidence interval: 0.49–0.90)]. Prenatal fruit and postnatal consumption did not significantly differ by WIC/poverty groups. Postnatal intake was significantly higher among breastfeeding than non-breastfeeding women (fruit: p < 0.0001; vegetable: p = 0.006). Conclusions for Practice Most intakes did not significantly differ by WIC/poverty groups and thus prompts research on WIC recipient’s dietary behaviors, reasons for non-participation in WIC, and the influence of the recent changes to the WIC food package.     

Longer Family Participation in WIC is Associated With Lower Childhood Sugar-Sweetened Beverage Intake

ObjectiveTo evaluate if children of families with a longer duration of participation in the Special Supplementation Nutrition Program for Women, Infants, and Children (WIC) consume fewer sugar-sweetened beverages (SSB) and more water.DesignA repeated cross-sectional study.SettingConducted among representative samples of WIC-participating families in Los Angeles County, California, in 2014, 2017, and 2020.ParticipantsChildren aged 4–59 months participating in WIC.Main Outcome MeasuresDaily servings of total SSBs, daily servings of specific types of SSBs, and daily servings of water.AnalysisMultivariable count regression models were used to estimate incidence rate ratios (IRR) and 95% confidence intervals (CI) for associations of the duration of family WIC participation with daily servings of total SSBs, water, and specific types of SSBs. Zero-inflated negative binomial regression models were used for total SSBs and specific types of SSBs, and Poisson regression was used for water.ResultsChildren of families with 2 years of WIC participation consumed significantly fewer daily servings of total SSBs (IRR, 0.95; 95% CI, 0.93–0.98; P = 0.002), fruit-flavored SSBs (IRR, 0.95; 95% CI, 0.91–0.99; P = 0.02), soda (IRR, 0.86; 95% CI, 0.76–0.98; P = 0.02), and water (IRR, 0.99; 95% CI, 0.98 to < 1.00; P = 0.03) than children of families with 1 year of WIC participation. Protective associations for total SSBs, fruit-flavored SSBs, and soda remained statistically significant and increased in magnitude through 10 years of family WIC participation.Conclusions and ImplicationsDuration of WIC participation was associated with decreased SSB intake by young children. Given the role that increasing water intake in lieu of SSBs plays in child obesity, improving the effectiveness of WIC nutrition education on parental perceptions and provision of fruit-flavored SSBs and water to their children merits detailed evaluation.     

Marginal,Low, and Very-Low Food Security among Children Are Associated with Intake of Select Dietary Factors during Summer

BackgroundSchool meals are associated with improved food security status and dietary intake. Children receiving free and reduced-price school meals lose access to these meals during the summer. The association between food security status and dietary intake in these children during summer is unclear.ObjectiveTo examine the association between food security status (high, marginal, low, and very-low food security) among children and intake of select dietary factors during summer in children certified for free and reduced-price school meals by age group (3 to 4 years, 5 to 8 years, 9 to 12 years, and 13 to 17 years).DesignCross-sectional analysis.Participants/settingSecondary data from 11,873 children aged 3 to 17 years in the control group of the US Department of Agriculture Summer Electronic Benefit Transfer for Children Demonstration Project.Main outcome measuresConsumption of total fruits and vegetables; fruits and vegetables, excluding fried potatoes; whole grains; added sugars; added sugars, excluding cereals; added sugars from sugar-sweetened beverages; and dairy products assessed using questions from the 2009-2010 National Health and Nutrition Examination Survey Multifactor Diet Screener.Statistical analysisMultiple linear regression.ResultsFor the majority of age groups, marginal food security, low food security, and very-low food security were associated with lower fruit and vegetable consumption and low food security and very-low food security were associated with lower dairy consumption, with children from households with very-low food security having the lowest consumption. Children from households with very-low food security consumed 0.73 (95% CI –0.93 to –0.53) to 0.99 (95% CI –1.59 to –0.39) cup equivalents less per day of fruits and vegetables and 0.49 (95% CI –0.65 to –0.34) to 0.68 (95% CI –1.07 to –0.29) cup equivalents less per day of dairy compared with children from households experiencing high food security.ConclusionsLower food security was associated with reduced consumption of fruits and vegetables and dairy products during summer in children from low-income households.     

The role of health behaviors and food insecurity in predicting fruit and vegetable intake in low-income children

Research supports the importance of adequate fruit and vegetable intake during childhood. The current study examines relationships between physical activity, sedentary behavior, sleep, food insecurity, and fruit and vegetable intake in a sample of low-income, elementary-aged children. 148 participants were recruited from several agencies serving low-income families in a large midwestern metropolitan area. A measurement model was specified to ensure good fit between the data and predictive model. A structural model was run and several significant findings emerged. Food insecurity significantly predicted vegetable intake (latent regression coefficient = ?0.18, p < 0.05), such that children with higher food insecurity consumed fewer servings of vegetables. Physical activity also significantly predicted fruit intake (latent regression coefficient = 0.32, p < 0.01) and vegetable intake (latent regression coefficient = 0.26, p < 0.01), such that children who were more physically active consumed more servings of fruits and vegetables. Data indicate that children with high food insecurity consumed fewer vegetables, and that physical activity is significantly related to fruit and vegetable intake. Possible implications for public policy are discussed.     

Dietary intakes of urban, high body mass index, African American children: family and child dietary attributes predict child intakes

ObjectiveTo identify family and child nutrition and dietary attributes related to children's dietary intakes.DesignAfrican American children (ages 8-11 years, n = 156), body mass index > 85th percentile, from urban, low-income neighborhoods. Baseline, cross-sectional data collected as part of an ongoing diabetes prevention intervention. Dietary intakes were collected by 3-day food diary to assess total energy, percent fat, discretionary fat, added sugar, whole grains, vegetables, fruit, meat, and dairy. Questionnaires on nutrition and dietary attributes administered to children and parents were used to develop 5 diet-related indices: child knowledge, child preferences, child snack habits, child beverage habits, and family food habits.ResultsA higher child nutrition knowledge score was significantly related to a lower starchy vegetable intake. Higher scores on the child snack habits index were significantly related to higher intakes of fruit, total fruits and vegetables, total fruits and nonstarchy vegetables, and to lower intakes of added sugars. A higher score on the family food habits index was significantly related to lower intakes of total energy and discretionary fat.Conclusions and ImplicationsTargeting both child and family food and nutrition attributes may be used to promote more healthful eating among urban, low-income, overweight African American children.     

Securing the Safety Net: Concurrent Participation in Income Eligible Assistance Programs

Participation in women, infants and children (WIC), supplemental nutritional assistance program (SNAP), temporary assistance for needy families (TANF), and medical assistance program (MAP) programs provide critical nutrition and health benefits to low-income families. Concurrent enrollment in these programs provides a powerful safety net, yet simultaneous participation is reported to be low. Underutilization undermines program objectives, client well-being and food security. This paper examines concurrent participation among the most needy WIC clients, those at/below 100 % of the federal poverty level (FPL), in SNAP, TANF and MAP. We examined the Maryland state WIC program infant electronic database (N = 34,409) for the 12-month period ending September 2010. Our analysis focused on two-thirds of these infants (N = 23,065) who were at/below the 100 % FPL. Mothers’ mean age was 26.8 ± 6 years; 20.6 % White; 52.7 % African American, and 23.4 % Hispanic. Approximately 10 % of infants weighed <2,500 g and 1.5 % weighed <1,500 g at birth. Average household income was $10,160; 55.7 % were at/below 50 % FPL. Two-thirds (68.4 %) participated in MAP, 31 % in SNAP and 9 % in TANF. Only 8 % were enrolled in all three programs whereas 28 % were not enrolled in any. There was a statistically significant difference in mean age and household income between multi-program beneficiaries and mothers who solely participated in WIC: 25.6 ± 5 years and $7,298 ± $4,496 compared with 27.2 ± 6 years and $12,216 ± $6,920, respectively (p < 0.001). Among WIC families at or below 100 % FPL, only 8 % received multi-program benefits. Specific factors responsible for participation on an individual level are not available. To optimize enrollment, a coordinated effort is essential to identify and overcome barriers to concurrent participation among these families.     

Longer Participation in the Special Supplemental Nutrition Program for Women,Infants, and Children Is Not Associated with Reduced Sugar-Sweetened Beverage Intake among Black Participants

This study assessed relationships of duration of family Special Supplemental Nutrition Program for Women, Infants and Children (WIC) participation with racial/ethnic disparities in child sugar-sweetened beverage (SSB) and water intake. Child beverage intake and family duration on WIC were collected during three cross-sectional surveys of WIC-participating families in Los Angeles County, California (2014, 2017 and 2020; n = 11,482). The associations of family duration of WIC participation, a proxy for the amount of WIC services received, with daily intake of total SSBs, fruit-flavored SSBs and water were assessed in race/ethnicity strata with multivariable negative binomial and Poisson regression models. Among English-speaking Hispanic children, those of families reporting 10 years of WIC participation consumed 33% and 27% fewer servings of total and fruit-flavored SSBs compared to those of families reporting 1 year on WIC. Among Black children, those from families reporting 5 and 10 years of participation in WIC consumed 33% and 45% more daily servings of fruit-flavored SSBs than those from families reporting 1 year on WIC. Disparities in daily total and fruit-flavored SSB intake between Black and White children increased with longer family duration on WIC. Duration of family WIC participation is associated with healthier beverage choices for infants and children, but does not appear to be equally beneficial across racial/ethnic groups in Los Angeles County.     

Racial/Ethnic Differences in Dietary Intake among WIC Families Prior to Food Package Revisions

ObjectiveTo compare the diets of African American and Hispanic families in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) prior to the 2009 food package revisions.MethodsMother-child dyads were recruited from 12 WIC sites in Chicago, IL. Individuals with 1 valid 24-hour recall were included in the analyses (n = 331 children, n = 352 mothers).ResultsCompared to their African American counterparts, diets of Hispanic mothers and children were lower (P < .001) in percentage of calories from fat, added sugars, sodium, and sweetened beverages, but higher (P < .001) in vitamin A, calcium, whole grains, fruit, and total dairy. However, no groups met national recommendations for percentage of calories from saturated fat, fiber, sodium, whole grains, vegetables, and total dairy.Conclusions and ImplicationsThere are racial/ethnic differences in dietary intake, and future research is needed to determine whether diets improve as a result of package revisions and whether uptake of these changes varies by race/ethnicity.     

The healthfulness of food and beverage purchases after the federal food package revisions: The case of two New England states

ObjectiveIn 2009, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) implemented new food packages to improve dietary intake among WIC participants. This paper examines how the healthfulness of food purchases among low-income households changed following this reform.MethodsPoint-of-sale data for 2137 WIC-participating and 1303 comparison households were obtained from a regional supermarket chain. The healthfulness of purchased foods and beverages was determined per their saturated fat, sugar, and sodium content. A pre-post assessment (2009–2010) of the product basket healthfulness was completed using generalized estimating equation models. Data were analyzed in 2015.ResultsAt baseline, healthy products accounted for most of the food volume purchased by WIC participants, but beverages were dominated by moderation (less healthy) items. With new subsidies for fruit, vegetables and whole grains, the WIC revisions increased the volume of healthy food purchases of WIC-participating households by 3.9% and reduced moderation foods by 1.8%. The biggest improvements were reductions in moderation beverages (down by 24.7% in volume), driven by milk fat restrictions in the WIC food package revisions. The healthfulness of the product basket increased post-WIC revisions; mainly due to a reduction in the volume of moderation food and beverages purchased (down by 15.5%) rather than growth in healthy products (up by 1.9%). No similar improvements were seen in a comparison group of low-income nonparticipants.ConclusionsAfter the WIC revisions, the healthfulness of participant purchases improved, particularly for beverages. Efforts to encourage healthy eating by people receiving federal food assistance are paying off.     

Alignment of California WIC Participant Preferences With Proposed WIC Food Package Recommendations

ObjectiveAssess alignment of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participant preferences with the National Academies of Sciences, Engineering, and Medicine WIC child food package recommendations and compare differences by race/ethnicity.MethodsCross-sectional examination of survey responses collected between January and May 2019 from 2,993 California WIC families with children aged 1–4 years.ResultsOver half of WIC participants (56.1%) wanted an increase in the amount allocated for fruits and vegetables. Many WIC participants (69.6%) thought the amount of juice offered by WIC was just right. Overall, the majority (91.0%) wanted to substitute more fruits and vegetables for juice. Most were satisfied with the amount of beans (78.4%), peanut butter (78.7%), and milk (88.3%). Preferences differed by race/ethnicity.Conclusions and ImplicationsPreferences of California WIC participants are highly aligned with the proposed National Academies of Sciences, Engineering, and Medicine changes for increasing fruits and vegetables. Notable differences by race/ethnicity suggest the need for more flexibility.     

Effects of Modified Foodservice Practices in Military Dining Facilities on Ad Libitum Nutritional Intake of US Army Soldiers

BackgroundModifying foodservice practices in military dining facilities could influence ad libitum nutritional intake patterns of soldiers.ObjectiveWe aimed to determine how changes in foodservice operations consistent with 2005 Dietary Guidelines for Americans affected soldiers' ad libitum nutritional intake in military dining facilities (DFACs).DesignTen DFACs participated, and the intervention was implemented in five DFACs in an independently sampled, partial crossover design. Nutrient intake of diners was assessed during a test meal using digital photography, and customer satisfaction with foodservice was assessed via surveys at baseline (n=602), and again at 6 months (n=519) and 12 months (n=458) after the intervention was implemented.ParticipantsVolunteers were US Army active duty soldiers recruited from among diners at 10 DFACs on Fort Bragg, NC.Main outcome measuresPrimary outcomes were intakes of energy and total fat, and percent energy from fat and saturated fat. Differences between diners' intakes in control and intervention DFACs were assessed using independent samples t tests.ResultsAt 6 months after implementing the intervention, diners at intervention DFACs had significantly lower lunchtime intakes of energy (945±338 kcal vs 1,061±380 kcal), total fat (38±19 g vs 47±25 g), percent energy from fat (35%±10% vs 39%±11%) and saturated fat (4.7%±1.7% vs 5.6%±2.3%), discretionary fat (30±18 g vs 39±24 g), and refined grains (2.3±1.7 oz equivalents vs 2.8±2.4 oz equivalents) compared with diners at control DFACs. Further, diners at intervention DFACs rated customer satisfaction higher than diners at control DFACs.ConclusionsThese findings suggest that modest changes in military DFAC serving practices to promote healthy eating and food selection can facilitate positive changes in soldiers' nutritional intake.     

Vitamin D intake in Australian adults and the modeled effects of milk and breakfast cereal fortification

ObjectiveVitamin D intake from foods or supplements is a safe and attractive means to improve vitamin D status of populations. The aim of this study was to help identify population subgroups that would benefit most from efforts to increase intake. To do so, we investigated which personal characteristics are associated with vitamin D intake in an Australian population and modeled possible effects of expanded food fortification practices.MethodsWe investigated vitamin D intake in a population-based random sample of 785 adults, using a validated food frequency questionnaire, and assessed associations with personal and behavioral characteristics. We identified vitamin D food sources and modeled the hypothetical effects of blanket fortification of milk and breakfast cereals.ResultsAverage total vitamin D intake was 4.4 (±4.0) μg/g and below adequate intake for most participants in all age and sex subgroups. Higher intake was associated with being female, having a serious medical condition, energy intake below the median, and vitamin D supplement use (all P < 0.05). The “meat, fish, and eggs” food group contributed most to total vitamin D intake (51%), followed by dairy products and related foods (43%). If all milk and breakfast cereals were to be fortified with vitamin D, the average intake of vitamin D from foods would increase from 3.6 (±2.4) μg/d to 6.3 (±3.2) μg/d, with similar increases in all age and sex subgroups.ConclusionsVitamin D intake in Australia is generally below recommended levels, and few personal characteristics help to identify subgroups with low intake. Blanket vitamin D fortification of milk and breakfast cereals would substantially increase average vitamin D intake in Australian adults of all ages.