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Fortified foods are the major dietary sources of vitamin D. Prior to the fortification of milk products in the 1930s, rickets (a bone disease seen in children) was a major public health problem in the United States. Milk in the United States is fortified with 10 micrograms (400 IU) of vitamin D per quart, and rickets is now uncommon in the US. It is interesting to note that because human milk may not contain adequate vitamin D, Vitamin D supplements are often recommended for exclusively breast-fed infants

Exposure to sunlight

Exposure to sunlight is an important source of vitamin D. Ultraviolet (UV) rays from sunlight trigger vitamin D synthesis in the skin. Many populations through out the world are exposed to quite suboptimal levels of sunlight, especially during the winter months.

In addition to geographical and seasonal factors, ultraviolet light from the sun may also be blocked by air pollution. The tendency to wear clothes, to live in cities where tall buildings block adequate sunlight from reaching the ground, to live indoors, to use synthetic sunscreens that block ultraviolet rays, all contribute to the inability of the skin to biosynthesize sufficient amounts of vitamin D3.

Under these conditions vitamin D becomes a true vitamin, in the sense that it must be supplied in the diet on a regular basis.