A study of more than 1,800 Swedish children reveals a public health success: since the country expanded its vitamin D fortification program in 2018, nearly all young children are now getting enough of this essential nutrient, even as researchers map out ways to make the strategy kinder to the climate.
The findings matter because vitamin D deficiency in childhood can affect bone development and immune function, yet it's a largely preventable problem. Sweden's approach of fortifying everyday foods—dairy products, cereals, porridge, and spreads—has proven remarkably effective. Among 18-month-olds in the study, 93% had sufficient vitamin D levels; among four-year-olds, the figure climbed to 96%. Not a single child showed signs of deficiency.
The research, published in the Nutrition Journal and conducted by scientists at the University of Gothenburg, the Swedish Food Agency, and RISE (Research Institutes of Sweden), analyzed data from 1,074 toddlers and 746 preschoolers surveyed between 2021 and 2024. For the youngest children, vitamin D drops and fortified dairy products were the primary sources. As children grew older and stopped taking drops, fortified dairy and spreads took over as the main suppliers.
There's a wrinkle, though. Sixteen percent of 18-month-olds and 61% of four-year-olds weren't meeting the recommended daily intake of 7.5 micrograms through diet alone—though the vitamin D drops and fortification efforts kept them from actual deficiency. André Hesselink, a dietician and doctoral student at the University of Gothenburg and one of the study's lead authors, sees this as a sign that the system is working as intended. "Our results show the crucial importance of fortified dairy products for vitamin D intake among young children in Sweden, especially after they stop taking vitamin D drops," he says.
But the research team also looked beyond nutrition to environmental cost, and here the picture becomes more interesting. Dairy products deliver vitamin D, yes, but they also carry a substantial carbon footprint. The scientists found that fortified plant-based alternatives—oat milk, almond drinks, and similar products—deliver comparable vitamin D with significantly lower greenhouse gas emissions. The same goes for fortified spreads. In a country increasingly aware of climate impact, this distinction matters.
The expansion of Sweden's mandatory fortification program in 2018 was intentional and strategic, designed to ensure more people could meet their vitamin D needs through everyday food rather than relying solely on supplements or drops. The results show it's working. What the study adds is proof that the country can fine-tune the approach—leaning more toward plant-based fortified alternatives—without sacrificing the health gains already achieved. Young Swedish children would get the vitamin D they need while their parents could feel better about the environmental impact of what's on the dinner table.
As Hesselink notes, the expanded fortification program "provides an opportunity for plant-based alternatives to play a more prominent role in the future for ensuring adequate intake of vitamin D and reducing the climate impact of our dietary habits." It's a reminder that good nutrition and environmental responsibility don't have to pull in opposite directions.