Nutritional Supplementation Guidelines for Adolescent Girls
Priority Supplement Recommendations
Adolescent girls should prioritize iron and calcium supplementation above all other nutrients, as these are the most critically deficient in this population and directly linked to serious long-term health consequences including iron-deficiency anemia and osteoporosis. 1
Iron Supplementation - First Priority
Iron deficiency represents the single most prevalent and consequential nutritional gap in adolescent girls, with more than 15% having intakes below the Estimated Average Requirement (EAR). 1
The CDC reports that 2-4% of adolescent girls ages 12-19 years show evidence of iron deficiency anemia, making female adolescents the highest-risk group among all school-age youth. 2, 1
Iron deficiency impairs hemoglobin production, which increases fatigue, shortens attention span, decreases work capacity, reduces resistance to infection, and impairs intellectual performance. 2, 1
Adolescent girls should consume adequate amounts of foods high in iron AND vitamin C together, as vitamin C significantly enhances iron absorption efficiency. 2, 1
Calcium Supplementation - Second Priority
More than 70% of adolescent girls fail to meet Dietary Guidelines for Americans recommendations for calcium intake, making this the second most critical nutritional deficiency. 1
Inadequate calcium intake during adolescence directly compromises peak bone mass development and increases long-term osteoporosis risk. 1
Additional Recommended Supplements
Vitamin D
- More than 70% of adolescent girls have vitamin D intakes below the Estimated Average Requirement, warranting supplementation consideration. 1
Vitamin E
- More than 95% of adolescent girls have vitamin E intakes less than the EAR, representing the most widespread vitamin deficiency in this population. 1
Magnesium
- More than 70% of adolescent girls have magnesium intakes below the EAR. 1
Clinical Context and Implementation
Why This Age Group Requires Special Attention
Adolescents aged 12-19 years represent the age group where food insecurity and nutritional gaps have the most negative dietary impact on long-term health outcomes. 1
Current dietary patterns in adolescent girls show insufficient consumption of multiple micronutrients including calcium, iron, zinc, potassium, and vitamins A, D, C, and folic acid. 1
The vast majority of adolescent girls consume more than 750 kcal/day (~40% of total energy) from solid fats and added sugars—approximately five times the recommended maximum intakes—while failing to meet basic nutrient requirements. 3
Food-First Approach Integration
More than 90% of adolescent girls fail to consume recommended amounts of fruits, vegetables, and dairy; 75% consume less than recommended amounts in the meat group. 3
Supplements should complement—not replace—dietary improvements, as diet patterns combining adequate intakes across all five food groups lead to greater overall nutritional adequacy than supplementation alone. 3
Common Pitfalls to Avoid
Do not recommend multivitamin-mineral products as the sole intervention, even though they are the most commonly used supplements (23.8% of adolescents). 4 These products often fail to provide adequate amounts of the priority nutrients (iron and calcium) that adolescent girls specifically need.
Avoid unrestrained supplementation without identifying specific nutritional deficiencies, as this exposes adolescents to potential adverse effects without evidence of benefit. 5
Be aware that approximately 34% of children and adolescents already use dietary supplements, with use of two or more supplements increasing from 4.3% to 7.1% between 2009-2018. 4 Screen for existing supplement use to avoid excessive intake above recommended upper limits.