title: Prevalence of Vitamin D deficiency in Pakistan and implications for the future.
abstract: OBJECTIVE
  vitamin D deficiency (25-hydroxyvitamin D) affects over one billion people worldwide. Vitamin D deficiency results in progression of osteoporosis as well as other conditions. Previous studies have shown high rates of vitamin D deficiency in Pakistan despite appreciable levels of sunshine. However, none have assessed vitamin D deficiency across all age groups, genders, incomes, and locations to guide future strategies.
  
  
  METHODS
  Questionnaire and blood sampling among 4830 randomly selected citizens.
  
  
  RESULTS
  High levels of deficiency among all age groups, genders, income levels, and locations. Amongst the selected citizens, 53.5% had vitamin D deficiency, 31.2% had insufficient vitamin D, and only 15.3% normal vitamin D.
  
  
  CONCLUSIONS
  High rates of vitamin D deficiency in Pakistan despite high levels of sunshine and previous Food Acts asking for food fortification with vitamin D. Public health strategies are needed to address high deficiency rates, including food fortification, i.e. nurture, alongside increasing exposure to sunlight, i.e. nature. This will involve all key stakeholder groups.
authors.affiliation: a Faculty of Pharmacy , Sargodha University , Sargodha , Pakistan.
authors.forename: H
authors.initials: H
authors.lastname: Riaz
authors.affiliation: b Green Templeton College , Oxford University , Oxford , UK.|c Nuffield Department of Primary Care Health Sciences , University of Oxford , Oxford , UK.
authors.forename: A E
authors.initials: AE
authors.lastname: Finlayson
authors.affiliation: a Faculty of Pharmacy , Sargodha University , Sargodha , Pakistan.
authors.forename: S
authors.initials: S
authors.lastname: Bashir
authors.affiliation: d Drugs Control and Traditional Medicines Division, National Institute of Health , Islamabad , Pakistan.
authors.forename: S
authors.initials: S
authors.lastname: Hussain
authors.affiliation: e Quaid-i-Azam University , Islamabad , Pakistan.
authors.forename: S
authors.initials: S
authors.lastname: Mahmood
authors.affiliation: d Drugs Control and Traditional Medicines Division, National Institute of Health , Islamabad , Pakistan.
authors.forename: F
authors.initials: F
authors.lastname: Malik
authors.affiliation: f Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institute , Karolinska University Hospital Huddinge , Stockholm , Sweden.|g Strathclyde Institute of Pharmacy and Biomedical Sciences , Strathclyde University , Glasgow , UK.
authors.forename: B
authors.initials: B
authors.lastname: Godman
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005527:Food, Fortified / Q000600:supply & distribution; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D015995:Prevalence; D013472:Sunlight; D011795:Surveys and Questionnaires; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D
keywords: 25-hydroxyvitamin-D; epidemiology; food supplements; pakistan; risk factors; strategies; vitamin D deficiency