Prevalence of vitamin D deficiency in Pakistan and implications for the future

Background and aims: Vitamin D deficiency (25-hydroxyvitamin D - VitDD) affects over one billion people worldwide. VitDD results in progression of osteoporosis as well as other conditions. Previous studies have shown high rates of VitDD in Pakistan despite appreciable levels of sunshine. However, none have assessed VitDD 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 VitDD among all age groups, genders, income levels and locations. 53.5% had VitDD, 31.2% had insufficient Vitamin D and only 15.3% normal Vitamin D. Conclusion: High rates of VitDD 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 VitDD rates, including food fortification, i.e. nurture, alongside increasing exposure to sunlight, i.e. nature. This will involve all key stakeholder groups