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

ABSTRACT

Background and aims: 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. Conclusion: 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.

KEYWORDS:

• 25-hydroxyvitamin-D
• epidemiology
• food supplements
• strategies
• risk factors
• pakistan
• vitamin D deficiency

Key Issues

• Vitamin D deficiency is a prevalent condition affecting over one billion people worldwide, and appears to be one of the most underdiagnosed and undertreated dietary insufficiencies.

• Vitamin D deficiency has been linked to the progression of osteoporosis and osteoporotic fractures arising from secondary hyperparathyroidism as well as a variety of other conditions. Consequently, vitamin D deficiency needs to be addressed.

• Previous studies have shown high rates of vitamin D deficiency in Pakistan despite appreciable levels of sunshine across cities and regions and previous Food Acts asking for food fortification with vitamin D. However, to date, no published appears to have assessed vitamin D deficiency across all age groups, genders, incomes, and locations in Pakistan to guide future strategies.

• Our findings demonstrated high levels of vitamin D deficiency among all age groups, genders, income levels, and locations in Pakistan. Thirty-eight percent of patients sampled had severe vitamin D deficiency, 29% moderate vitamin D deficiency, and 25% mild vitamin D deficiency, using our definitions, with only 8.6% normal vitamin D levels.

• These findings have considerable implications for the future morbidity and mortality of citizens in Pakistan as well as costs.

• Public health strategies are needed to address high vitamin D deficiency rates. These include food fortification, i.e. nurture, alongside increasing exposure to sunlight, i.e. nature, involving all key stakeholder groups including religious leaders.

• Religious leaders, in their sermons on Fridays, could emphasize the importance of vitamin D deficiency. Initially emphasizing diet; however in the longer term reviewing issues such as dress in public with limited opportunities for exposure in private to overcome high levels of moderate to severe vitamin D deficiency in Pakistan

Acknowledgments

We appreciate the hard work done by the data collectors without whose efforts the study would not have been completed.

Financial & competing interests disclosure

The study was part funded by the University of Sargodha, and the writing of this paper was in part supported by a grant from the Karolinska Institute. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.