ORIGINAL ARTICLE Pakistani immigrant children and adults in Denmark have severely low vitamin D status R Andersen 1 , C Mølgaard 2 , LT Skovgaard 3 , C Brot 1 , KD Cashman 4 , J Jakobsen 5 , C Lamberg-Allardt 6 and L Ovesen 1 1 Department of Nutrition, National Food Institute, Technical University of Denmark, Søborg, Denmark; 2 Department of Human Nutrition, Faculty of Life Sciences, University of Copenhagen, Frederiksberg, Denmark; 3 Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark; 4 Department of Food Science and Technology, University College Cork, Cork, Ireland; 5 Department of Chemistry, National Food Institute, Technical University of Denmark, Søborg, Denmark and 6 Division of Nutrition, University of Helsinki, Helsinki, Finland Objective: To determine vitamin D and bone status in adolescent girls, pre-menopausal women and men of Pakistani origin, to single out determinants of vitamin D status and to determine the association between vitamin D status, bone metabolism and bone status. Subjects/Methods: Cross-sectional study, Copenhagen (551N), January-November. Serum 25-hydroxyvitamin D (S-25OHD), serum intact parathyroid hormone (S-iPTH), bone turnover markers and whole body and lumbar spine bone mineral density were measured. Sun, smoking and clothing habits, age, body mass index (BMI), and vitamin D and calcium from food and from supplements were recorded. Thirty-seven girls (median age, range: 12.2 years, 10.1–14.7), 115 women (36.2 years, 18.1–52.7) and 95 men (38.3 years, 17.9–63.5) of Pakistani origin (immigrants or descendants with Pakistani parents) took part in the study. Results: Median concentration of S-25OHD was 10.9, 12.0 and 20.7 nmol/l for girls, women and men, respectively. Forty-seven per cent of the girls, 37% of the women and 24% of the men had elevated S-iPTH, and there was a negative relationship between S-iPTH and S-25OHD. Use of vitamin D-containing supplements had a positive association with S-25OHD for men (P ¼ 0.04) and women (P ¼ 0.0008). Twenty-one per cent of the women and 34% of the men had osteopenia. Neither S-25OHD nor S-iPTH was associated with lumbar spine or whole body bone mineral content. Conclusions: Severely low vitamin D status and elevated S-iPTH is common among Pakistani immigrants in Denmark. The low vitamin D status is not associated with bone markers or bone mass among relatively young Pakistanis. European Journal of Clinical Nutrition (2008) 62, 625–634; doi:10.1038/sj.ejcn.1602753; published online 18 April 2007 Keywords: vitamin D status; 25-hydroxyvitamin D; bone status; bone turnover markers; Pakistani immigrants; Denmark Introduction Vitamin D is a primary regulator of calcium homoeostasis and bone metabolism. The active metabolites of vitamin D facilitate the absorption of calcium and phosphorus in the gut to maintain blood calcium concentrations that are vital to proper bone mineralization. Vitamin D deficiency can result in rickets in children, and in osteomalacia and/or osteoporosis in adults and elderly (Heaney, 2003; Zitter- mann, 2003). Since the main source of vitamin D is ultraviolet light, reduced sun exposure, due to clothing habits, dark skin pigmentation or living at northern latitudes, can lead to vitamin D deficiency. Diet is a secondary source of vitamin D, since only few foods contain significant amounts of vitamin D. In the late 1960s and early 1970s Pakistani men moved to Denmark as labour immigrants. Many of the immigrants settled down and have now lived in Denmark for about 30 years with their family and descendants. Presently about Received 27 April 2006; revised 5 March 2007; accepted 8 March 2007; published online 18 April 2007 Correspondence: R Andersen, Department of Nutrition, National Food Institute, Technical University of Denmark, Mørkhøj Bygade 19, DK-2860 Søborg, Denmark. E-mail: ria@food.dtu.dk Guarantor: R Andersen. Contributors: RA collected the data, wrote the manuscript and undertook the statistical analyses with advice from LTS, CM and LO. RA, CB, KDC, CL-A, CM and LO designed the study. JJ undertook the measurements of S-25OHD. KDC undertook the measurements of bone turnover markers. CL-A undertook the measurements of S-iPTH, calcium and phosphate. All contributed to the manuscript. European Journal of Clinical Nutrition (2008) 62, 625–634 & 2008 Nature Publishing Group All rights reserved 0954-3007/08 $30.00 www.nature.com/ejcn