For instance, Sahu et al. described the dietary intake in rural India as remarkably monotonous from meal to meal, with a low consumption of dairy and foods containing reasonable amounts of vitamin D [36]. As a consequence, it is difficult to find an association between dietary intake and serum 25(OH)D. The darker

skin types of the immigrant populations are a suitable protection against the intensity and amount of sunlight in their countries of origin, while they are a risk factor selleckchem for vitamin D deficiency in northerly European countries. The serum 25(OH)D concentrations of the populations in the country of origin may, therefore, indicate normal or reference concentrations. However, those populations may themselves be deficient or suffer from insufficient concentrations as a whole. Given that until recently, mankind lived and worked outside, the serum 25(OH)D concentrations of groups who currently spend much of their time outdoors might, therefore, be considered “normal” [47]. Serum YH25448 cost 25(OH)D concentrations of rural populations, who are expected to have a greater exposure to sunlight as a result of their agricultural occupation than urban populations [20, 21], might be a more suitable indicator of normal concentrations than

those of total populations. The high (>100 nmol/l) serum 25(OH)D concentrations in subgroups of two Turkish studies, which were performed at the end of the summer, suggest a large Selleck SCH772984 impact of sunlight.

As sun exposure does not lead to toxic vitamin D concentrations due to a feedback mechanism, these serum 25(OH)D concentrations are expected to be within the normal or reference range, which is an additional argument that the low serum 25(OH)D concentrations (found in immigrant populations) can be interpreted as a deficiency. Of course, assay differences might also explain part of the difference with other studies. Symptomatic vitamin D deficiency is also suggested by the prevalence of rickets in Turkey, India, and some African countries [48–53]. The incidence of rickets in Eastern Turkey declined from 6.09% to 0.099% Oxalosuccinic acid after a nationwide free vitamin D supplementation program [54]. Within European countries, rickets is not highly prevalent, but immigrant populations are groups at risk [55–57]. Additionally, although most nonwestern immigrant populations are younger than the indigenous European populations, cases of osteomalacia in nonwestern immigrants have been observed [58, 59]. Finch et al. found all but one case of osteomalacia within the vegetarian Asian group in England, the group with lowest vitamin D concentrations in their study [32]. Furthermore, osteoporotic and peripheral fractures were found in the vitamin-D-deficient subgroup in Morocco [17]. Erkal et al.