Exploring Family Perspectives on a Group-Based Hands-on Advanced Carbohydrate Counting Education Program for Children and Adolescents with Type 1 Diabetes: A Qualitative Study.

The care needs of children and adolescents with type 1 diabetes and their families are frequently approached as if they were identical to those of adults, overlooking the distinct challenges young people may face. It has been stated that children and adolescents often find conventional conversations with diabetes specialists tiresome and unpleasant. The present study focuses on familial experiences of an advanced carbohydrate counting program tailored to children and adolescents. The data encompass semi-structured interviews with families who participated in a group-based child-centered advanced carbohydrate counting program. The analysis revealed five themes: (1) peer-to-peer interaction is an essential determinant of sharing and learning; (2) illness perception significantly influences dietary intake; (3) normalization of diabetes in everyday life eases the disease burden; (4) repetition of dietary knowledge is important for retention; and (5) creating a safe and playful learning environment is crucial to engaging children and adolescents in their own treatment. The present findings suggest that it would be beneficial to explore and consider alternative teaching approaches that are adapted to a more interactive and engaging learning environment that is specifically tailored to children and adolescents. This entails moving away from traditional individual approaches.

Effects of basic carbohydrate counting versus standard dietary care for glycaemic control in type 2 diabetes (The BCC Study): a randomised, controlled trial.

BACKGROUND: Clinical guidelines recommend basic carbohydrate counting (BCC), or similar methods to improve carbohydrate estimation skills and to strive for higher consistency in carbohydrate intake potentially improving glycaemic control. However, evidence for this approach in type 2 diabetes (T2D) is limited. OBJECTIVE: To examine the efficacy of a structured education program in BCC as add-on to standard dietary care on glycaemic control in individuals with T2D. METHODS: The BCC Study was a randomized, controlled, open-label, parallel-group trial. Individuals with T2D aged 18-75 years with glycated haemoglobin A1c (HbA1c) 53-97 mmol/mol (7.0-11.0%) were randomly assigned (1:1) to BCC or standard dietary care. The primary outcomes were differences in changes in HbA1c or glycaemic variability (calculated as mean amplitude of glycaemic excursions [MAGE]) between groups after six months of intervention. RESULTS: Between September 2018 and July 2021, 48 participants were randomly assigned, 23 to BCC and 25 to standard dietary care. Seven participants did not receive the allocated intervention. From a baseline-adjusted mean of 65 mmol/mol (95% CI 62-68 [8.1%, 7.8-8.4]), HbA1c changed by -5 mmol/mol (-8 to -1 [-0.5%, -0.7 to -0.1]) in BCC and -3 mmol/mol (-7 to 1 [-0.3%, -0.6 to 0.1]) in standard care with an estimated treatment effect of -2 mmol/mol (-7 to 4 [-0.2%, -0.6 to 0.4]); p = 0.554. From a baseline-adjusted mean of 4.2 mmol/l (3.7 to 4.8), MAGE changed by -16% (-33 to 5) in BCC and by -3% (-21 to 20) in standard care with an estimated treatment effect of -14% (-36 to 16); p = 0.319. Only median carbohydrate estimation error in favour of BCC (estimated treatment difference -55% (-70 to -32); p < 0.001) remained significant after multiple testing adjustment. CONCLUSIONS: No glycaemic effects were found but incorporating BCC as a supplementary component to standard dietary care led to improved skills in estimating carbohydrate intake among individuals with T2D.

Dietary changes based on food purchase patterns following a type 2 diabetes diagnosis.

OBJECTIVE: The study explores whether type 2 diabetes (T2D) diagnosis affects food consumption patterns in line with the dietary recommendations provided to individuals in relation to a diagnosis. DESIGN: Based on detailed food purchase data, we explore which dietary changes are most common following a T2D diagnosis. Changes are investigated for several energy-adjusted nutrients and food groups and overall adherence to dietary guidelines. SETTING: We use data on diagnosis of T2D and hospitalisation in relation to T2D for a sample of adult Danes registered in the official patient register. This is combined with detailed scanner data on food purchases, which are used as a proxy for dietary intake. PARTICIPANTS: We included 274 individuals in Denmark who are diagnosed during their participation in a consumer panel where they report their food purchases and 16 395 individuals who are not diagnosed. RESULTS: Results suggest some changes in dietary composition following diagnosis, as measured by a Healthy Eating Index and for specific food groups and nutrients, although the long-term effects are limited. Socio-economic characteristics are poor predictors of dietary changes following diagnosis. Change in diet following diagnosis vary with the pre-diagnosis consumption patterns, where individuals with relatively unhealthy overall diets prior to diagnosis improve overall healthiness more compared to individuals with relatively healthy diets prior to diagnosis. CONCLUSIONS: Adherence to dietary advice is low, on average, but there is large variation in behavioural change between the diagnosed individuals. Our results stress the difficulty for diagnosed individuals to shift dietary habits, particularly in the long term.

Intention and Perceptions of Healthy Eating versus Actual Intake Among Patients with Type 1 and Type 2 Diabetes and the General Population.

PURPOSE: Intention and perceptions of healthy eating may affect diet-related behavior. We assessed the intention and perceptions of eating healthily in patients with type 1 (T1D) and type 2 diabetes (T2D) compared with the general population. Secondly, differences in diet quality were assessed in patients with diabetes perceiving their dietary habits as more or less healthy. MATERIALS AND METHODS: This cross-sectional study included data on socioeconomic status, dietary intake, and questions on healthy eating from adults with T1D (n=426), T2D (n=348) and from the general population (n=2899). RESULTS: Patients with T2D were less likely to perceive their dietary habits as healthy compared with T1D and the general population. Patients with T1D or T2D perceiving their dietary habits as healthy reported higher intake of vegetables, fruit, fish, fibre and protein. In addition, patients with T1D with perceived healthy versus less healthy dietary habits had lower sugar intake and higher alcohol intake. Overall, adherence to dietary guidelines in patients with T1D and T2D was too low both in self-perceived healthy and less healthy eaters. In comparison with T1D patients, patients with T2D were less likely and the general population was more likely to strive to eat a healthy diet. CONCLUSION: Patients with T2D had poorer self-perception of their dietary healthiness and less intention of eating healthily, compared with patients with T1D and the general population. Actual diet quality was higher amongst patients with T1D and T2D perceiving their dietary habits as healthy than those perceiving their dietary habits as less healthy. But inadequate intakes were found in all groups. Health care providers should address and explore the patient's intention and perceptions of healthy eating when discussing dietary changes in diabetes to improve nutritional support.

Non-adherence to established dietary guidelines associated with increased mortality: the Copenhagen General Population Study.

AIMS: The relevance of adherence to established dietary guidelines is repeatedly challenged. We hypothesised that non-adherence to established dietary guidelines is associated with an excess risk of cardiovascular, non-cardiovascular and all-cause mortality. METHODS: We studied 100,191 white adult Danes aged 20-100 years recruited in 2003-2015 and followed up until December 2018. During follow-up equalling 865,600 person-years, 9273 individuals died. Participants' diets were assessed at baseline by a food frequency questionnaire focusing on key foods defining a healthy diet according to Danish dietary guidelines. Individuals were divided into five categories ranging from very high to very low adherence to dietary guidelines and studied with Cox and Fine-Gray regression models. At study inclusion, we collected demographic and lifestyle characteristics by questionnaire, made a physical examination and took a blood sample. RESULTS: Cardiovascular, non-cardiovascular and all-cause mortality increased gradually with increasing non-adherence to dietary guidelines. Cardiovascular mortality was 30% higher (95% confidence interval 7-57%), non-cardiovascular mortality 54% higher (32-79%) and all-cause mortality 43% higher (29-59%) in individuals with very low adherence to dietary guidelines compared with those with very high adherence after adjustments for age, sex, education, income, smoking, leisure time physical activity and alcohol intake. Mortality risk estimates were similar in all strata of adjusted variables. CONCLUSION: Non-adherence to Danish food-based dietary guidelines is associated with up to 43% increased all-cause mortality in a dose-response manner. The mortality excess was seen for both cardiovascular and non-cardiovascular causes. The public has good reasons to have confidence in and to adhere to established dietary guidelines.

Late-evening food intake is highly prevalent among individuals with type 2 diabetes.

Late-evening food intake is associated with cardiometabolic risk. We assessed the prevalence of late-evening and night-time eating in individuals with type 2 diabetes and its association with BMI and HbA1c. We hypothesized food intake during late evening and night-time to be prevalent among individuals with type 2 diabetes and to be associated with higher BMI and higher HbA1c. This cross-sectional analysis includes 348 adults with type 2 diabetes from an outpatient diabetes clinic in Denmark. Frequency of late-evening and night-time eating was assessed from a food frequency questionnaire and clinical data were obtained from electronic medical records. Participants were divided into those reporting to eat frequently (≥3 times/week) in the evening after dinner and/or during night-time (late-eaters) and those who did not (reference group) and BMI and HbA1c levels were compared between groups with and without adjustment for diabetes duration and antidiabetic medication. 42% of the study population reported to eat frequently (≥3 times/week) in the late evening and 8% reported to do so during the night. Most late-eaters reported to eat breakfast regularly, suggesting a long eating window and short fasting period in this group. BMI and HbA1c did not differ between late-eaters and the reference group. Eating late in the evening or during the night was prevalent among individuals with type 2 diabetes across BMI and HbA1c levels. Whether restriction of food intake during evening and night-time can induce weight loss and improve glycemic control in individuals with type 2 diabetes needs testing in randomized controlled trials.

The quality of dietary carbohydrate and fat is associated with better metabolic control in persons with type 1 and type 2 diabetes.

BACKGROUND: Diet quality is generally poor in persons with diabetes and it is unknown whether this is associated with worse glycaemic control and atherogenic lipid profile. The aim was to examine diet quality in relation to important markers of metabolic control in adults with type 1 diabetes (T1D) and type 2 diabetes (T2D). METHODS: The study was cross-sectional and included 423 (49% females) persons with T1D and 339 (29% females) persons with T2D recruited from an outpatient diabetes clinic in Denmark. Data were collected from July 2014 to January 2015. Diet quality was assessed with a food frequency questionnaire to examine eight key dietary components (carbohydrates, saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, added sugar, dietary fibre, fruit and vegetables). Clinical data assessing metabolic control (haemoglobin A1c (HbA1c), total cholesterol (total C), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), systolic and diastolic blood pressure and body mass index were extracted from the electronic medical records. RESULTS: In T1D, higher intake of carbohydrates and added sugar was associated with higher HbA1c; higher fruit intake was associated with lower total C and LDL-C; and higher intake of carbohydrates and dietary fibre was associated with lower HDL-C. In T2D, higher intake of saturated fat was associated with higher total C; higher intake of added sugar was associated with higher LDL-C; and higher intake of polyunsaturated fat was associated with higher diastolic blood pressure. CONCLUSIONS: In Danish adults with T1D and T2D, both the total intake and the quality of carbohydrates and fat were associated with an unfavourable glucose regulation and lipid profile. Thus, our findings support a constant focus on diet and emphasise the need for dietary support in people with diabetes to improve diet quality, metabolic control and possibly reduce cardiovascular risk.

Effects of basic carbohydrate counting versus standard outpatient nutritional education (The BCC Study): study protocol for a randomised, parallel open-label, intervention study focusing on HbA1c and glucose variability in patients with type 2 diabetes.

INTRODUCTION: Recommendations on energy intake are key in body weight management to improve glycaemic control in people with type 2 diabetes (T2D). International clinical guidelines recommend a variety of eating patterns to promote energy restriction as the primary dietetic approach to body weight control in managing T2D. In addition, individualised guidance on self-monitoring carbohydrate intake to optimise meal timing and food choices (eg, basic carbohydrate counting (BCC)) is recommended to achieve glycaemic control. However, the evidence for this approach in T2D is limited. The objective of this study was to compare the effect of an educational programme in BCC as add-on to the usual dietary care on glycaemic control in people with T2D. METHODS AND ANALYSES: The study is designed as a randomised, controlled trial with a parallel-group design. The study duration is 12 months with data collection at baseline, and after 6 and 12 months. We plan to include 226 adults with T2D. Participants will be randomised to one of two interventions: (1) BCC as add-on to usual dietary care or (2) usual dietary care. The primary outcome is changes in glycated haemoglobin A1c or mean amplitude of glycaemic excursions from baseline and after 6-month intervention between and within study groups. Further outcome measures include changes in time in range, body weight and composition, lipid profile, blood pressure, mathematical literacy skills, carbohydrate estimation accuracy, dietary intake, diet-related quality of life, perceived competencies in diet and diabetes and perceptions of an autonomy supportive dietician-led climate, physical activity and urinary biomarkers. ETHICS AND DISSEMINATION: The protocol has been approved by the Ethics Committee of the Capital Region, Copenhagen, Denmark. Study findings will be disseminated widely through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER: NCT03623139.

The dietary education trial in carbohydrate counting (DIET-CARB Study): study protocol for a randomised, parallel, open-label, intervention study comparing different approaches to dietary self-management in patients with type 1 diabetes.

INTRODUCTION: Clinical guidelines recommend that patients with type 1 diabetes (T1D) learn carbohydrate counting or similar methods to improve glycaemic control. Although systematic educating in carbohydrate counting is still not offered as standard-of-care for all patients on multiple daily injections (MDI) insulin therapy in outpatient diabetes clinics in Denmark. This may be due to the lack of evidence as to which educational methods are the most effective for training patients in carbohydrate counting. The objective of this study is to compare the effect of two different educational programmes in carbohydrate counting with the usual dietary care on glycaemic control in patients with T1D. METHODS AND ANALYSIS: The study is designed as a randomised controlled trial with a parallel-group design. The total study duration is 12 months with data collection at baseline, 6 and 12 months. We plan to include 231 Danish adult patients with T1D. Participants will be randomised to one of three dietician-led interventions: (1) a programme in basic carbohydrate counting, (2) a programme in advanced carbohydrate counting including an automated bolus calculator or (3) usual dietary care. The primary outcome is changes in glycated haemoglobin A1c or mean amplitude of glycaemic excursions from baseline to end of the intervention period (week 24) between and within each of the three study groups. Other outcome measures include changes in other parameters of plasma glucose variability (eg, time in range), body weight and composition, lipid profile, blood pressure, mathematical literacy skills, carbohydrate estimation accuracy, dietary intake, diet-related quality of life, perceived competencies in dietary management of diabetes and perceptions of an autonomy supportive dietician-led climate, physical activity and urinary biomarkers. ETHICS AND DISSEMINATION: The protocol has been approved by the Ethics Committee of the Capital Region, Copenhagen, Denmark. Study findings will be disseminated widely through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT03623113).

Dietary habits and adherence to dietary recommendations in patients with type 1 and type 2 diabetes compared with the general population in Denmark.

OBJECTIVES: The aim of the present study was to examine dietary habits and adherence to dietary recommendations in adult patients with type 1 diabetes (T1D) and type 2 diabetes (T2D) compared with the general population in Denmark. METHODS: The study was cross-sectional and included 426 patients with T1D and 348 patients with T2D recruited from an outpatient diabetes clinic in the capital region of Denmark. Dietary habits were assessed by a food frequency questionnaire and compared with dietary data from 2,899 participants without diabetes from the Danish National Survey of Dietary Habits and Physical Activity. RESULTS: Patients with diabetes had a 20-50% lower intake of added sugar and alcohol, and a 10-20% higher intake of fibre and vegetables compared with the general population (p<0.001 for all). Patients with T2D had a 37% lower intake of alcohol compared with T1D (p<0.001). Adherence to dietary recommendations (e.g. fibre, saturated fat, vegetables, fruit and fish) were low in all groups but lowest in the general population. CONCLUSION: The Danish diet is too high in saturated fat and too low in dietary fibre, vegetable, fruit and fish compared to dietary recommendations in both patients with diabetes and the general population. However, our data demonstrate that patients with diabetes consume a healthier diet compared to the general population: Limiting the intake of added sugar and alcohol, and increasing the intake of vegetables and dietary fibre.

Dietary education must fit into everyday life: a qualitative study of people with a Pakistani background and type 2 diabetes.

BACKGROUND: The high prevalence of diabetes among South Asian populations in European countries partially derives from unhealthy changes in dietary patterns. Limited studies address perspectives of South Asian populations with respect to utility of diabetes education in everyday life. This study explores perspectives on dietary diabetes education and healthy food choices of people living in Denmark who have a Pakistani background and type 2 diabetes. METHODS: In-depth interviews were conducted between October 2012 and December 2013 with 12 participants with type 2 diabetes who had received dietary diabetes education. Data analysis was systematic and was based on grounded theory principles. RESULTS: Participants described the process of integrating and utilizing dietary education in everyday life as challenging. Perceived barriers of the integration and utilization included a lack of a connection between the content of the education and life conditions, a lack of support from their social networks for dietary change, difficulty integrating the education into everyday life, and failure to include the participants' taste preferences in the educational setting. CONCLUSION: Dietary education that is sensitive to the attitudes, wishes, and preferences of the participants and that aims at establishing a connection to the everyday life of the participants might facilitate successful changes in dietary practices among people with a Pakistani background and type 2 diabetes. The findings suggest that more focus should be placed on collaborative processes in the dietary educational setting in order to achieve appropriate education and to improve communication between this population and health care professionals.

Development of culturally sensitive dialog tools in diabetes education.

Person-centeredness is a goal in diabetes education, and cultural influences are important to consider in this regard. This report describes the use of a design-based research approach to develop culturally sensitive dialog tools to support person-centered dietary education targeting Pakistani immigrants in Denmark with type 2 diabetes. The approach appears to be a promising method to develop dialog tools for patient education that are culturally sensitive, thereby increasing their acceptability among ethnic minority groups. The process also emphasizes the importance of adequate training and competencies in the application of dialog tools and of alignment between researchers and health care professionals with regards to the educational philosophy underlying their use.

Effects of unsaturated fat dietary supplements on blood lipids, and on markers of malnutrition and inflammation in hemodialysis patients.

OBJECTIVE: We examined the effects of commercially available unsaturated fat dietary supplements on blood lipids, and on markers of malnutrition and inflammation, in an adult population of hemodialysis (HD) patients. DESIGN: This was a restricted, randomized (equal blocks), investigator-blinded 2x6 week crossover trial, without a washout interval. SETTING: This study was conducted at the Department of Nephrology, Copenhagen University Hospital Herlev, Herlev, Denmark, in spring 2007. PATIENTS: Participants included 40 (30 males and 10 females) stable, adult patients undergoing regular HD, with a mean age of 64.6 years and a mean body mass index of 23.3kg/m(2). INTERVENTION: In addition to patients' habitual diets, oral unsaturated fat supplements (90mL of Calogen [SHS International, Ltd., Liverpool, UK] and 4 capsules of Pikasol [Dansk Droge, Ishoej, Denmark]) were given in one period, whereas no supplements were given in the other. Dietary supplements contributed 1.8 MJ (430kcal), 47g fat, 26.5g monounsaturated fatty acids, and 3g marine n-3 polyunsaturated fatty acids per day. Blood sampling and nutritional assessments were performed at baseline, after 6 weeks, and after 12 weeks. MAIN OUTCOME MEASURES: Dietary intakes, blood lipids, dry body weight, serum albumin, and serum C-reactive protein comprised our main outcome measures. RESULTS: According to a per-protocol analysis of 14 study completers, fat supplementation resulted in significantly increased total energy intake (+1.6 MJ/day, or 380kcal/day) and an increased dietary fat energy percentage (+9%). We observed no significant changes in blood lipids. Dry body weight (+0.49kg, P=.04) increased, and serum C-reactive protein concentration fell (-1.69mg/L, P=.01), with fat supplementation. Intention-to-treat analysis of 39 participants confirmed the absence of adverse blood-lipid changes. CONCLUSIONS: Unsaturated fat supplementation increased total dietary energy intake to recommended levels, had no adverse impact on blood lipids, improved nutritional status as assessed according to dry body weight, and reduced systemic inflammation as assessed according to C-reactive protein serum concentrations. Adding unsaturated fat to the diet seems to be a safe and effective way to prevent and treat malnutrition in hemodialysis patients.

[Kidney function and immunosuppression of kidney-transplanted patients]. / Enkeltcenteropgørelse af nyretransplanterede patienters nyrefunktion og immunsuppressive behandling.

INTRODUCTION: The number of kidney-transplanted patients is growing. This report describes the age, sex distribution, kidney function, graft age, and immunosuppressive drugs of kidney-transplanted patients followed at the outpatient clinic of the nephrology department at Copenhagen University Hospital, Herlev, Denmark. MATERIALS AND METHODS: Cross-sectional study of all living kidney-transplanted patients with a functioning graft followed at Copenhagen University Hospital, Herlev (n=241). Data were extracted from patient records during November 2005-March 2006. RESULTS: The sex distribution (131 males, 110 females) was equal. The average patient age was 52 years (SD 12), the average glomerular filtration rate 43 ml/min/1.73 m2 (range 6-114 ml/min/1.73 m2), and the average graft age was 8.3 years (range 0-28 years). Hyperparathyroidism was highly prevalent (64%). The majority of patients (74%) were treated with triple-drug immunosuppression, in most cases (46%) with the combination prednisolone-ciclosporine-azathioprine. During recent years, azathioprine has been increasingly replaced by mycophenolate mofetil. CONCLUSIONS: The majority of kidney-transplanted patients with a functioning graft have sufficient kidney function to keep the patients free of uremic symptoms. Hyperparathyroidism is frequent. The immunosuppressive regimens used for kidney-transplanted patients are currently changing.

Impact of vitamin D status and obesity on C-reactive protein in kidney-transplant patients.

OBJECTIVE: We examined whether vitamin D status and obesity are associated with low-grade systemic inflammation, as assessed by serum concentrations of C-reactive protein (CRP) in an adult population of kidney-transplant patients. DESIGN: This was a single-center, cross-sectional study. SETTING AND PATIENTS: Data were collected between December 2005 and April 2006 from 161 adult (aged >18 years) kidney-transplant patients (mean age, 53.1 years; SD, 11.5 years; females/males, 78/83), with a median kidney-graft age of 7.0 years and serum CRP levels < or =10 mg/L. METHODS: Vitamin D status was assessed by serum concentrations of 25-hydroxyvitamin D (25-OHD) and 1,25-dihydroxyvitamin D (1,25(OH)(2)D). The presence of low-grade systemic inflammation was assessed by serum CRP. Selected lifestyle factors and anthropometric variables were determined in a subgroup of patients (n = 90). Bivariate correlation and multiple regression analyses were performed. RESULTS: Hypovitaminosis D (ie, S-25-OHD < or =75 nmol/L) was present in 73% of females, and 89% of males. The median level of serum CRP was 1.7 mg/L. Vitamin D status was not significantly associated with serum CRP. In the patient subgroup, indices of obesity (body mass index, body weight, and fat mass) correlated positively, and lean body mass correlated negatively, with serum CRP. Only fat mass remained significantly associated with serum CRP in multiple regression analysis. CONCLUSIONS: No impact of vitamin D status on low-grade systemic inflammation was found. Fat mass correlated positively with CRP, suggesting that obesity may increase the risk of cardiovascular disease and chronic allograft rejection in kidney-transplant patients.

Vitamin D status in kidney transplant patients: need for intensified routine supplementation.

BACKGROUND: A high prevalence of vitamin D insufficiency has been found in the general population and in patients with chronic kidney disease. OBJECTIVE: The aim was to examine vitamin D status and determinants and metabolic correlates of serum 25-hydroxyvitamin D in a population of adult Danish kidney transplant patients. DESIGN: This was a cross-sectional study of 173 adult kidney transplant patients with a mean (+/-SD) age of 53.4 +/- 11.7 y and a median graft age of 7.4 y (interquartile range: 3.3-12.7 y). Serum concentrations of intact parathyroid hormone (S-PTH), 25-hydroxyvitamin D [S-25(OH)D], and 1,25-dihydroxyvitamin D [S-1,25(OH)(2)D] were measured. Dietary and supplementary intake of vitamin D, avoidance of solar ultraviolet B exposure, and selected lifestyle factors were assessed in a subgroup (n = 97). RESULTS: Fifty-one percent of the patients had vitamin D insufficiency [S-25(OH)D 40-75 nmol/L], and an additional 29% had moderate-to-severe vitamin D deficiency [S-25(OH)D < or = 39 nmol/L]. In multiple regression analysis, sun avoidance (negative association) and vitamin D supplementation (positive association) were independent determinants of S-25(OH)D concentrations. Low S-25(OH)D concentrations were associated with 1) increased S-PTH concentrations (P = 0.0002), independently of S-1,25(OH)(2)D concentrations, and 2) decreased S-1,25(OH)(2)D concentrations (P = 0.002), independently of graft function. CONCLUSIONS: Hypovitaminosis D is common among Danish kidney transplant patients and is associated with reduced concentrations of S-1,25(OH)(2)D and increased S-PTH concentrations. Sun avoidance and vitamin D supplementation are important determinants of vitamin D status. The observed hypovitaminosis D might be corrected by intensified routine vitamin D supplementation as opposed to the current supplementation practice.