Evaluation of vitamin D status in suspected cases of metabolic syndrome
Keywords:Coronary heart disease, Fasting blood glucose, High density lipoprotein, Metabolic syndrome, Triglycerides, Type 2 diabetes mellitus
Background: Metabolic syndrome is associated with an increased risk of cardiovascular disease and type 2 diabetes mellitus. Vitamin D has been linked to glucose metabolism and insulin regulation. Hence, this study aims to evaluate the association between the serum level of vitamin D and metabolic syndrome. This may help generate additive strategies in the prevention and management of this syndrome. The objective of the study was to compare the levels of serum vitamin D in subjects with metabolic syndrome and subjects without metabolic syndrome.
Methods: A prospective study with 80 subjects was conducted at a tertiary care hospital in Southern India. The sample comprised 40 subjects in the age group of (18-60 years) with metabolic syndrome as cases and 40 subjects without metabolic syndrome in the age groups of (18-60 years) as controls. The presence of any 3 of the following- fasting blood glucose (FBS ≥100mg/dl), triglycerides (TGL≥150mg/dl) and high-density lipoprotein cholesterol (HDL-C ≤40mg/dl-men, ≤50mg/dl-women) levels, blood pressure (≥130/85mmHg or drug treatment) and abdominal waist circumference (>94 cm (37 in) in men and >80 cm (31 in) in women) were used as criteria to screen for the presence (cases) or absence (controls) of metabolic syndrome. Serum vitamin D (25-hydroxy vitamin D) levels were compared between the two groups.
Results: Mann Whitney U test was used to compare the vitamin D levels between the two groups. Significantly (p=0.05) lower vitamin D levels were seen in the cases compared to the controls.
Conclusions: Metabolic syndrome is associated with significantly lower serum vitamin D levels. We suggest that further studies with a larger sample size be undertaken to confirm the same.
Obunai K, Jani S, Dangas GD. Cardiovascular morbidity and mortality of the metabolic syndrome. Med Clin North Am. 2007 Nov;91(6):1169-84.
Third Report of the National Cholesterol Education Program (NCEP. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106(25):3143-421.
Saklayen MG. The Global Epidemic of the Metabolic Syndrome. Curr Hypertens Rep. 2018 Feb;20(2):12.
Rao RG. Diabetes and cardiovascular disease in South Asians: A global perspective. J Clin Prev Cardiol [Internet]. 2018 Oct 1;7(4):161-7. Available at: http://www.jcpconline.org/article.asp?issn=2250-3528
Alberti KGMM, Zimmet P, Shaw J. Metabolic syndrome-a new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med. 2006 May;23(5):469-80.
Chiu KC, Chu A, Go VLW, Saad MF. Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction. Am J Clin Nutr. 2004 May;79(5):820-5.
Daskalopoulou SS, Mikhailidis DP, Elisaf M. Prevention and treatment of the metabolic syndrome. Angiology. 2004;55(6):589-612.
VanWormer JJ, Boucher JL, Sidebottom AC, Sillah A, Knickelbine T. Lifestyle changes and prevention of metabolic syndrome in the Heart of New Ulm Project. Prev Med Reports. 2017;6:242-5.
Christodoulou S, Goula T, Ververidis A, Drosos G. Vitamin D and bone disease. Biomed Res Int. 2013;2013:396541.
Maki KC, Rubin MR, Wong LG, McManus JF, Jensen CD, Marshall JW, et al. Serum 25-hydroxyvitamin D is independently associated with high-density lipoprotein cholesterol and the metabolic syndrome in men and women. J Clin Lipidol. 2009 Aug 1;3(4):289-96.
Dobnig H, Pilz S, Scharnagl H, Renner W, Seelhorst U, Wellnitz B, et al. Independent association of low serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels with all-cause and cardiovascular mortality. arch intern med. 2008;168(12):1340-9.
Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics. 2008 Aug;122(2):398-417.
Patel A, Zhan Y. Vitamin D in cardiovascular disease. Int J Prev Med. 2012 Sep;3(9):664.
Makariou S, Liberopoulos E, Florentin M, Lagos K, Gazi I, Challa A, et al. The relationship of vitamin D with non-traditional risk factors for cardiovascular disease in subjects with metabolic syndrome. Arch Med Sci. 2012/07/04. 2012 Jul 4;8(3):437-43.
Hashemipour S, Larijani B, Adibi H, Javadi E, Sedaghat M, Pajouhi M, et al. Vitamin D deficiency and causative factors in the population of Tehran. BMC Public Health. 2004 Aug;4(1):38.
Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the international diabetes federation task force on epidemiology and prevention; national heart, lung, and blood institute; American heart association; world heart federation; international atherosclerosis society; and international association for the study of obesity. Circulation. 2009;120(16):1640-5.
Arneson WL, Arneson DL. Current methods for routine clinical laboratory testing of vitamin D levels. Lab Med. 2013;44(1):e38-42.
Ford ES, Ajani UA, McGuire LC, Liu S. Concentrations of serum vitamin D and the metabolic syndrome among U.S. adults. Diabetes Care. 2005 May 1;28(5):1228 LP-1230.
Reis JP, Mühlen D von, Miller ER. Relation of 25-hydroxyvitamin D and parathyroid hormone levels with metabolic syndrome among US adults. Eur J Endocrinol. 2008;159(1):41-8.
Boucher BJ. Inadequate vitamin D status: does it contribute to the disorders comprising syndrome ‘X’? Br J Nutr. 2007/03/09. 1998;79(4):315-27.
Ebeling PR, Gagnon C, Daly RM, Sikaris K, Lu ZX, Magliano DJ, et al. Low serum 25-hydroxyvitamin d is associated with increased risk of the development of the metabolic syndrome at five years: results from a national, population-based prospective study (the Australian diabetes, obesity and lifestyle study: Aus Diab). J Clin Endocrinol Metab. 2012 Jun 1;97(6):1953-61.
Maghbooli Z, Hossein-Nezhad A, Khoshniat M, Adibi H, Mohammadzadeh N, Larijani B. A study of bone mineral density in diabetes mellitus in Iranian women. Iran J Public Health. 2007;37-44.
Anderssen SA, Carroll S, Urdal P, Holme I. Combined diet and exercise intervention reverses the metabolic syndrome in middle-aged males: results from the Oslo diet and exercise study. Scand J Med Sci Sports. 2007 Dec 1;17(6):687-95.
Hyppönen E, Boucher BJ, Berry DJ, Power C. 25-hydroxyvitamin D, IGF-1, and metabolic syndrome at 45 years of age. Diabetes. 2008 Feb 1;57(2):298 LP-305.
Zemel MB, Shi H, Greer B, Dirienzo D, Zemel PC. Regulation of adiposity by dietary calcium. FASEB J Off Publ Fed Am Soc Exp Biol. 2000;14(9):1132-8.
Saghafi H, Hossein-Nezhad A, Rahmani M, Larijani B. Relationship between lipid profile and bone turnover in pre and postmenopausal women. Iranian J Publ Health Suppl. 2008 Jan 1;37:23-9.
Norman AW, Cade C. Vitamin D3 improves impaired glucose tolerance and insulin secretion in the vitamin d-deficient rat in vivo. Endocrinology. 1986 Jul 1;119(1):84-90.
Aparna P, Muthathal S, Nongkynrih B, Gupta SK. Vitamin D deficiency in India. J Fam Med Prim care. 2018;7(2):324.
Pilz S, März W, Cashman KD, Kiely ME, Whiting SJ, Holick MF, et al. Rationale and plan for vitamin D food fortification: A review and guidance paper. Frontiers in endocrinology. 2018;9:373.