Printer Friendly

ASSOCIATION BETWEEN DECREASE IN SERUM VITAMIN D LEVEL AND INCREASE IN BODY MASS INDEX.

Byline: Shazia Rashid, Rakhshan Khurshid, Uzma Faryal Amir, Sheikh Muhammad Qaisar Rashid, Bibi Hajra and Muhammad Afaq Ali

ABSTRACT

Background: Levels of vitamin D in the population have come under increasing examination; however there are only a few studies in Saudi Arabia which measure levels in the general population. The objective of the study was to measure the association between decrease in level of vitamin D and increase in BMI in males and females of Saudi population.

Material and Methods: A cross sectional study of 94 participants with age range 16-75 years in a group of Saudi Arabian people was conducted. Duration of study was six months (June to November 2014). Both male and female were comprised into four groups, group A with an age range 15-30 years, group B with age range of 31-45 years, group C with age range of 46-61 years and group D with age range of 62-75 years. Individuals who visited with complaints of musculo skeletal pain, backache and easy fatigability were included in the study. Their body weight and height were measured for BMI. Serum levels of 25-hydroxy vitamin D [25(OH)D] in relation to demographic characteristics (age, sex) and selected health risk factors (physical activity, body mass index) were examined.

Results: Overall, the mean level of serum 25(OH )D was <20 IU in 70% female and 30% male which is recognized as vitamin D deficiency. A highly significant positive correlation (P<0.001) was observed between decrease in vitamin D and increase in BMI with r value 0.812 and 0.963 in male and female respectively.

Conclusion: Vitamin D deficiency is strongly associated in young obese people of both genders.

KEY WORDS: Vitamin D; Obesity; Body Mass Index.

INTRODUCTION

Vitamin D deficiency occurs worldwide. Factors like low sunlight exposure, age-related reduction in cutaneous synthesis, high Body Mass Index (BMI) and foods low in vitamin D increase the likelihood of vitamin D deficiency1,2 Obesity is one of the major factors of vitamin D deficiency although its exact mechanism is not known.3 It is suggested that obese individuals may avert sun light exposure, that is important for the cutaneous synthesis of vitamin D.4

Instead, it is also proposed that increased formation of vitamin D metabolite 1,25-dihydroxy vitamin D may have negative feedback on the hepatic synthesis of vitamin D.5 It is also found that in obesity there is increased metabolic clearance of vitamin D especially in women, may be because of increased uptake by adipose tissue.6 Prevalence of obesity was higher among women as compared to men (33.5% vs 24.1%). Among women, obesity was associated with marital status, education and hypertension whereas for men obesity was linked with marital status, diet, physical activity, diagnosis of diabetes, hypercholesterolemia and hypertension.7

Distinguishing vitamin D deficiency in children may be significant for their skeletal and cardiovascular wellbeing. Fractures, Blount disease, slipped capital femoral epiphysis and impaired glucose homeostasis are more common in obese people and may be associated with vitamin D deficiency.8,9

Insufficiency of vitamin D is reported in approximately 36% elderly patients and also among patients with osteoporosis. The prevalence of vitamin D deficiency that is<50 nmol/L was 87.8% and insufficiency being [greater than or equal to]50-75 nmol/L was 9.7%, respectively.10

According to World Health Organization sponsored MONICA Project 30% of the Arab World population is overweight or obese, including both adolescents and adults.11 The reason may be lack of physical activity due to the luxury life including accessibility of housemaids, cars and sophisticated household appliances.12 Cutoffs Values have also been described as deficiency being 50 nmol/L.13 Vitamin D has a vital role in the synthesis of bone tissue and low levels of vitamin D may lead to rickets, osteoporosis, increased susceptibility to fractures, tooth loss and osteomalacia.14-17

Deficiency of Vitamin D is also linked with a swarm of chronic conditions, including type 1 diabetes, hypertension and multiple sclerosis.1 However, these studies are usually cross sectional and carried out in different conditions making assessments difficult. Inadequate vitamin D status (<50 nmol/L) is an increasingly important health issue in Saudi Arabia as it is essential for skeletal health in every age group. Besides adults and elderly people identification of deficiency of vitamin D is also important in children as well as adolescents due to occurrence of peak bone-mass accrual.

The objective of the study was to measure the association between decrease in level of vitamin D and increase in BMI in males and females of Saudi population.

MATERIAL AND METHODS

This cross sectional study was conducted at department of King Abdul Aziz Specialist Hospital, Al-Jouf, Kingdom of Saudi Arabia from June to November 2014. Sample size was 94 selected through convenient sampling technique. Inclusion criteria was individuals of both sexes having complaints of bone pain, backache or easy fatigability. Exclusion criteria was individuals with renal disease or bone disorders. Demographic variables were gender and age having attributes of 15-30,31-45, 46-61 and 62-75 years. Research variables were BMI with 4 attributes of healthy weight, over weight, obese and severely obese. Vitamin D having 3 attributes of normal (30-75 IU), vitamin D insufficiency (20-29 IU) and vitamin D deficiency (<20 IU). Measurements of vitamin D was done by using the DiaSorin radioimmunoassay kit (Stillwater, MN).

Age, BMI and vitamin D being numeric were expressed as means +-SD, whereas gender and age group being categorical were analyzed through frequency and percentages. Linear relations between serum levels of vitamin D and BMI were computed by using Pearson correlation coefficient. Results were considered significant if p values was <0.05. A structured performa was used to record data. Data was analyzed by SPSS 20.0.

RESULTS

Out of 94 subjects 30% were males and 70% were females. Distribution of the sample by age groups, BMI and vitamin D levels is given in table-1. A highly significant positive correlation (P40###15.29 +-7.35

###49.2%###15-30###22-25###12.42 +-5.82

###22%###31-45###26-30###12.57 +-6.37

Female (70%)

###17.4%###46-61###31-39###17.55 +-5.22

###11.4%###62-75###>40###19.47 +-5.97**

DISCUSSION

Although the role of vitamin D for bone health is well established recent studies also propose the protective role of vitamin D against non-communicable diseases.18

Present study showed that females (70%) were more prone to musculoskeletal pain and easy fatigability as compared to males (30%). However a study found the prevalence of vitamin D deficiency (<50 nmol/l) was 22% in men and 39% in women. A study reported that the prevalence of deficiency of vitamin D increasing with age, was more in females in the obese subjects and those who have sedentary life style.19

We found that both male and female with age 16-75 years have severe vitamin D (<20 IU) deficiency. A highly significant correlation (p <0.001) was observed between decreased vitamin D and increased BMI with r value 0.812 and 0.963 in male and female respectively.

In males the range of vitamin D was 12-15 IU in all age groups. However in females the vitamin D deficiency was more frequent (49.2%) in subjects aged 15-30 years followed by 22% in subjects aged 31-45 years. However a study found that the prevalence of deficiency of vitamin D was 30% in females of 50 to 60 years of age and greater than 80% in females after the age of 80 years.20 According to a study deficiency of vitamin D ( 65 was 13% in females and 8% in males.22 Our study is in contrast with a study who reported that cutaneous synthesis of vitamin D and its stores decrease with age. Achlorhydria is common in older subjects and it may limit calcium absorption.23 A study carried out on people living in Saudi Arabia reported that vitamin D deficiency affects bone mass density as well as bone turnover markers among Saudi Arabian males and is largely attributed to sedentary lifestyle, minimal exposure to sunlight, older age and obesity.10

According to recommended normal values of vitamin D (30-75 IU) is a highly significant difference was observed when compared with values of vitamin D of male and females. According to a study serum level of vitamin D should be >32 IU to improve calcium absorption.24 It is suggested that proper vitamin D concentration may also be significant for providing the enzyme renal 1-alpha-hydroxylase which is necessary for the production of 1,25-dihydroxy vitamin D.25

Deficiency of vitamin D may initiate and aggravate osteoporosis among adults and causes bone aches and it is the most important factor in predicting the risk of fractures of the neck of femur.26

Present study also observed that there is a significant direct relationship of low levels of vitamin D with high values of BMI in all age groups in both sexes. According to another study high values of BMI were also associated with low vitamin D levels in obese males as well as females. Study reported that obese people may have sedentary life style, however this inverse relationship has also been attributed to cholecalciferol, the precursor of vitamin D present in adipose tissue and may be responsible for low body vitamin D levels as conversion to 25(OH)D does not occur.27 Another study reported that obesity did not affect the capability of the skin to synthesize vitamin D , but may have affected the release of vitamin D from skin into the circulation.

Present study was carried out in summer season and we agreed with a study that plentiful existence of sunlight may not prevent the deficiency of vitamin D.20

However according to a study the most significant predictors of reduced 25(OH)D in both sexes were winter and spring season.29

Diet and supplements and maintenance of normal body weight are chief modifiable factors for increasing vitamin D level and thus potentially influencing vulnerability to common chronic diseases. Present study was in agreement with a study who found that low vitamin D status was considerably associated with sedentary lifestyle and obesity (BMI [greater than or equal to]30).30

CONCLUSION

Vitamin D deficiency is strongly associated in young obese people of both genders.

REFERENCES

1. Holick MF. High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc 2006;81:353-73.

2. Larose TL, Chen Y, Camargo CA Jr, Langhammer A, Romundstad P, Mai XM. Factors associated with vitamin D deficiency in a Norwegian population: the HUNT Study. JECH 2014;68:165-70.

3. Holick M. Vitamin D deficiency. N Engl J Med 2007;357:266-81.

4. Compston JE, Vedi S, Ledger JE, Webb A, Gazet JC, Pilkington TRE. Vitamin D status and bone histomorphometry in gross obesity. Am J Clin Nutr 1981;34:2359-63.

5. Bell NH, Epstein S, Greene A, Shary J, Oexmann MJ, Shaw S. Evidence for alteration of the vitamin D-endocrine system in obese subjects. J Clin Invest 1985;76:370-3.

6. Liel Y, Ulmer E, Shary J, Hollis BW, Bell NH. Low circulating vitamin D in obesity. Calcif Tissue Int 1988;43:199-201.

7. Erem C, Arslan C, Hacihasanoglu A, Deger O, Topbas M, Ukinc K et al. Prevalence of obesity and associated risk factors in a Turkish population (trabzon city, Turkey). Obes Res 2004;12:1117-27.

8. Dimitri P, Bishop N, Walsh JS, Eastell R. Obesity is a risk factor for fracture in children but is protective against fracture in adults: a paradox. Bone 2012;50:457-66.

9. Brown D. Seasonal variation of slipped capital femoral epiphysis in the United States. J Pediatr Orthop 2004;24:139-43.

10. Ardawi MS, Sibiany AM, Bakhsh TM, Qari MH, Maimani AA. High prevalence of vitamin D deficiency among healthy Saudi Arabian men: relationship to bone mineral density, parathyroid hormone, bone turnover markers, and lifestyle factors. Osteoporos Int 2012 ;23:675-86.

11. Roya K, Pour MH, Zadegan NS, Sadry GH, Ansari R, Alikhassy H et al. Obesity and Associated Modifiable Environmental Factors in Iranian Adolescents: Isfahan Heart Health Promotion from Childhood. Pediatr Int 2003;45:435-42.

12. Galal, Osman M. The Nutrition Transition in Egypt: Obesity, Under nutrition, and the Food Consumption Context 2002;p.147.

13. Lau SL, Gunton JE, Athayde NP, Byth K, Cheung NW. Serum 25-hydroxyvitamin D and glycated haemoglobin levels in women with gestational diabetes mellitus. Med J Aust 2011;194:334-7.

14. Holick MF, Binkley NC, Bischoff-Ferrari HA. Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011;96:1911-30.

15. Brewer L, Williams D, Moore A. Current and future treatment options in osteoporosis. Eur J Clin Pharmacol 2011;67:321-31.

16. "BMI Classification". Global Database on Body Mass Index. World Health Organization 2006. Retrieved July 27, 2012.

17. Sahay M and Sahay R. Rickets: vitamin D deficiency and dependency. Indian J Endocrinol Metab 2012;16:164-76.

18. Hirani V, Cumming RG, Blyth FM, Naganathan V, Le Couteur DG, Handelsman DJ. Vitamin D status among older community dwelling men living in a sunny country and associations with lifestyle factors: the Concord Health and Ageing in Men Project, Sydney, Australia.J Nutr Health Aging 2013;17:587-93.

19. Daly R, Gagnon C, Lu Z, Magliano D, Dunstan D, Sikaris K et al. Prevalence of vitamin D deficiency and its determinants in Australian adults aged 25 years and older: a national, population based study. Clin Endocrinol 2012;77:26-35.

20. BandeiraF, Griz L, Dreyer P, Eufrazino C, Bandeira C, Freese E. Vitamin D deficiency: a global perspective. ABEandM 2006;50:128-30.

21. Ross AC, Manson JE, Abrams SA. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab 2011;96:53-8.

22. Hirani V, Tull K, Ali A, Mindell J. Urgent action needed to improve vitamin D status among older people in England. Age Ageing 2010;39:62-8.

23. Gloth FM, Gundberg CM, Hollis BH, Haddad JG, Tobin JD. Vitamin D deficiency in homebound elderly person. JAMA 1995;274:1638-6.

24. Heaney RP. Functional indices of vitamin D status and ramifications of vitamin D deficiency. Am J Clin Nutr 2004;80:S1706-9.

25. Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers and cardiovascular disease. Am J Clin Nutr 2004;80(6 Suppl):S1678-88.

26. Pittas AG, Dawson-Hughes B, Li T, Van Dam R, Willett WC, Manson JE et al. Vitamin D and calcium intake in relation to type 2 diabetes in women. Diabetes Care 2006;29:650-6.

27. Brock K, Huang W-Y, Fraser DR, Ke L, Tseng M, Stolzenberg-Solomon R et al. Low vitamin D status is associated with physical inactivity, obesity and low vitamin D intake in a large US sample of health middle-aged men and women. J Steroid Biochem Mol Biol 2010;121:462-6.

28. Wortsman J, Matsuka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 20v00;72:690-3.

29. Jolliffe DA, Hanifa Y, Witt KD, Venton TR, Rowe M, Timms PM et al. Environmental and genetic determinants of vitamin D status among older adults in London, UK. J Steroid Biochem Mol Biol 2016;164:30-5.

30. Thuesen B, Husemoen L, Fenger M, Jakobsen J, Schwarz P, Toft U. Determinants of vitamin D status in a general population of Danish adults. Bone 2012;50:605-10.
COPYRIGHT 2017 Asianet-Pakistan
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2017 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Publication:Gomal Journal of Medical Sciences
Article Type:Report
Geographic Code:7SAUD
Date:Sep 30, 2017
Words:2754
Previous Article:IMAGES IN CLINICAL MEDICINE.
Next Article:ASSOCIATION OF MATERNAL BMI WITH FETAL BIRTH WEIGHT AND MATERNAL HEIGHT WITH FETAL CROWN HEEL LENGTH.
Topics:

Terms of use | Privacy policy | Copyright © 2021 Farlex, Inc. | Feedback | For webmasters |