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Fayoumi T, Gari A, Alarawi M, Almutairi S, Shalabi BH, Safdar O, Al Kadi H. A Retrospective Study on Vitamin D Status and Its Association With Cardiometabolic Risk Factors Among Children With Chronic Kidney Disease at King Abdulaziz University Hospital. Cureus 2023; 15:e39340. [PMID: 37351236 PMCID: PMC10284311 DOI: 10.7759/cureus.39340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Vitamin D deficiency is a significant global health issue. It is prevalent in chronic kidney disease (CKD) patients, which is an important cause of death among children. Many studies have found a link between low vitamin D status in CKD patients and cardiovascular disease (CVD) risk factors. However, there are no data on this relationship in children with CKD in Saudi Arabia. AIMS We aimed to demonstrate this association among children with CKD admitted to the King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia. MATERIALS AND METHODS Data were collected between June and August 2020 from a convenience sample of pediatric patients. RESULTS In total, 153 pediatric patients with CKD stages 2-5 were admitted to the KAUH between 2010 and 2019, and 67.3% had CKD stage 5. Approximately 4.6% and 10.5% of the participants were overweight or obese, respectively. Patients who fell into the lower 25-hydroxyvitamin D (25[OH]D) tertile were older, had higher body mass index (BMI) values, and had higher blood pressure than those in the upper two tertiles; however, these differences were not statistically significant. There was a significant inverse association of 25(OH)D levels with BMI, blood pressure, and serum creatinine levels. CONCLUSIONS The results of this retrospective study suggest that patients with CKD and lower vitamin D levels have a higher BMI and blood pressure and are therefore at higher risk of developing CVD. Future prospective studies with a larger sample size are needed to confirm these findings. Randomized clinical trials are also needed to investigate the effect of sufficient vitamin D status on reducing CVD in patients with CKD.
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Affiliation(s)
- Tala Fayoumi
- Medical Intern, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Atheer Gari
- Medical Intern, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Marah Alarawi
- Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Samia Almutairi
- Medical Intern, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | | | - Osama Safdar
- Pediatrics Department, King Abdulaziz University Hospital, Jeddah, SAU
| | - Hanan Al Kadi
- Physiology Department, King Abdulaziz University Hospital, Jeddah, SAU
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Aerobic Exercise Ameliorates Myocardial Fibrosis via Affecting Vitamin D Receptor and Transforming Growth Factor-β1 Signaling in Vitamin D-Deficient Mice. Nutrients 2023; 15:nu15030741. [PMID: 36771445 PMCID: PMC9919278 DOI: 10.3390/nu15030741] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/26/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023] Open
Abstract
Myocardial fibrosis is a pathological phenomenon associated with cardiovascular disease (CVD) that plays a crucial role in the development of heart diseases. Vitamin D deficiency can promote the development of CVD and exercise plays a role in the treatment of CVD. This study aimed to explore the effects of 12-week aerobic exercise training on myocardial fibrosis in vitamin D-deficient mice. A vitamin D-deficient mouse model was induced by a vitamin D-deficient (0 IU Vitamin D3/kg) diet. Twenty-four C57BL/6J male mice were randomly divided into three groups: a control sedentary group (CONS, n = 8), a vitamin D-deficient sedentary group (VDDS, n = 8), and a vitamin D-deficient exercise group (VDDE, n = 8) which was aerobically trained for 12 weeks. The results showed that the serum 25-hydroxyvitamin D [25(OH)D] levels of the VDDS group were <50 nmol/L, which was significantly lower than that of the CONS group. Compared with the CONS group, the VDDS group showed cardiac dysfunction and significant fibrosis, together with lower vitamin D receptor (VDR) mRNA and protein expression levels, higher mRNA expression levels of profibrotic and inflammatory factors, and higher transforming growth factor-β1 (TGF-β1) and phospho-Smad2/3 (P-Smad2/3) protein expression levels. Serum 25(OH)D levels in the VDDE group were significantly higher than those in the VDDS group. Compared with the VDDS group, the VDDE group showed improved cardiac function and alleviated myocardial fibrosis. Meanwhile, the VDDE group had significantly higher VDR mRNA and protein expression levels; lower mRNA expression levels of profibrotic and inflammatory factors; and lower TGF-β1 and P-Smad2/3 protein expression levels. In conclusion, aerobic exercise training remains a promising intervention for treating myocardial fibrosis in vitamin D deficiency.
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Qorbani M, Zarei M, Moradi Y, Appannah G, Djalainia S, Pourrostami K, Ejtahed HS, Mahdavi-Gorabi A, Naderali EK, Khazdouz M. Effect of vitamin D supplementation on cardiac-metabolic risk factors in elderly: a systematic review and meta-analysis of clinical trials. Diabetol Metab Syndr 2022; 14:88. [PMID: 35752843 PMCID: PMC9233853 DOI: 10.1186/s13098-022-00859-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There has been a longstanding interest in the potential effect of vitamin D in preventing cardiac-metabolic diseases. However, there are divergent results regarding the impact of vitamin D supplementation (VDS) on managing cardiac-metabolic outcomes in the elderly population. MATERIAL AND METHOD We systematically searched electronic databases; Web of Science, PubMed, Scopus, EMBASE, Cochrane, and ProQuest. We included all trials that evaluated the effect of VDS on cardiac-metabolic risk factors in the elderly population, which were published until 30 September 2021. The effects of VDS on cardiac-metabolic outcomes were assessed using standardized mean difference (SMD). A random-effect model was used to pool the SMD and 95% confidence interval (CI). RESULT The literature search identified 4409 studies, of which 12 trials met inclusion criteria. Results of random effect meta-analysis indicated a significant reduction in total cholesterol (TC) (SMD: - 0.14 mg/dl; 95% CI: - 0.25, - 0.02) and triglyceride (TG) (SMD: - 0.45 mg/dl; 95% CI: - 0.86, - 0.04) with VDS compared to the placebo. The subgroup analyses revealed that the reduction of TG in patients with diabetes and vitamin D deficiency was significant. Furthermore, short-term intervention (≤ 6 months) induced a significantly lower level of TG and insulin in comparison to longer duration (> 6 months). CONCLUSION The study suggests that VDS could improve insulin concentration and dyslipidemia in the elderly population. The systematic review was registered in Alborz university of medical sciences with 2060-01-03-1397 number and the Ethics council IR.ABZUMS.REC.1397.207 number.
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Affiliation(s)
- Mostafa Qorbani
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Zarei
- Department of Nutrition Community, Deputy of Health affairs, Ministry of Health and Medical Education, Tehran, Iran
| | - Yousef Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Geeta Appannah
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor Malaysia
| | - Shirin Djalainia
- Development of Research & Technology Center, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Kumars Pourrostami
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Hanieh-Sadat Ejtahed
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Armita Mahdavi-Gorabi
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Maryam Khazdouz
- Growth and Development Research Center, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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Liu D, Meng X, Tian Q, Cao W, Fan X, Wu L, Song M, Meng Q, Wang W, Wang Y. Vitamin D and Multiple Health Outcomes: An Umbrella Review of Observational Studies, Randomized Controlled Trials, and Mendelian Randomization Studies. Adv Nutr 2021; 13:1044-1062. [PMID: 34999745 PMCID: PMC9340982 DOI: 10.1093/advances/nmab142] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/29/2020] [Accepted: 11/19/2021] [Indexed: 12/18/2022] Open
Abstract
Observational studies, randomized controlled trials (RCTs), and Mendelian randomization (MR) studies have yielded inconsistent results on the associations of vitamin D concentrations with multiple health outcomes. In the present umbrella review we aimed to evaluate the effects of low vitamin D concentrations and vitamin D supplementation on multiple health outcomes. We summarized current evidence obtained from meta-analyses of observational studies that examined associations between vitamin D concentrations and multiple health outcomes, meta-analyses of RCTs that investigated the effect of vitamin D supplementation on multiple health outcomes, and MR studies that explored the causal associations of vitamin D concentrations with various diseases (international prospective register of systematic reviews PROSPERO registration number CRD42018091434). A total of 296 meta-analyses of observational studies comprising 111 unique outcomes, 139 meta-analyses of RCTs comprising 46 unique outcomes, and 73 MR studies comprising 43 unique outcomes were included in the present umbrella review. Twenty-eight disease outcomes were identified by both meta-analyses of observational studies and MR studies. Seventeen of these reported disease outcomes had consistent results, demonstrating that lower concentrations of vitamin D were associated with a higher risk for all-cause mortality, Alzheimer's disease, hypertension, schizophrenia, and type 2 diabetes. The combinations of consistent evidence obtained by meta-analyses of observational studies and MR studies together with meta-analyses of RCTs showed that vitamin D supplementation was associated with a decreased risk for all-cause mortality but not associated with the risk for Alzheimer's disease, hypertension, schizophrenia, or type 2 diabetes. The results indicated that vitamin D supplementation is a promising strategy with long-term preventive effects on multiple chronic diseases and thus has the potential to decrease all-cause mortality. However, the current vitamin D supplementation strategy might not be an efficient intervention approach for these diseases, suggesting that new strategies are highly needed to improve the intervention outcomes.
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Affiliation(s)
- Di Liu
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China,Centre for Biomedical Information Technology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, China
| | - Xiaoni Meng
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Qiuyue Tian
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Weijie Cao
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Xin Fan
- School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Lijuan Wu
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Manshu Song
- Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Qun Meng
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Wei Wang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China,Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia,School of Public Health, Shandong First Medical University and Shandong Academy of Medical Science, Tai'an, Shandong, China
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Variability in genes regulating vitamin D metabolism is associated with vitamin D levels in type 2 diabetes. Oncotarget 2018; 9:34911-34918. [PMID: 30405883 PMCID: PMC6201852 DOI: 10.18632/oncotarget.26178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/17/2018] [Indexed: 12/19/2022] Open
Abstract
Mortality rate is increased in type 2 diabetes (T2D). Low vitamin D levels are associated with increased mortality risk in T2D. In the general population, genetic variants affecting vitamin D metabolism (DHCR7 rs12785878, CYP2R1 rs10741657, GC rs4588) have been associated with serum vitamin D. We studied the association of these variants with serum vitamin D in 2163 patients with T2D from the “Sapienza University Mortality and Morbidity Event Rate (SUMMER) study in diabetes”. Measurements of serum vitamin D were centralised. Genotypes were obtained by Eco™ Real-Time PCR. Data were adjusted for gender, age, BMI, HbA1c, T2D therapy and sampling season. DHCR7 rs12785878 (p = 1 x 10–4) and GC rs4588 (p = 1 x 10–6) but not CYP2R1 rs10741657 (p = 0.31) were significantly associated with vitamin D levels. One unit of a weighted genotype risk score (GRS) was strongly associated with vitamin D levels (p = 1.1 x 10–11) and insufficiency (<30 ng/ml) (OR, 95%CI = 1.28, 1.16–1.41, p = 1.1 x 10–7). In conclusion, DHCR7 rs12785878 and GC rs4588, but not CYP2R1 rs10741657, are significantly associated with vitamin D levels. When the 3 variants were considered together as GRS, a strong association with vitamin D levels and vitamin D insufficiency was observed, thus providing robust evidence that genes involved in vitamin D metabolism modulate serum vitamin D in T2D.
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Apostolakis M, Armeni E, Bakas P, Lambrinoudaki I. Vitamin D and cardiovascular disease. Maturitas 2018; 115:1-22. [PMID: 30049340 DOI: 10.1016/j.maturitas.2018.05.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/22/2018] [Accepted: 05/30/2018] [Indexed: 02/01/2023]
Abstract
Vitamin D, a soluble steroid hormone synthesized in the skin after sun exposure, plays a crucial role in calcium metabolism and is also involved in cardiovascular pathophysiology. The aim of this review is to summarize the available evidence (a) on the association between endogenous vitamin D status and cardiovascular disease, and (b) on the effect of vitamin D supplementation on cardiovascular outcomes. Most studies have shown an inverse association between vitamin D levels and cardiovascular outcomes. Randomized controlled trials, however, do not consistently support a beneficial effect of vitamin D administration on cardiovascular health. Population characteristics, comorbid conditions such as diabetes, the overall population prevalence of cardiovascular disease, vitamin D status and the regimen of vitamin D supplementation may account for the conflicting results.
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Affiliation(s)
- Michail Apostolakis
- Menopause Clinic, 2nd Department of Obstetrics and Gynaecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Armeni
- Menopause Clinic, 2nd Department of Obstetrics and Gynaecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Bakas
- Menopause Clinic, 2nd Department of Obstetrics and Gynaecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Irene Lambrinoudaki
- Menopause Clinic, 2nd Department of Obstetrics and Gynaecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
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Tarighi S, Najafi M, Hossein-Nezhad A, Ghaedi H, Meshkani R, Moradi N, Fadaei R, Kazerouni F, Shanaki M. Association Between Two Common Polymorphisms of Vitamin D Binding Protein and the Risk of Coronary Artery Disease: A Case-control Study. J Med Biochem 2017; 36:349-357. [PMID: 30581332 PMCID: PMC6294082 DOI: 10.1515/jomb-2017-0015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/07/2017] [Indexed: 12/15/2022] Open
Abstract
Background Coronary Artery Disease (CAD) is one of the most widespread non-communicable diseases. Vitamin Dbinding protein (VDBP) and its genetic poly morphisms have been highlighted as the susceptible components for CAD. The aim of the present study was to examine the association of VDBP single nucleotide poly morphisms (SNPs) - rs7041 and rs4588 - with CAD susceptibility among the Iranian population. Methods A total of 143 men with CAD and 145 healthy age-sex matched controls underwent genotyping for the - rs7041 and rs4588 polymorphisms using the polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) method. Serum level of 25(OH)D was assayed using microplate colorimetric enzyme immunoassay. Results We found a significant association between GG genotype (rs7041) and CAD (p=0.02, OR=0.537 95% CI =0.306-0.944). Regarding rs4588 polymorphism, a significant difference was observed in which the CA genotype (p=0.00032, OR=2.578, 95% CI=1.579-4.208) and allele A (P=0.028, OR=1.491, 95% CI=1.043-2.132) were significantly higher in CAD patients compared to controls. In spite of lower serum levels of 25(OH)D in CAD patients, we found no significant association between these SNPs and Vitamin D serum concentrations. Conclusion We concluded that VDBP polymorphisms affect the susceptibility to CAD in Iranian men. Therefore, further studies are required to clarify the association of VDBP phenotypes and its serum levels with CAD.
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Affiliation(s)
- Shahriar Tarighi
- Department of Medical Laboratory Sciences, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Najafi
- Department of Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran, Cardiac Outcome Research and Education (CORE), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Arash Hossein-Nezhad
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Ghaedi
- Department of Medical Genetics, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Meshkani
- Department of Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Nariman Moradi
- Department of Clinical Biochemistry, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Fadaei
- Department of Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Faranak Kazerouni
- Department of Medical Laboratory Sciences, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrnoosh Shanaki
- Department of Medical Laboratory Sciences, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- E-mail:
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Grübler MR, März W, Pilz S, Grammer TB, Trummer C, Müllner C, Schwetz V, Pandis M, Verheyen N, Tomaschitz A, Fiordelisi A, Laudisio D, Cipolletta E, Iaccarino G. Vitamin-D concentrations, cardiovascular risk and events - a review of epidemiological evidence. Rev Endocr Metab Disord 2017; 18:259-272. [PMID: 28451877 DOI: 10.1007/s11154-017-9417-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Vitamin D has long been established as an elemental factor of bone physiology. Beyond mineral metabolism, the expression of the vitamin D receptor has been identified throughout the cardiovascular (CV) system. Experimental studies showed beneficial effects of vitamin D on heart and vessels, but vitamin D intoxication in animals also led to hypercalcemia and vascular calcification. Our knowledge has been extended by epidemiological studies that showed that 25-hydroxyvitamin D (25(OH)D) levels are inversely associated with an increased CV risk itself, but also with established CV risk factors, such as arterial hypertension, endothelial dysfunction and atherosclerosis. Conversely, randomized controlled trials could not document significant and consistent effects of vitamin D supplementation on CV risk or events. Potential explanations may lie in differences in reference ranges or the possibility that low vitamin D in CV disease is only an epiphenomenon. In the latter case, the key question is why low 25(OH)D levels are such a strong predictor of health. While we wait for new data, the current conclusion is that vitamin D is a strong risk marker for CV risk factors and for CV diseases itself.
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Affiliation(s)
- Martin Robert Grübler
- Swiss Cardiovascular Centre Bern, Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland.
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.
| | - Winfried März
- Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, and Rheumatology), Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
- Synlab Academy, Synlab Services GmbH, and Augsburg, Mannheim, Germany
| | - Stefan Pilz
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, Netherlands
| | - Tanja B Grammer
- Mannheim Institute of Public Health, Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Christian Trummer
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Christian Müllner
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Verena Schwetz
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Marlene Pandis
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Nicolas Verheyen
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Andreas Tomaschitz
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Graz, Austria
- Bad Gleichenberg Clinic, Schweizereiweg 4, 8344, Bad Gleichenberg, Austria
| | | | | | - Ersilia Cipolletta
- Department of Medicine, Surgery Odontoiatrics-Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Guido Iaccarino
- Department of Medicine, Surgery Odontoiatrics-Scuola Medica Salernitana, University of Salerno, Salerno, Italy
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Lucato P, Solmi M, Maggi S, Bertocco A, Bano G, Trevisan C, Manzato E, Sergi G, Schofield P, Kouidrat Y, Veronese N, Stubbs B. Low vitamin D levels increase the risk of type 2 diabetes in older adults: A systematic review and meta-analysis. Maturitas 2017; 100:8-15. [PMID: 28539181 DOI: 10.1016/j.maturitas.2017.02.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 02/09/2017] [Accepted: 02/14/2017] [Indexed: 12/18/2022]
Abstract
Low serum levels of 25 hydroxyvitamin D (25OHD) (hypovitaminosis D) is common in older adults and associated with several negative outcomes. The association between hypovitaminosis D and diabetes in older adults is equivocal, however. We conducted a meta-analysis investigating if hypovitaminosis D is associated with diabetes in prospective studies among older participants. Two investigators systematically searched major electronic databases, from inception until 10/07/2016. The cumulative incidence of diabetes among groups was estimated according to baseline serum 25OHD levels. Random effect models were used to assess the association between hypovitaminosis D and diabetes at follow-up. From 4268 non-duplicate hits, 9 studies were included; these followed 28,258 participants with a mean age of 67.7 years for a median of 7.7 years. Compared with higher levels of 25OHD, lower levels of 25OHD were associated with a higher risk of developing diabetes (6 studies; n=13,563; RR=1.31; 95% CI: 1.11-1.54; I2=37%). The findings remained significant after adjusting for a median of 11 potential confounders in all the studies available (9 studies; n=28,258; RR=1.17; 95% CI: 1.03-1.33; p=0.02; I2=0%). In conclusion, our data suggest that hypovitaminosis D is associated with an elevated risk of future diabetes in older people. Future longitudinal studies are required and should seek to confirm these findings and explore potential pathophysiological underpinnings.
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Affiliation(s)
- Paola Lucato
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
| | - Marco Solmi
- Institution for clinical Research and Education in Medicine (IREM), Padova, Italy; Department of Neurosciences, University of Padova, Padova, Italy
| | - Stefania Maggi
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
| | - Anna Bertocco
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
| | - Giulia Bano
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
| | - Caterina Trevisan
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
| | - Enzo Manzato
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
| | - Giuseppe Sergi
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
| | - Patricia Schofield
- Faculty of Health, Social Care and Education, Anglia Ruskin University,Bishop Hall Lane, Chelmsford CM1 1SQ, UK
| | - Youssef Kouidrat
- Department of Nutrition and Obesity, AP-HP, Maritime Hospital, F-62600 Berck, France
| | - Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
| | - Brendon Stubbs
- Department of Nutrition and Obesity, AP-HP, Maritime Hospital, F-62600 Berck, France; Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom.
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Zittermann A. The Biphasic Effect of Vitamin D on the Musculoskeletal and Cardiovascular System. Int J Endocrinol 2017; 2017:3206240. [PMID: 28912809 PMCID: PMC5587949 DOI: 10.1155/2017/3206240] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/10/2017] [Indexed: 01/03/2023] Open
Abstract
This narrative review summarizes beneficial and harmful vitamin D effects on the musculoskeletal and cardiovascular system. Special attention is paid to the dose-response relationship of vitamin D with clinical outcomes. In infants and adults, the risk of musculoskeletal diseases is highest at circulating 25-hydroxyvitamin D (25OHD) concentrations below 25 nmol/L and is low if 40-60 nmol/L are achieved. However, evidence is also accumulating that in elderly people the risk of falls and fractures increases again at circulating 25OHD levels > 100 nmol/L. Cohort studies report a progressive increase in cardiovascular disease (CVD) events at 25OHD levels < 50 nmol/L. Nevertheless, meta-analyses of randomized controlled trials suggest only small beneficial effects of vitamin D supplements on surrogate parameters of CVD risk and no reduction in CVD events. Evidence is accumulating for adverse vitamin D effects on CVD outcomes at 25OHD levels > 100 nmol/L, but the threshold may be influenced by the level of physical activity. In conclusion, dose-response relationships indicate deleterious effects on the musculoskeletal system and probably on the cardiovascular system at circulating 25OHD levels < 40-60 nmol/L and >100 nmol/L. Future studies should focus on populations with 25OHD levels < 40 nmol/L and should avoid vitamin D doses achieving 25OHD levels > 100 nmol/L.
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Affiliation(s)
- Armin Zittermann
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
- *Armin Zittermann:
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Skaaby T, Thuesen BH, Linneberg A. Vitamin D, Cardiovascular Disease and Risk Factors. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 996:221-230. [DOI: 10.1007/978-3-319-56017-5_18] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
Vitamin D is a precursor of the steroid hormone calcitriol that is crucial for bone and mineral metabolism. Both the high prevalence of vitamin D deficiency in the general population and the identification of the vitamin D receptor in the heart and blood vessels raised interest in the potential cardiovascular effects of vitamin D. Experimental studies have demonstrated various cardiovascular protective actions of vitamin D, but vitamin D intoxication in animals is known to induce vascular calcification. In meta-analyses of epidemiological studies, vitamin D deficiency is associated with an increased cardiovascular risk. Findings from Mendelian randomization studies and randomized, controlled trials (RCTs) do not indicate significant effects of a general vitamin D supplementation on cardiovascular outcomes. Previous RCTs, however, were not adequately designed to address extraskeletal events, and did not focus on vitamin D-deficient individuals. Therefore, currently available evidence does not support cardiovascular benefits or harms of vitamin D supplementation with the commonly used doses, and whether vitamin D has cardiovascular effects in individuals with overt vitamin D deficiency remains to be evaluated. Here, we provide an update on clinical studies on vitamin D and cardiovascular risk, discuss ongoing vitamin D research, and consider the management of vitamin D deficiency from a cardiovascular health perspective.
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