Vitamin K: a nutrient which plays a little-known role in glucose metabolism

The effect of vitamin K4 supplementation on insulin resistance in individuals with type 2 diabetes: a double-blind randomised placebo-controlled clinical trial

PURPOSE

The purpose of this study was to assess the possible clinical effects of vitamin K4 supplementation in individuals with type 2 diabetes namely insulin resistance, glycaemic control, and lipid profile.

METHODS

This was a prospective randomised double-blind placebo-controlled clinical trial. A total of 106 patients were randomised to receive either 1 mg of vitamin K4 (menadiol diacetate) or placebo for 24 weeks.

RESULTS

Ninety patients (n = 45 in each study group) were included in the final analysis. After 24 weeks, homeostatic model assessment of insulin resistance (HOMA-IR) (16.54 ± 7.81 vs. 29.09 ± 36.56, P = 0.027) and fasting serum insulin (FSI) (6.86 ± 3.45 vs. 11.13 ± 12.66 µU/ml, P = 0.032) were significantly lower in the vitamin K group compared to placebo. Additionally, triglycerides (TG) (144.94 ± 50.7 vs. 172.8 ± 101.5 mg/dl, P = 0.031) and very low-density lipoproteins (VLDL) levels (28.9 ± 9.88 vs. 34.6 ± 20.30 mg/dl, P = 0.027) decreased significantly in the vitamin K group after 24 weeks compared to baseline. Moreover, more patients in the vitamin K group (35.6%) had their antidiabetic medication doses reduced after 24 weeks compared to placebo (13.3%, P = 0.029).

CONCLUSION

Vitamin K4 supplementation for 24 weeks is capable of improving insulin resistance and TG levels in individuals with type 2 diabetes. In addition, the improvement in insulin resistance was reflected in the decrease in antidiabetic medication doses. However, it did not affect fasting plasma glucose (FPG) or glycated haemoglobin (HbA1c).

TRIAL REGISTRATION

The study was registered on clinicaltrials.gov with ID: NCT04285450.

Dietary vitamin K3 activates mitophagy, improves antioxidant capacity, immunity and affects glucose metabolism in Litopenaeus vannamei

An 8-week feeding experiment was conducted to appraise the influence of dietary vitamin K₃ on the growth performance, antioxidant capacities, immune responses, mitophagy and glucose metabolism in Litopenaeus vannamei. Six diets containing graded dietary vitamin K₃ (0.40(control), 9.97, 20.29, 39.06, 79.81 and 156.02 mg kg^-1 of vitamin K₃, respectively) levels were formulated. A total of 900 shrimp with 0.90 g initial weight were randomly assigned to six diets with three replications. Our results revealed that diets supplemented with 9.97-156.02 mg kg^-1 vitamin K₃ didn't affect the growth performance in L. vannamei. In general, compared with the control group, 39.06 mg kg^-1 vitamin K₃ group significantly increased (P < 0.05) the total antioxidative capacity, and the activities of catalase, glutathione, nitric oxide synthase, alkaline phosphatase and acid phosphatase in serum and hepatopancreas. 39.06 mg kg^-1 vitamin K₃ group significantly decreased (P < 0.05) the malondialdehyde in serum and hepatopancreas. The mRNA levels of antioxidant and immune related genes were increased synchronously (P < 0.05). In addition, 39.06 mg kg^-1 vitamin K₃ group increased glycogen content and levels of mitophagy (pink1, ampkα, parkin, lc3, atg13, atg12) genes. Expression levels of glucose transport related gene (glut1), glycolysis related genes (hk, pfk), glycogen synthesis related genes (gsk-3β, gys), insulin-like peptides (ILPs)/AKT/PI3K pathway related genes (insr, irsl, akt, pi3k, pdpk1) were increased in the hepatopancreas of 39.06 mg kg^-1 vitamin K₃ group. In conclusion, the present results indicated that although dietary supplementing vitamin K₃ had no influence on the growth performance, 39.06 mg kg^-1 vitamin K₃ could activate ampkα/pink1/parkin mediated mitophagy, improve antioxidant capacity and immune response. Moreover, vitamin K₃ could trigger ILPs/AKT/PI3K signaling pathways and influence glucose metabolism in L. vannamei. This finding would help to advance the field of vitamin K₃ nutrition and guide the development of future crustacean feeds.

Effect of supplementation with vitamins D3 and K2 on undercarboxylated osteocalcin and insulin serum levels in patients with type 2 diabetes mellitus: a randomized, double-blind, clinical trial

BACKGROUND

Patients with type 2 diabetes mellitus (T2DM) are characterized by chronic hyperglycemia as a consequence of decreased insulin sensitivity, which contributes to bone demineralization and could also be related to changes in serum levels of osteocalcin and insulin, particularly when coupled with a deficiency in the daily consumption of vitamins D3 and K2. The objective of this study was to evaluate the effect of vitamin D3 and vitamin K2 supplements alone or in combination on osteocalcin levels and metabolic parameters in patients with T2DM.

METHODS

A double-blind, randomized clinical trial was carried out in 40 patients aged between 30 and 70 years old for 3 months. Clinical and laboratory assessment was carried out at the beginning and at the end of the treatment. The patients were divided into three groups: (a) 1000 IU vitamin D3 + a calcinated magnesium placebo (n = 16), (b) 100 µg of Vitamin K2 + a calcinated magnesium placebo (n = 12), and (c) 1000 IU vitamin D3 + 100 µg vitamin K2 (n = 12).

RESULTS

After treatment in the total studied population, a significant decrease in glycemia (p = 0.001), HOMA-IR (Homeostatic model assessment-insulin resistance) (p = 0.040), percentage of pancreatic beta cells (p < 0.001), uOC/cOC index and diastolic blood pressure (p = 0.030) were observed; in vitamin D3 group, differences in serum undercarboxylated osteocalcin (p = 0.026), undercarboxylated to carboxylated osteocalcin index (uOC/cOC) (p = 0.039) glucose (p < 0.001) and  % of functional pancreatic beta cells (p < 0.001) were demonstrated. In vitamin K2 group a significant decrease in glycemia (p = 0.002), HOMA-IR (p = 0.041), percentage of pancreatic beta cells (p = 0.002), and in cOC (p = 0.041) were observed, conversely cOC concentration was found high. Finally, in the vitamins D3 + K2 a significant decrease in glycemia (p = 0.002), percentage of pancreatic beta cells (p = 0.004), and in the uOC/cOC index (p = 0.023) were observed.

CONCLUSION

Individual or combined supplementation with vitamins D3 and K2 significantly decreases the glucose levels and  % of functional pancreatic beta cells, while D3 and D3 + K2 treatments also induced a reduction in the uOC/cOC index. Only in the group with vitamin D3 supplementation, it was observed a reduction in undercarboxylated osteocalcin while vitamin K2 increased the carboxylated osteocalcin levels.Trial registration NCT04041492.

Traditional plain yogurt: a therapeutic food for metabolic syndrome?

Dairy products have an important role in a healthy diet due to their high-quality protein and rich micronutrients. Yogurt, a fermented milk product, has a similar composition to milk but is a more concentrated product in terms of group B vitamins, minerals, and proteins. It is known that bioactive metabolites and live enzymes that occur by fermentation and digestion, affect the health positively by improving gut microbiota. In recent years, the prevalence of metabolic syndrome, which threatens public health, is increasing rapidly. As with other noninfectious diseases, the diet has an important effect on the prevention and treatment of metabolic syndrome. It has been demonstrated that yogurt has a high-quality amino acid pattern, reduces energy intake by stimulating satiety, and regulates blood glucose level. In addition to the rich protein variety, yogurt also contains peptides that positively affect blood pressure. Unlike milk, increased acidity during the fermentation of yogurt positively affects calcium absorption. Calcium plays an important role in the control of blood glucose and energy metabolism through insulin-dependent and non-insulin-dependent routes. In addition to reducing inflammation, calcium has a positive effect on the regulation of the blood lipid profile by increasing fecal fat excretion. There are many lipid and lipoid nutrients such as saturated fatty acids, phospholipids, sphingolipids, and conjugated linoleic acid that may affect the blood lipid profile in yogurt positively or negatively. There are seen very few randomized controlled studies that are focused on the relationship between yogurt and metabolic syndrome, and these are based on contradictory results. In this review, based on the clinical studies conducted to date, and the nutrient content of yogurt, possible mechanisms of these contradictory results are investigated.

Statin Use is Associated With Insulin Resistance in Participants of the Canadian Multicentre Osteoporosis Study

Context

Statins have been linked to the development of diabetes and atherosclerotic plaque calcification in patients with cardiac disease.

Objective

To determine the association between statin use and statin characteristics and insulin resistance and abdominal aortic calcification (AAC) in participants of the Canadian Multicentre Osteoporosis Study (CaMos).

Design

Observational study.

Setting

General community.

Participants

Nondiabetic participants of the Kingston CaMos site.

Intervention

Insulin resistance and AAC in statin users and nonstatin users were compared with and without the inclusion of a propensity score (PS) to be on a statin. The covariates of hypertension, sex, body mass index, smoking, kidney stones, and age that were included in the PS were selected based on clinical judgment confirmed by the statistical analysis of a difference between statin users and nonstatin users.

Main Outcome Measures

Insulin resistance measured by the homeostasis model assessment (HOMA-IR) and AAC assessed on lateral spine radiographs using the Framingham methodology.

Results

Using a general linear model, statin use was associated with higher levels of HOMA-IR after stratified PS adjustment (β = 1.52, [1.18-1.95], P < 0.01). Hydrophilic statin users (n = 9) and lipophilic statins users (n = 30) had higher HOMA-IR compared to nonstatin users (n = 125) ([β = 2.29, (1.43-3.68), P < 0.001] and [β = 1.36, (1.04-1.78), P < 0.05]), respectively, in general linear models after stratified PS adjustment. Statin use was associated with AAC without stratifying by PS in the Wilcoxon test, but was no longer significant when stratified by PS.

Conclusions

Statins, widely prescribed drugs to lower cholesterol, may have unintended consequences related to glucose homeostasis that could be relevant in healthy aging.

Microwave Assisted Cloud Point Extraction for the Determination of Vitamin K Homologues in Vegetables by Liquid Chromatography with Tandem Mass Spectrometry

Liquid chromatography-electrospray ionization tandem mass spectrometry (LC-ESI-MS/MS) with a triple quadrupole (QqQ) is proposed for determining the vitamin K homologues, phylloquinone (PK), menaquinone-4 (MK) and menadione (MD), in vegetables. The analytes were isolated from the samples (1-1.5 g) by ultrasound assisted extraction using acetonitrile (2 mL), and the liquids were submitted to microwave assisted cloud point extraction with Triton X-45. The enrichment factors were between 20 and 50, depending on the vitamin homologue in question. The analytes were determined by LC-ESI-QqQ-MS/MS in the multiple reaction monitoring (MRM) mode, providing unequivocal identification and quantification, with limits of detection of 0.8, 1.0, and 16 ng/g for MK, PK, and MD, respectively. Recovery assays for samples spiked at two concentration levels, between 40 and 600 ng/g depending on the compound, provided recoveries in the 90-114% range. Only PK was detected in the samples analyzed, at concentrations in the 90-2350 ng/g range.