Correlation Between Serum 25(OH)D and Abdominal Visceral Fat Area in Patients with Type 2 Diabetes Mellitus in the Context of different Bone Mass

VITAMIN D DEFICIENCY AS AN INDEPENDENT PREDICTOR OF CARDIOVASCULAR DISEASE

Context

In addition to traditional risk factors for cardiovascular diseases, there are new risk factors with potentially relevant prognostic, such as vitamin D deficiency.

Objective

The study aims to analyze the relationship between vitamin D deficiency and the occurrence of cardiovascular disease, in patients who already have at least one cardiovascular risk factor.

Design

It is a prospective, observational study. Follow- up time was 24 months.

Subjects and methods

A total of 77 patients were included in the study, aged over 18 years, who had at least one cardiovascular risk factor. Their vitamin D levels were measured and they were monitored for a period of 2 years, in order to see which one developed cardiovascular diseases.

Results

Of the 77 patients, 56 (72.7%) had serum deficient levels of vitamin D and the mean serum level was 16 ng/mL (± 8.6 ng/mL). Statistically significant differences were observed only in the case of dyslipidemia (p=0.0334). The evolution to cardiovascular disease occurred in 39 of the cases (50.6%). The only independent risk factors for progression to cardiovascular disease demonstrated in this study were serum vitamin D (OR = 0.9024, 95% CI: 0.83-0.97 and age (OR = 1.1313, 95% CI: 1.05-1.21).

Conclusion

The results shows that patients with cardiovascular risk factors and advanced age are at a higher risk of developing cardiovascular disease, if they also have vitamin D deficiency.

INSULIN RESISTANCE AND PATHOGENESIS OF POSTMENOPAUSAL OSTEOPOROSIS

Osteoporosis (OP) is a disease predisposing postmenopausal women to fractures, and often accompanied by insulin resistance (IR) and metabolic syndrome (MetS). Previous studies provided contradictory results concerning prevalence of MetS in postmenopausal OP. To better understand the pathogenesis of IR, we reviewed cellular and molecular aspects and systematically reviewed studies providing homeostasis model assessment (HOMA) index. Bone is an active endocrine organ maintaining its integrity by orchestrated balance between bone formation and resorption. Both osteoblasts and osteoclasts contain receptors for insulin and insulin-like growth factor-1 (IGF-1) operating in skeletal development and in the adult life. Defects in this system generate systemic IR and bone-specific IR, which in turn regulates glucose homeostasis and energy metabolism through osteocalcin. Examination of genetic syndromes of extreme IR revealed intriguing features namely high bone mineral density (BMD) or accelerated growth. Studies of moderate forms of IR in postmenopausal women reveal positive correlations between HOMA index and BMD while correlations with osteocalcin were rather negative. The relation with obesity remains complex involving regulatory factors such as leptin and adiponectin to which the contribution of potential genetic factors and in particular, the correlation with the degree of obesity or body composition should be added.

HEMATOLOGICAL INDICES RELATED TO VITAMIN D DEFICIENCY IN OBESE CHILDREN

Introduction

Vitamin D is involved in differentiation and induction of erythropoiesis in bone marrow cells.

Aim

We compared the serum 25(OH) vitamin D level in obese children versus control and found correlations between vitamin D level and hematological indices in obese children.

Materials and methods

25 overweight and obese patients and 15 normal weight children were enrolled in an observational study .

Results

In obese children, the serum level of 25(OH) vitamin D was significantly (p<0.04) lower (20.60 ng/mL) compared with the value from normal weight ones (25.63 ng/mL) and the body fat percentage BFP was higher. We found a positive correlation (r=0.44, p<0.05) between serum vitamin D and hemoglobin level and a negative one between serum vitamin D and the number of platelets (r= -0.43, p<0.05). Also, the serum iron was at the lower normal limit in the obese children and negatively correlated with the percent of the body fat (r= -0,62, p<0.05).

Conclusion

Obese children have vitamin D deficiency. The hemoglobin level and the number of platelets are correlated with the serum level of 25(OH) vitamin D. Supplements with vitamin D may have pleiotropic effects, including those on bone marrow activity.

BODY COMPOSITION CHANGES IN MEN WITH HIV/HCV COINFECTION, HIV MONOINFECTION, AND HCV MONOINFECTION

Context

Both human immunodeficiency virus (HIV) infection and hepatitis C virus (HCV) infection represent systemic diseases that may develop metabolic complications, thus HIV/HCV coinfection metabolic changes need to be depicted.

Objective

We aimed to evaluate the body composition changes in patients with either HIV and HCV monoinfections or HIV/HCV coinfection.

Methods

123 young men divided into three groups: 41 with HIV/HCV coinfection, 42 with HIV-monoinfection, and 40 with HCV-monoinfection were evaluated for total and regional bone and soft tissue body composition assessments using a Dual-energy X-ray absorptiometry (DXA) and were compared with 40 healthy men with age and body mass index similar to the study groups. To detect sarcopenia, we calculated the appendicular limbs' lean mass index (ALMI), for obesity, we used the percent of body fat, and for lipodystrophy, we calculated the trunk/limbs index.

Results

HIV/HCV coinfection is associated with a significant higher bone demineralization in all regions of interest compared to HCV or HIV monoinfections and to controls. The prevalence of bone demineralization in HIV/HCV patients was 31.7%, more frequently at lumbar spine. Fat mass and lean mass were significantly lower in HIV/HCV-coinfected patients than in controls. Lipodystrophy was found in similar percentages in all three evaluated groups (80.4% in HIV/HCV, 92.5% in HIV, and 95% in the HCV group). Sarcopenia was higher in HIV/HCV group (43.9%) and important in HCV-monoinfection group (30%).

Conclusions

HIV/HCV-coinfected patients had the highest prevalence of bone demineralization, fat mass, and lean mass loss, compared to controls and to HIV and HCV monoinfections.