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Open Access 01-12-2019 | Obesity | Research article

Prevalence of vitamin D deficiency and its association with metabolic derangements among children with obesity

Authors: S. G. S. Adikaram, D. B. D. L. Samaranayake, N. Atapattu, K. M. D. L. D. Kendaragama, J. T. N. Senevirathne, V. Pujitha Wickramasinghe

Published in: BMC Pediatrics | Issue 1/2019

Abstract

Background

It is known that obesity is associated with vitamin D deficiency and observational studies have shown vitamin D deficiency to be linked with the development of type 2 diabetes. There are no comprehensive data regarding vitamin D deficiency in children with obesity in Sri Lanka and the objective of the study was to assess the prevalence of Vitamin D deficiency and its association with metabolic derangements among children with obesity.

Methodology

Two hundred and two children between 5 and 15 years of age attending the obesity clinic Lady Ridgeway Hospital (LRH) were recruited excluding those having possible secondary causes for obesity. Blood was drawn after 12-h overnight fast for fasting blood glucose(FBG), lipid profile, serum insulin, alanine aminotransferase (ALT),aspartate aminotransferase(AST), Vitamin D, parathyroid hormone(PTH),high sensitivity C reactive protein(hs-CRP). Oral glucose tolerance test (OGTT) was done with 2 h random blood glucose. Anthropometry, blood pressure were measured, and body fat mass was assessed using bio-impedance.

Results

Vitamin D deficiency (< 20 ng/ml) was seen in 152(75.2%) children and 43(21.3%) had insufficient (20-30 ng/ml) levels. Skin fold thickness, fasting and post-glucose insulin, HOMA-IR, PTH, LDL, Serum cholesterol and hs-CRP showed statistically significant negative correlations with Vitamin D levels.

Conclusions

Vitamin D deficiency was significantly high in Sri Lankan children with obesity and showed significant negative correlations with indicators of insulin resistance and adiposity.

Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr. 2000;72:690–3.CrossRef

Kadowaki S, Norman AW. Time course study of insulin secretion after 1,25-dihydroxyvitamin D3 administration. Endocrinology. 1985;117(5):1765–71. https://doi.org/10.1210/endo-117-5-1765.CrossRefPubMed

Lee S, Clark SA, Gill RK, Christakos S. 25-Dihydroxyvitamin D3 and pancreatic β-cell function: vitamin D receptors, gene expression, and insulin secretion. Endocrinology. 1994;134(4):1602–10. https://doi.org/10.1210/endo.134.4.8137721.CrossRefPubMed

Scragg R, Holdaway I, Singh V, Metcalf P, Baker J, Dryson E. Serum 25-hydroxyvitamin D3levels decreased in impaired glucose tolerance and diabetes mellitu. Diabetes Res Clin Pract. 1995;27(3):181–8. https://doi.org/10.1016/0168-8227(95)01040-K.CrossRefPubMed

Sooy K, Schermerhorn T, Noda M, Surana M, Rhoten WB, Meyer M, Fleischer N, Sharp GW, Christakos S. Calbindin-D(28k) controls [Ca²⁺]_i and insulin release. Evidence obtained from calbindin-d(28k) knockout mice and βcell lines. J Biol Chem. 1999;274(48):34343–9. https://doi.org/10.1074/jbc.274.48.34343.CrossRefPubMed

Reyman M, Verrijn Stuart AA, van Summeren M, Rakhshandehroo M, Nuboer R, de Boer FK, et al. Vitamin D deficiency in childhood obesity is associated with high levels of circulating inflammatory mediators, and low insulin sensitivity. Int J Obes. 2014;38(1):46–52. https://doi.org/10.1038/ijo.2013.75.CrossRef

Hettiarachchi M, Liyanage C. Coexisting micronutrient deficiencies among Sri Lankan pre-school children: a community-based study. Matern Child Nutr. 2012;8(2):259–66. https://doi.org/10.1111/j.1740-8709.2010.00290.x.CrossRefPubMed

Marasinghe E, Chackrewarthy S. AbeysenaC,RajindrajithS.Micronutrient status and its relationship with nutritional status in preschool children in urban Sri Lanka. Asia Pac J Clin Nutr. 2015;24(1):144–51. https://doi.org/10.6133/apjcn.2015.24.1.17.CrossRefPubMed

Obesity and Overweight.WHO fact sheet.[online] Available at: https://www.who.int/growthref/who2007_bmi_for_age/en/ [accessed 20.03.2017].

10.

Dimension _X ^pand Plus Creatinine assay. Semens healthcare diagnostics Inc. USA (Issue date 30.07.2104).

11.

IMMULITE/IMMULITE 1000 intact PTH(PILKPP.19,2015-04-20).

12.

Holick MF, Binkley NC, Bischoff, Ferrari FA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D Deficiency.Clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911–30. https://doi.org/10.1210/jc.2011-0385.CrossRefPubMed

13.

Hettihawa LM, Palangasinghe S, Jayasinghe SS, Gunasekara SW, Weerarathna TP. Comparison of insulin resistance by indirect methods - HOMA, QUICKI and McAuley - with fasting insulin in patients with type 2 diabetes in Galle, Sri Lanka: a pilot study. Online J Health Allied Sci. 2006;1:2.

14.

Ten S, Maclaren N. Insulin resistance syndrome in children. J Clin Endocrinol Metab. 2004;89(6):2526–39. https://doi.org/10.1210/jc.2004-0276.CrossRefPubMed

15.

Singh Y, Garg MK, Tandon N, Marwaha RM. A study of insulin resistance by HOMA-IR and its cut-off value to identify metabolic syndrome in urban Indian adolescents. J Clin Res Pediatr Endocrinol. 2013;5(4):245–51. https://doi.org/10.4274/jcrpe.1127.CrossRefPubMedPubMedCentral

16.

Zimmet P, Alberti KGMM, Kaufman F, Tajima N, Silink MandArslanian S. The metabolic syndrome in children and adolescents – IDF consensus report. Pediatr Diabetes. 2007;8:299–306.CrossRef

17.

American Academyof Pediatrics. Cholesterol in Childhood Committee on Nutrition 1998;101(1):141–147 doi: https://pediatrics.aappublications.org/content/101/1/141

18.

Jackson LV, Thalanga NKS, Cole TJ. Blood pressure centiles for Great Britain. Archives of Diseases in Childhood. 2007;92:298–303. https://doi.org/10.1136/adc.2005.081216.CrossRef

19.

McCarthy HD, Jarrett KV, Crawley HF. The development of waist circumference percentiles in British children aged 5.0-16.9yrs. Eur J Clin Nutr. 2001;55(10):902–7. https://doi.org/10.1038/sj.ejcn.1601240.CrossRefPubMed

20.

Wickramasinghe VP, Arambepola C, Bandara P, et al. Definingobesityusing a biological end point in Sri Lankanchildren. Indian J Pediatr. 2017;84:117. https://doi.org/10.1007/s12098-016-2191-2.CrossRefPubMed

21.

Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28:412–9.CrossRef

22.

Turer CB, Lin H, Flores G. Prevalence of vitamin D deficiency among overweight and obese US children. Pediatrics. 2013;131(1):152–61. https://doi.org/10.1542/paeds.2012-1711.CrossRef

23.

Moore C, Liu Y. Adipocity predicts vitamin D status of children. FASEB J. 2015;29:747.

24.

McGill AT, Stewart JM, Lithander FE, Strik CM, Poppitt SD. Relationships of low serum vitamin D₃ with anthropometry and markers of the metabolic syndrome and diabetes in overweight and obesity. Nutr J. 2008;7:4. https://doi.org/10.1186/1475-2891-7-4.CrossRefPubMedPubMedCentral

25.

Kelishadi R, Salek S, Salek M, Hashemipour M, Movahedian M. Effects of vitamin D supplementation on insulin resistance and cardio-metabolic risk factors in children with metabolic syndrome: a triple-masked controlled trial. Jornal de Pediatria (VersãoemPortuguês). 2014;90(1):28–34. https://doi.org/10.1016/j.jped.2013.06.006.CrossRef

26.

Didriksen A, Burild A, Jakobsen J, Fuskevag OM, Jorde R. Vitamin D3 increases inabdominal subcutaneous fat tissue after supplementation with vitamin D3. Eur J Endocrinol. 2015;172:235–41.CrossRef

27.

Cade C, Norman AW. Vitamin D₃ improves impaired glucose tolerance and insulin secretion in the vitamin D-deficient rat in vivo. Endocrinology. 1986;119(1):84–90. https://doi.org/10.1210/endo-119-1-84.CrossRefPubMed

28.

Maestro B, Campión J, Dávila N, Calle C. Stimulation by 1,25-dihydroxyvitamin D₃ of insulin receptor expression and insulin responsiveness for glucose transport in U-937 human promonocytic cells. Endocr J. 2000;47:383–91. https://doi.org/10.1507/endocrj.47.383.CrossRefPubMed

29.

Talaei A, Mohamadi M, Adgi Z. The effect of vitamin D on insulin resistance in patients with type 2 diabetes. Diabetol Metab Syndr 2013;5:8 doi:https://doi.org/10.1186/1758-5996-5-8.CrossRefPubMedPubMedCentral

30.

Song Y, Wang L, Pittas AG, Del Gobbo LC, Zhang C, Manson JE, Hu FB. Blood 25-hydroxy vitamin D levels and incident type 2 diabetes: a meta-analysis of prospective studies. Diabetes Care. 2013;36(5):1422–8. https://doi.org/10.2337/dc12-0962.CrossRefPubMedPubMedCentral

31.

Danescu LG, Levy S, Levy J. Vitamin D and diabetes mellitus. Endocrine. 2009;35:11–7. https://doi.org/10.1007/s12020-008-9115-5.CrossRefPubMed

32.

Gelaye B, Revilla L, Lopez T, Suarez L, Sanchez SE, Hevner K, et al. Association between insulin resistance and C- reactive protein among Peruvian adults. Diabetol Metab Syndr. 2010;2:30. https://doi.org/10.1186/1758-5996-2-30.CrossRefPubMedPubMedCentral

33.

Ridker PM. C-reactive protein and the prediction of cardiovascular events among those at intermediate risk: moving an inflammatory hypothesis toward consensus. J Am Coll Cardiol. 2007;49:2129–38. https://doi.org/10.1016/j.jacc.2007.02.052.CrossRefPubMed

34.

Amini Z, Bryant S, Smith C, Singh R, Kumar S. Is the serum vitamin D-parathyroid hormone relationship influenced by obesity in children? Horm Res Paediatr. 2013;80(4):252–6. https://doi.org/10.1159/000354645.CrossRefPubMed

35.

Kalaichelvi T, Samaranayake D, Wickramasinghe P, Thoradeniya ST, Lanerolle P. Vitamin D deficiency and its association with adiposity among primary school children aged 8–9 years in Colombo municipal area, 130th Anniversary International Medical Congress of the Sri Lanka Medical Association 2017,Abstract No 712,oral presentation.

36.

Dhillon PK, Narang GS, Arora S, Kukreja S. A hospital based prospective study of vitamin D deficiency in a selected group of apparently healthy children one to five years of age. Sri Lanka J Child Health. 2015;44(3):158–62. https://doi.org/10.4038/sljch.v44i3.8014.CrossRef

37.

Francisco B, Luiz G, Patricia D, Catia E, Cristina B, Eduardo F. Vitamin D deficiency: a global perspective. Arq Bras Endocrinol Metab. 2006;50(4):640–6 [cited 2019 Mar 04].CrossRef

Title: Prevalence of vitamin D deficiency and its association with metabolic derangements among children with obesity
Authors: S. G. S. Adikaram
D. B. D. L. Samaranayake
N. Atapattu
K. M. D. L. D. Kendaragama
J. T. N. Senevirathne
V. Pujitha Wickramasinghe
Publication date: 01-12-2019
Publisher: BioMed Central
Keywords: Obesity
Obesity
Insulins
Vitamin D Deficiency
Insulins
Published in: BMC Pediatrics / Issue 1/2019
Electronic ISSN: 1471-2431
DOI: https://doi.org/10.1186/s12887-019-1558-8

At a glance: The STEP trials

Springer Medicine

Prevalence of vitamin D deficiency and its association with metabolic derangements among children with obesity

Abstract

Background

Methodology

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methodology

Results

Conclusions

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