Research Article of International Journal of Aging Research
Prevalence of hypovitaminosis D and its relation to cardiovascular risk among elderly diabetic female patients
Walaa W. Aly1, Hend M. Taha1, Khalid E. Elsorady1, Wessam E. Saad2, Ahmed K. Mortagy1
1Geriatric and Gerontology Department, Faculty of Medicine, Ain Shams University.
2Clinical Pathology Department, Ain Shams University Hospitals.
Vitamin D deficiency is highly prevalent worldwide and certain groups as elderly persons women and institutionalized persons are particularly prone to severe deficiency. Objective: To identify the prevalence of hypovitaminosis D and its relation to cardiovascular risk among elderly diabetic female patients. Method: A cross sectional study conducted from the first of October 2014 to the end of March, 2016, where 163 elderly diabetic females who attended Ain shams university hospital at that time were included. They underwent careful history taking, body mass index calculation, blood pressure measurement and Serum 25(OH) D measurement, assessment of insulin secretion including fasting serum C-peptide and CPI measurement in addition to assessment of glycemic control by fasting blood sugar estimation. The level of 25 hydroxy vitamin D (25OHD) was measured. Results: The prevalence of vitamin D deficiency (25OHD level <20 ng/mL ) and insufficiency (25OHD concentration of 20–29 ng/mL) among elderly Egyptian diabetic female patients are 71.2% and 28.2% resp. There is statistically significant association between vitamin D deficiency and low fasting C peptide level and c peptide index. The 3 independent predictor of the presence of vitamin D deficiency were types of diabetic medications, low C-peptide and CPI values and upon logistic regression analysis for these 3 variables, lower CP level was an independent predictor of the presence of vitamin D deficiency. Results showed a weak negative correlation between serum 25(OH)D, systolic BP, BMI and HOMA IR in studied subjects. Conclusion: Prevalence of vitamin D deficiency among elderly Egyptian diabetic female patients is 71.2%. There is statistically significant association between vitamin D deficiency and low fasting C peptide level and c peptide index.
Keywords: Hypovitaminosis D, cardiovascular risk, diabetic females.
How to cite this article:
Walaa W. Aly, Hend M. Taha, Khalid E. Elsorady, Wessam E. Saad, Ahmed K. Mortagy. Prevalence of hypovitaminosis D and its relation to cardiovascular risk among elderly diabetic female patients. International Journal of Aging Research, 2018, 1:15. DOI:10.28933/ijoar-2018-07-2801
1. Botros RM, Sabry IM, Abdelbaky RS, et al. (2015): Vitamin D deficiency among healthy Egyptian females. Endocrinol Nutr., 62(7):314-21.
2. Nordin BEC, Peacock M and Aaron J, et al. (1980): Osteoporosis and osteomalacia. Clin Endocrinol Metab., 9:177.
3. MacLaughlin J and Holick MF (1985): Aging decreases the capacity of human skin to produce vitamin D3. J Clin Invest., 76(4):1536-1538.
4. Bikle DD (2014): Vitamin D Metabolism, Mechanism of Action, and Clinical Applications. Chemistry and Biology 21: March 20, 319-329.
5. Bashir F, Khan ZU, Qureshi S, et al. (2016): Prevalence of Hypovitaminosis D in Type 2 Diabetes Mellitus and its Relationship with Glycemic Control. J Liaquat Uni Med Health Sci.,15(02):83-9.
6. Takiishi T, Gysemans C, Bouillon R, et al. (2010): Vitamin D and diabetes. Endocrinology and Metabolism Clinics of North America, 39:419-446.
7. Sung CC, Liao MT, Lu KC and Wu CC (2012): Role of vitamin D in Insulin Resistance. Journal of Biomedicine and Biotechnology Volume 2012, Article ID 634195
8. Seshadri KG, Tamilselvan B and Rajendran A (2011): Role of Vitamin D in Diabetes. J Endocrinol Metab, 1(2):47-56.
9. Chiu KC, Chu A, Go VL and Saad MF (2004): Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction. Am. J. Clin. Nutr., 79(5):820–825.
10. Das B, Mishra TK, Routray SN, et al. (2013): Vitamin D deficiency: A new risk factor for cardiovascular disease, JIACM, 14(3-4): 247-52.
11. Martins D, Wolf M, Pan D, et al. (2007): Prevalence of cardiovascular risk factors and the serum levels of 25-hydroxyvitamin D in the United States: data from the Third National Health and Nutrition Examination Survey. Arch Intern Med.,167(11):1159-65.
12. Grundy SM (2007): Metabolic syndrome: a multiplex cardiovascular risk factor. J Clin Endocrinol Metab., 92:399–404.
13. Li YC, Kong J, Wei M, et al. (2002): 1,25-Dihydroxyvitamin D(3) is a negative endocrine regulator of the renin-angiotensin system. J Clin Invest., 110:229–38.
14. Singh B and Saxena A (2010): Surrogate markers of insulin resistance: A review. World J Diabetes,1(2):36-47.
15. Wallace TM, Levy JC and Matthews DR (2004): Use and abuse of HOMA modeling. Diabetes Care, 27:1487–1495.
16. Prando R, Odetti P, Melga P, Giusti R, Ciuchi E, Cheli V. (1996): Progressive deterioration of beta-cell function in nonobese type 2 diabetic subjects. Postprandial plasma C-peptide level is an indication of insulin dependency. Diabetes Metab, 22:185–191.
17. Haupt E, Haupt A, Herrmann R, Benecke-Timp A, Vogel H, Walter C. (1999): The KID study V: the natural history of type 2 diabetes in younger patients still practising a profession. Heterogeneity of basal and reactive C-peptide levels in relation to BMI, duration of disease, age and HbA1. Exp Clin Endocrinol Diabetes, 107:236–243.
18. Albareda M, Rigla M, Rodriguez-Espinosa J, et al. (2005): Influence of exogenous insulin on C-peptide levels in subjects with type 2 diabetes. Diabetes Res Clin Pract, 68: 202–206.
19. Mancia G, Fagard R, Narkiewicz K et al. (2013): ESH/ESC Guidelines for the management of arterial hypertension. European Heart Journal,34:2159–2219. DOI: http://dx.doi.org/10.1093/eurheartj/eht151
20. Dawson-Hughes B, Mithal A, Bonjour JP, et al. (2010): IOF position statement: vitamin D recommendations for older adults. Osteoporos Int., 21:1151-4. [PMID: 20422154]
21. Hedblad B, Nilsson P, Janzon L and Berglund G (2000): Relation between insulin resistance and carotid intima-media thickness and stenosis in non-diabetic subjects. Results from a cross-sectional study in Malmo, Sweden. Diabet Med.,17: 299-307.
22. Gayoso-Diz P, Otero-González A, Rodriguez-Alvarez MX, et al. (2013): Insulin resistance (HOMA-IR) cut-off values and the metabolic syndrome in a general adult population: effect of gender and age: EPIRCE cross-sectional study. BMC Endocrine Disorders,13:47, http://www.biomedcentral.com/1472-6823/13/47
23. Iwata M, Maeda S, Kamura Y, et al. (2012): Genetic risk score constructed using 14 susceptibility alleles for type 2 diabetes is associated with the early onset of diabetes and may predict the future requirement of insulin injections among Japanese individuals. Diabetes Care, 35:1763–1770.
24. Ohkura T, Shiochi H, Fujioka Y, et al. (2013). 20/(fasting C-peptide × fasting plasma glucose) is a simple and effective index of insulin resistance in patients with type 2 diabetes mellitus: a preliminary report. Cardiovasc Diabetol, 12:21.
25. Funakoshi, S., Fujimoto, S., Hamasaki, A. et al. (2011a): Utility of indices using C-peptide levels for indication of insulin therapy to achieve good glycemic control in Japanese patients with type 2 diabetes. Journal of Diabetes Investigation, 2(4):297-303, (J Diabetes Invest, doi: 10.1111/j.2040-1124.2010.00096.x, 2011).
26. Isaia G, Giorgino R and Adami S (2001): High prevalence of hypovitaminosis D in female type 2 diabetic population. Diabetes Care.24(8):1496.
27. Raška I Jr, Rašková M, Zikán V and Škrha J (2016): High Prevalence of Hypovitaminosis D in Postmenopausal Women with Type 2 Diabetes Mellitus. Prague Medical Report,117(1):5–17.
28. Muscogiuri G, Nuzzo V, Gatti A, et al (2016): Hypovitaminosis D: a novel risk factor for coronary heart disease in type 2 diabetes? Endocrine., 51(2):268-73. doi: 10.1007/s12020-015-0609-7. Epub 2015 May 1.
29. Deepika G, Veeraiah N, Govardhan B and Reddy DN (2015): Role of vitamin d status in diabetes mellitus patients; variation with age, sex, season and ethnicity in indian population. Journal of Science, 5(9): 807-813.
30. Deleskog A, Hilding A, Brismar K, et al. (2012): Low serum 25-hydroxyvitamin D level predicts progression to type 2 diabetes in individuals with prediabetes but not with normal glucose tolerance. Diabetologia, 55(6):1668–1678.
31. Boucher BJ, Mannan N, Noonan K, et al. (1995): Glucose intolerance and impairment of insulin secretion in relation to vitamin D deficiency in East London Asians. Diabetologia, 38(10):1239–1245.
32. Özkan B and Döneray H (2011): The non-skeletal effects of vitamin D. Çocuk Sa?l??? ve Hastal?klar? Dergisi,54:99-119.
33. Taverna MJ, Pacher N, Bruzzo F, et al. (2001): Beta-cell function evaluated by HOMA as a predictor of secondary sulphonylurea failure in Type 2 diabetes. Diabetic medicine: a journal of the British Diabetic Association, 18(7):584 8. PMID: 11553190.
34. Shim WS, Kim SK, Kim HJ, et al. (2006): Decrement of postprandial insulin secretion determines the progressive nature of type-2 diabetes. European journal of endocrinology / European Federation of Endocrine Societies,155(4):615–22. doi: 10.1530/eje.1.02249 PMID: 16990662.
35. Chandler PD, Giovannucci EL, Scott JB, et al. (2015): Effects of Vitamin D Supplementation on C-peptide and 25 hydroxyvitamin D Concentrations at 3 and 6 Months. Sci. Rep., 5:10411; doi: 10.1038/srep10411.
36. Harinarayan CV, Arvind S, Joshi S, et al. (2014): Improvement in Pancreatic beta Cell Function with Vitamin D and Calcium Supplementation in Vitamin D Deficient Non-Diabetic Subjects. Endocr Pract., 20(2):129-38.
37. Scragg R, Sowers M and Bell C (2004): Serum 25-hydroxyvitamin D, diabetes, and ethnicity in the Third National Health and Nutrition Examination Survey. Diabetes Care, 27(12):2813–2818.
38. Kayaniyil S, Vieth R, Retnakaran R, et al. (2010): Association of vitamin D with insulin resistance and beta-cell dysfuntion in subjects at risk for type 2 diabetes. Diabetes Care., 33(6):1379-81.
39. Iwao T, Sakai K and Sata M (2013): Postprandial serum C-peptide is a useful parameter in the prediction of successful switching to liraglutide monotherapy from complex insulin therapy in Japanese patients with type 2 diabetes. Journal of diabetes and its complications,27:87–91,doi:10.1016/j.jdiacomp.2012.07.001.
40. Miñambres I, Sánchez-Quesada JL, Vinagre I, et al. (2014): Hypovitaminosis D in type 2 diabetes: relation with features of the metabolic syndrome and glycemic control. Endocr. Res., 40(3):160–165.
41. González-Molero I, Rojo-Martínez G, Morcillo S, et al. (2013): Hypovitaminosis D and incidence of obesity: a prospective study. Eur. J. Clin. Nutr., 67(6):680–682.
42. Vimaleswaran KS, Berry DJ, Lu C, et al. (2013): Causal relationship between obesity and vitaminD status: bi-directional Mendelian randomization analysis of multiple cohorts. PloSMedicine, 10(2): Article ID e1001383.
43. Taheri E, Saedisomeolia A, Djalali M, et al. (2012): The relationship between serum 25-hydroxy vitamin D concentration and obesity in type 2 diabetic patients and healthy subjects. J Diabetes Metab Disord., 11:16. doi:10.1186/2251-6581-11-16.
44. De Pergola G, Nitti A, Bartolomeo N, et al. (2013): Possible role of hyperinsulinemia and insulin resistance in lower vitamin D levels in overweight and obese patients. Biomed Res Int, 2013:921348. doi:10.1155/2013/921348
45. Parikh SJ, Edelman M, Uwaifo GI, et al. (2004): The relationship between obesity and serum 1,25-dihydroxy vitamin D concentrations in healthy adults. J Clin Endocrinol Metab, 89:1196-9.
46. Mcgill AT, Stewart JM, Lithander FE, et al. (2008): Relationships of low serum vitamin D3 with anthropometry and markers of the metabolic syndrome and diabetes in overweight and obesity. Nutr J., 7:1-5
47. Forman JP, Giovannucci E, Holmes MD, et al. (2007): Plasma 25-hydroxyvitamin D levels and risk of incident hypertension. Hypertension., 49:1063-9. [PMID: 17372031].
48. Burgaz A, Byberg L, Rautiainen S, et al. (2011): Confirmed hypertension and plasma 25(OH)D concentrations amongst elderly men. J Intern Med., 269:211-218.
49. Chandana SR, Kocharla LP, Harris SS and Kakarala RR (2009): Association of Vitamin D Deficiency with Hypertension in Uninsured Women. Journal of Health Disparities Research and Practice, 3(1): 43–52.
50. Thomas MK, Lloyd-Jones DM, Thadhani RI, et al. (1998): Hypovitaminosis D in medical inpatients. N Engl J Med., 338(12):777-783.
51. Landin-Wilhelmsen K, Wilhelmsen L, Wilske J, et al. (1995): Sunlight increases serum 25(OH) vitamin D concentration whereas 1,25(OH)2D3 is unaffected. Results from a general population study in Göteborg, Sweden (The WHO MONICA Project). Eur J Clin Nutr., 49(6):400-407.
52. Muray S, Parisi E, Cardus A, et al. (2003): Influence of vitamin D receptor gene polymorphisms and 25-hydroxyvitamin D on blood pressure in apparently healthy subjects. J. Hypertens., 21:2069-2075.
53. Gannage-Yared MH, Chedid R, Khalife S, et al. (2009): Vitamin D in relation to metabolic risk factors, insulin sensitivity and adiponectin in a young Middle-Eastern population. Eur. J. Endocrinol.,160(6):965-971.
54. Pasco JA, Henry MJ, Nicholson GC, et al. (2009): Behavioural and physical characteristics associated with vitamin D status in women. Bone, 44:1085-1091.
55. Grimes DS, Hindle E and Dyer T (1996): Sunlight, cholesterol and coronary heart disease. QJM., 89:579-89. [PMID: 8935479].
56. Rostand SG (1997): Ultraviolet light may contribute to geographic and racial blood pressure differences. Hypertension, 30:150-156. [PMID: 9260973]