Telesna masa i obim struka kao prediktori nedostatka vitamina D kod bolesnika sa dijabetesom tipa 2 i kardiovaskularnom bolešću

Abstract

Uvod/Cilj. Nedostatak vitamina D je poznat faktor rizika od oboljenja skeleta. Sve je više podataka o ulozi nedostatka vitamina D u razvoju dijabetesa melitusa tipa 2 (T2DM), dislipidemije, hipertenzije, i drugih kardiovaskularnih bolesti (KVB). Cilj studije bio je da se ustanovi učestalost nedostatka vitamina D kod bolesnika sa T2DM sa ili bez KVB, korelacija nedostatka vitamina D sa antropometrijskim i metaboli čkim parametrima i odrede prediktori nedostatka vitamina D. Metode. U studiju je bilo uključeno 88 bolesnika sa T2DM [(49 muškaraca/39 žena, životno doba 61,0 ± 0,9 god, indeks telesne mase (ITM) 29,9 ± 0,4 kg/m2)] i 67 bolesnika (44 muškaraca/23 žena, životno doba 63,6 ± 1,0 god, ITM 29,2 ± 0,5 kg/m2) sa T2DM i KVB (infarkt miokarda kod 57 bolesnika i angina pektoris kod 10 bolesnika). Ovi bolesnici su upoređeni sa 87 zdrava ispitanika (35 muškarca/ 52 žena, životno doba 52,8 ± 1,4 god, ITM 27,2 ± 0,5 kg/m2). Mereni su telesna masa, visina, obim struka i ITM, kao i nivo holesterola, triglicerida, hemoglobina A1c (HbA1c) i 25-hidroksi vitamin D[25(OH)D]. Prema nivou 25(OH)D svi ispitanici bili su podeljeni u tri grupe: težak nedostatak vitamina D (≤ 15 ng/mL), nedostatak vitamina D (15-20 ng/mL) i zadovoljavajući nivo vitamina D (? 20 ng/mL). Ispitana je korelacija nivoa vitamina D sa antropometrijskim i metaboličkim parametrima i određeni su prediktori nedostatka vitamina D. Rezultati. Težak nedostatak vitamina D registrovan je kod 16,1% zdravih ispitanika, 21,6% bolesnika sa T2DM i 26,9% bolesnika sa T2DM i KVB. Bolesnici sa T2DM koji su imali težak nedostatak vitamina D imali su veću telesnu masu, obim struka, nivoe holesterola i triglicerida u poređenju sa bolesnicima sa T2DM koji su imali zadovoljavajući nivo vitamina D. Nivo 25(OH)D korelisao je sa ITM i obimom struka kod svih ispitanika, ali nije korelisao sa metaboličkim parametrima (lipidi, HbA1c). Najbolji prediktori nivoa vitamina D kod svih ispitanika bili su telesna masa, obim struka i ITM. Zaključak. Visoka učestalost nedostatka vitamina D kod bolesnika sa T2DM, a posebno kod bolesnika sa T2DM i KVB ukazuje na potrebu supstitucije vitaminom D iako još uvek nema dovoljno podataka o tome.

Background/Aim. Vitamin D deficiency is a well-established risk factor for bone disease, but emerging data suggest that altered vitamin D homeostasis may play a role in the development of type 2 diabetes mellitus (T2DM), dyslipidemia hypertension, and other cardiovascular diseases (CVD). The aim of this study was to investigate the prevalence of vitamin D deficiency in patients with T2DM with/without CVD, to correlate it with anthropometric and metabolic parameters and to determine the predictors of vitamin D deficiency. Methods. A total of 88 patients with T2DM (49 male/39 female, aged 61.0 ± 0.9 yrs, body mass index (BMI) 29.9 ± 0.4 kg/m2) and 67 patients (44 male/23 female, aged 63.6 ± 1.0 yrs, BMI 29.2 ± 0.5 kg/m2) with T2DM and CVD (myocardial infarction in 57 patients and angina pectoris in 10 patients) were included in this study. These patients were compared with 87 healthy subjects (35 male/52 female, aged 52.8 ± 1.4 yrs, BMI 27.2 ± 0.5 kg/m2). Weight, height, waist circumference and BMI were recorded in all patients. Also, total cholesterol, triglycerides, hemoglobin A1c (HbA1c) and 25-hydroxy-vitamin D [25(OH)D] levels were measured in all. According to 25(OH)D level, all subjects were divided into three categories: severe vitamin D deficiency (≤ 15 ng/mL), vitamin D insufficiency (15-20 ng/mL) and vitamin D sufficiency (? 20 ng/mL). We correlated vitamin D levels with anthropometric and metabolic status and determined the predictors of vitamin D deficiency. Results. Severe vitamin D deficiency was registered in 16.1% healthy subjects, in 21.6% patients with T2DM and in 26.9% patients with T2DM and CVD. Patients with T2DM who were vitamin D deficient had increased weight, waist circumference, cholesterol and triglyceride levels when compared with patients with T2DM who had sufficient vitamin D level. 25(OH)D levels correlated with BMI and waist circumference in all subjects, but did not correlate with metabolic parameters (lipids, HbA1c). The best predictors of vitamin D level in all subjects were weight, waist circumference and BMI. Conclusion. The high prevalence of vitamin D deficiency in patients with T2DM and particularly in patients with T2DM and CVD suggests that supplementation with vitamin D may be beneficial although there is still not sufficient evidence for recommending prescribing vitamin D.