Gender-Dependent Association of Vitamin D Deficiency with Obesity and Hypercholesterolemia (LDLC) in Adults

Author(s): Norah Almesri, Nagalla S. Das, Muhallab E. Ali, Khalid Gumaa, Hayder A. Giha*.

Journal Name: Endocrine, Metabolic & Immune Disorders - Drug Targets
(Formerly Current Drug Targets - Immune, Endocrine & Metabolic Disorders)

Volume 20 , Issue 3 , 2020

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Abstract:

Background: Obesity, dyslipidemia and vitamin D deficiency are growing health problems in the Arabian Gulf region. Their association with each other is yet to be clarified.

Methods: Three-hundred and fourteen Bahraini adults, 164 males and 150 females comparable in median age (34.5 vs. 31.0 yrs), body mass index (BMI), and ethnicity were recruited. The plasma level of 25-hydroxyvitamin D3 (25OHD3) was measured by chemiluminescent immunoassay and lipid profile parameters were measured by an automated clinical chemistry analyzer. Based on BMI, study subjects were grouped into underweight, normal, overweight, moderate obesity, and severe obesity subjects.

Results: The results revealed an extremely high prevalence of vitamin D deficiency (79.9%) and insufficiency (18.8%). The predictors of low 25OHD3 levels were female gender, small age, conservative dressing, least exposure to sunlight, and less fish intake. In all subjects, the lowest 25OHD3 level was seen in underweight and severe obesity groups. Furthermore, the 25OHD3 level was significantly higher in males as compared to females and it was positively correlated with the age. However, detailed analysis showed that overweight males unlike females had the highest 25OHD3 levels which were significantly higher than in the severely obese males. While the lipid profile parameters were positively correlated with BMI, the total and LDL cholesterols were negatively correlated with the levels of 25OHD3 in males.

Conclusion: Vitamin D deficiency was associated with both severely obese and underweight subjects, in the former it was likely to be institutional while in the latter it was likely to be nutritional. Furthermore, hypercholesterolemia (LDL-C) was associated with 25OHD3 sub-normality. Further analysis revealed that the significant associations were gender-dependent.

Keywords: Vitamin D, obesity, gender, BMI, hypercholesterolemia, Bahrain.

[1]
Liel, Y.; Ulmer, E.; Shary, J.; Hollis, B.W.; Bell, N.H. Low circulating vitamin D in obesity. Calcif. Tissue Int., 1988, 43(4), 199-201.
[http://dx.doi.org/10.1007/BF02555135] [PMID: 3145124]
[2]
Migliaccio, S.; Di Nisio, A.; Mele, C.; Scappaticcio, L.; Savastano, S.; Colao, A. Obesity and hypovitaminosis D: causality or casualty? Int. J. Obes. Suppl., 2019, 9(1), 20-31.
[http://dx.doi.org/10.1038/s41367-019-0010-8] [PMID: 31391922]
[3]
Non-communicable Diseases Country Profiles; World Health Organisation: Geneva, Switzerland, 2011, p. 209.
[4]
Kilpi, F.; Webber, L.; Musaigner, A.; Aitsi-Selmi, A.; Marsh, T.; Rtveladze, K.; McPherson, K.; Brown, M. Alarming predictions for obesity and non-communicable diseases in the Middle East. Public Health Nutr., 2014, 17(5), 1078-1086.
[http://dx.doi.org/10.1017/S1368980013000840] [PMID: 23642403]
[5]
National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Food and Nutrition Board; Roundtable on Obesity Solutions Callahan, E.A. Callahan, E.A., Eds.; Eds. Callahan, EA, Eds.; Proceedings of a Workshop, US2019.
[6]
Musaiger, A.O.; Al-Roomi, K.; Bader, Z. Social, dietary and lifestyle factors associated with obesity among Bahraini adolescents. Appetite, 2014, 73, 197-204.
[http://dx.doi.org/10.1016/j.appet.2013.11.002] [PMID: 24231426]
[7]
Fukumoto, S.; Ozono, K.; Michigami, T.; Minagawa, M.; Okazaki, R.; Sugimoto, T.; Takeuchi, Y.; Matsumoto, T. Pathogenesis and diagnostic criteria for rickets and osteomalacia - proposal by an expert panel supported by Ministry of Health, Labour and Welfare, Japan, The Japanese Society for Bone and Mineral Research and The Japan Endocrine Society. Endocr. J., 2015, 62(8), 665-671.
[http://dx.doi.org/10.1507/endocrj.EJ15-0289] [PMID: 26156530]
[8]
Kayaniyil, S.; Vieth, R.; Harris, S.B.; Retnakaran, R.; Knight, J.A.; Gerstein, H.C.; Perkins, B.A.; Zinman, B.; Hanley, A.J. Association of 25(OH)D and PTH with metabolic syndrome and its traditional and nontraditional components. J. Clin. Endocrinol. Metab., 2011, 96(1), 168-175.
[http://dx.doi.org/10.1210/jc.2010-1439] [PMID: 20980431]
[9]
van Schoor, N.M.; Lips, P. Worldwide vitamin D status. Best Pract. Res. Clin. Endocrinol. Metab., 2011, 25(4), 671-680.
[http://dx.doi.org/10.1016/j.beem.2011.06.007] [PMID: 21872807]
[10]
Holick, M.F.; MacLaughlin, J.A.; Clark, M.B.; Holick, S.A.; Potts, J.T., Jr; Anderson, R.R.; Blank, I.H.; Parrish, J.A.; Elias, P. Photosynthesis of previtamin D3 in human skin and the physiologic consequences. Science, 1980, 210(4466), 203-205.
[http://dx.doi.org/10.1126/science.6251551] [PMID: 6251551]
[11]
Fontana, L.; Eagon, J.C.; Trujillo, M.E.; Scherer, P.E.; Klein, S. Visceral fat adipokine secretion is associated with systemic inflammation in obese humans. Diabetes, 2007, 56(4), 1010-1013.
[http://dx.doi.org/10.2337/db06-1656] [PMID: 17287468]
[12]
Izaola, O; de Luis, D; Sajoux, I; Domingo, JC Vidal, M Inflammation and obesity (lipoinflammation). Nutr Hosp., 2015, 1;31(6), 2352-8.
[13]
Giulietti, A.; van Etten, E.; Overbergh, L.; Stoffels, K.; Bouillon, R.; Mathieu, C. Monocytes from type 2 diabetic patients have a pro-inflammatory profile. 1,25-Dihydroxyvitamin D(3) works as anti-inflammatory. Diabetes Res. Clin. Pract., 2007, 77(1), 47-57.
[http://dx.doi.org/10.1016/j.diabres.2006.10.007] [PMID: 17112620]
[14]
Chen, T.C.; Chimeh, F.; Lu, Z.; Mathieu, J.; Person, K.S.; Zhang, A.; Kohn, N.; Martinello, S.; Berkowitz, R.; Holick, M.F. Factors that influence the cutaneous synthesis and dietary sources of vitamin D. Arch. Biochem. Biophys., 2007, 460(2), 213-217.
[http://dx.doi.org/10.1016/j.abb.2006.12.017] [PMID: 17254541]
[15]
Klop, B; Elte, JW; Cabezas, MC Dyslipidemia in obesity: mechanisms and potential targets. Nutrients, 2013, 12;5(4), 1218-40.
[http://dx.doi.org/10.3390/nu5041218]
[16]
Prabhu, AV; Luu, W; Sharpe, LJ; Brown, AJ Cholesterol-mediated Degradation of 7-Dehydrocholesterol Reductase Switches the Balancefrom Cholesterol to Vitamin D Synthesis. J Biol Chem, 2016, 15;291(16), 8363-73.
[17]
Skaaby, T.; Thuesen, B.H.; Linneberg, A.; Vitamin, D.; Vitamin, D. Cardiovascular Disease and Risk Factors. Adv. Exp. Med. Biol., 2017, 996, 221-230.
[http://dx.doi.org/10.1007/978-3-319-56017-5_18] [PMID: 29124703]
[18]
Friedewald, W.T.; Levy, R.I.; Fredrickson, D.S. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin. Chem., 1972, 18(6), 499-502.
[PMID: 4337382]
[19]
Rautela, G.S.; Liedtke, R.J. Automated enzymic measurement of total cholesterol in serum. Clin. Chem., 1978, 24(1), 108-114.
[PMID: 618640]
[20]
Ross, A.C.; Taylor, C.L.; Yaktine, A.L.; Del Valle, H.B., Eds.; Dietary Reference Intakes for Calcium and Vitamin D; Institute of Medicine: Washington, DC, 2011. http://www.ncbi.nlm.nih.gov/books/NBK56070/
[21]
Yach, D.; Stuckler, D.; Brownell, K.D. Epidemiologic and economic consequences of the global epidemics of obesity and diabetes. Nat. Med., 2006, 12(1), 62-66.
[http://dx.doi.org/10.1038/nm0106-62] [PMID: 16397571]
[22]
Vimaleswaran, K.S.; Berry, D.J.; Lu, C.; Tikkanen, E.; Pilz, S.; Hiraki, L.T.; Cooper, J.D.; Dastani, Z.; Li, R.; Houston, D.K.; Wood, A.R.; Michaëlsson, K.; Vandenput, L.; Zgaga, L.; Yerges-Armstrong, L.M.; McCarthy, M.I.; Dupuis, J.; Kaakinen, M.; Kleber, M.E.; Jameson, K.; Arden, N.; Raitakari, O.; Viikari, J.; Lohman, K.K.; Ferrucci, L.; Melhus, H.; Ingelsson, E.; Byberg, L.; Lind, L.; Lorentzon, M.; Salomaa, V.; Campbell, H.; Dunlop, M.; Mitchell, B.D.; Herzig, K.H.; Pouta, A.; Hartikainen, A.L.; Streeten, E.A.; Theodoratou, E.; Jula, A.; Wareham, N.J.; Ohlsson, C.; Frayling, T.M.; Kritchevsky, S.B.; Spector, T.D.; Richards, J.B.; Lehtimäki, T.; Ouwehand, W.H.; Kraft, P.; Cooper, C.; März, W.; Power, C.; Loos, R.J.; Wang, T.J.; Järvelin, M.R.; Whittaker, J.C.; Hingorani, A.D.; Hyppönen, E. Causal relationship between obesity and vitamin D status: bi-directional Mendelian randomization analysis of multiple cohorts. PLoS Med., 2013, 10(2)e1001383
[http://dx.doi.org/10.1371/journal.pmed.1001383] [PMID: 23393431]
[23]
Pinelli, N.R.; Jaber, L.A.; Brown, M.B.; Herman, W.H. Serum 25-hydroxy vitamin d and insulin resistance, metabolic syndrome, and glucose intolerance among Arab Americans. Diabetes Care, 2010, 33(6), 1373-1375.
[http://dx.doi.org/10.2337/dc09-2199] [PMID: 20332348]
[24]
Lim, J.S.; Kim, K.M.; Rhee, Y.; Lim, S.K. Gender-dependent skeletal effects of vitamin D deficiency in a younger generation. J. Clin. Endocrinol. Metab., 2012, 97(6), 1995-2004.
[http://dx.doi.org/10.1210/jc.2011-3098] [PMID: 22442269]
[25]
van Schoor, N.M.; de Jongh, R.T.; Daniels, J.M.; Heymans, M.W.; Deeg, D.J.; Lips, P. Peak expiratory flow rate shows a gender-specific association with vitamin D deficiency. J. Clin. Endocrinol. Metab., 2012, 97(6), 2164-2171.
[http://dx.doi.org/10.1210/jc.2011-3199] [PMID: 22472566]
[26]
Zainel, AAL; Qotba, H; Al Nuaimi, A; Syed, M Vitamin D status among adults (18-65 years old) attending primary healthcare centres in Qatar: a cross-sectional analysis of the Electronic Medical Records for the year 2017. BMJ Open., 2019, 18;9(8), e029334.
[27]
Holvik, K.; Meyer, H.E.; Haug, E.; Brunvand, L. Prevalence and predictors of vitamin D deficiency in five immigrant groups living in Oslo, Norway: the Oslo Immigrant Health Study. Eur. J. Clin. Nutr., 2005, 59(1), 57-63.
[http://dx.doi.org/10.1038/sj.ejcn.1602033] [PMID: 15280907]
[28]
Mithal, A.; Wahl, D.A.; Bonjour, J.P.; Burckhardt, P.; Dawson-Hughes, B.; Eisman, J.A.; El-Hajj Fuleihan, G.; Josse, R.G.; Lips, P.; Morales-Torres, J. Global vitamin D status and determinants of hypovitaminosis D. Osteoporos. Int., 2009, 20(11), 1807-1820.
[http://dx.doi.org/10.1007/s00198-009-0954-6] [PMID: 19543765]
[29]
Saintonge, S.; Bang, H.; Gerber, L.M. Implications of a new definition of vitamin D deficiency in a multiracial us adolescent population: the National Health and Nutrition Examination Survey III. Pediatrics, 2009, 123(3), 797-803.
[http://dx.doi.org/10.1542/peds.2008-1195] [PMID: 19255005]
[30]
Johnson, L.K.; Hofsø, D.; Aasheim, E.T.; Tanbo, T.; Holven, K.B.; Andersen, L.F.; Røislien, J.; Hjelmesæth, J. Impact of gender on vitamin D deficiency in morbidly obese patients: a cross-sectional study. Eur. J. Clin. Nutr., 2012, 66(1), 83-90.
[http://dx.doi.org/10.1038/ejcn.2011.140] [PMID: 21792214]
[31]
Jaiswal, M.; Schinske, A.; Pop-Busui, R. Lipids and lipid management in diabetes. Best Pract. Res. Clin. Endocrinol. Metab., 2014, 28(3), 325-338.
[http://dx.doi.org/10.1016/j.beem.2013.12.001] [PMID: 24840262]
[32]
Karhapää, P.; Pihlajamäki, J.; Pörsti, I.; Kastarinen, M.; Mustonen, J.; Niemelä, O.; Kuusisto, J. Diverse associations of 25-hydroxyvitamin D and 1,25-dihydroxy-vitamin D with dyslipidaemias. J. Intern. Med., 2010, 268(6), 604-610.
[http://dx.doi.org/10.1111/j.1365-2796.2010.02279.x] [PMID: 20831628]
[33]
Cutillas-Marco, E; Prosper, AF; Grant, WB; Morales-Suárez-Varela, MM Vitamin D status and hypercholesterolemia in Spanish general population. Dermatoendocrinol, 2013, 1;5(3), 358-62.
[34]
García-Bailo, B; Da Costa, LA; Arora, P; Karmali, M; El-Sohemy, A Badawi, A Plasma vitamin D and biomarkers of cardiometabolic disease risk in adult Canadians, 2007-2009. Prev Chronic Dis., 2013, 6,10, E91.
[35]
Ginsberg, H.N.; MacCallum, P.R. The obesity, metabolic syndrome, and type 2 diabetes mellitus pandemic: Part I. Increased cardiovascular disease risk and the importance of atherogenic dyslipidemia in persons with the metabolic syndrome and type 2 diabetes mellitus. J. Cardiometab. Syndr., 2009, 4(2), 113-119.
[http://dx.doi.org/10.1111/j.1559-4572.2008.00044.x] [PMID: 19614799]
[36]
Manickam, B.; Neagu, V.; Kukreja, S.C.; Barengolts, E. Relationship between glycated hemoglobin and circulating 25-hydroxyvitamin D concentration in African American and Caucasian American men. Endocr. Pract., 2013, 19(1), 73-80.
[http://dx.doi.org/10.4158/EP12168.OR] [PMID: 23186960]
[37]
Chakhtoura, M.; Rahme, M.; Chamoun, N.; El-Hajj Fuleihan, G. Vitamin D in the Middle East and North Africa. Bone Rep., 2018, 8(8), 135-146.
[http://dx.doi.org/10.1016/j.bonr.2018.03.004] [PMID: 29955632]
[38]
Clemens, T.L.; Adams, J.S.; Henderson, S.L.; Holick, M.F. Increased skin pigment reduces the capacity of skin to synthesise vitamin D3. Lancet, 1982, 1(8263), 74-76.
[http://dx.doi.org/10.1016/S0140-6736(82)90214-8] [PMID: 6119494]
[39]
Guo, J; Lovegrove, JA; Givens, DI A Narrative Review of The Role of Foods as Dietary Sources of Vitamin D of Ethnic Minority Populations with Darker Skin: The Underestimated Challenge Nutrients, 2019, 3;11(1), E81.


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Article Details

VOLUME: 20
ISSUE: 3
Year: 2020
Page: [425 - 436]
Pages: 12
DOI: 10.2174/1871530319666191009154528
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