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Yao M, Oduro PK, Akintibu AM, Yan H. Modulation of the vitamin D receptor by traditional Chinese medicines and bioactive compounds: potential therapeutic applications in VDR-dependent diseases. Front Pharmacol 2024; 15:1298181. [PMID: 38318147 PMCID: PMC10839104 DOI: 10.3389/fphar.2024.1298181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/08/2024] [Indexed: 02/07/2024] Open
Abstract
The Vitamin D receptor (VDR) is a crucial nuclear receptor that plays a vital role in various physiological functions. To a larger extent, the genomic effects of VDR maintain general wellbeing, and its modulation holds implications for multiple diseases. Current evidence regarding using vitamin D or its synthetic analogs to treat non-communicable diseases is insufficient, though observational studies suggest potential benefits. Traditional Chinese medicines (TCMs) and bioactive compounds derived from natural sources have garnered increasing attention. Interestingly, TCM formulae and TCM-derived bioactive compounds have shown promise in modulating VDR activities. This review explores the intriguing potential of TCM and bioactive compounds in modulating VDR activity. We first emphasize the latest information on the genetic expression, function, and structure of VDR, providing a comprehensive understanding of this crucial receptor. Following this, we review several TCM formulae and herbs known to influence VDR alongside the mechanisms underpinning their action. Similarly, we also discuss TCM-based bioactive compounds that target VDR, offering insights into their roles and modes of action.
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Affiliation(s)
- Minghe Yao
- Henan University of Chinese Medicine, Zhengzhou, China
- Collaborative Innovation Center of Research and Development on the Whole Industry Chain of Yu-Yao, Zhengzhou, China
| | - Patrick Kwabena Oduro
- Jacobs School of Medicine and Biomedical Sciences, The State University of New York, University at Buffalo, Buffalo, NY, United States
| | - Ayomide M. Akintibu
- School of Community Health and Policy, Morgan State University, Baltimore, MD, United States
| | - Haifeng Yan
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
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Gholami A, Montazeri-Najafabady N, Karimzadeh I, Dabbaghmanesh MH, Talei E. The effect of BsmI (rs1544410) single nucleotide polymorphism of vitamin D receptor (VDR) on insulin resistance in healthy children and adolescents: a cross-sectional study. BMC Pediatr 2024; 24:54. [PMID: 38233797 PMCID: PMC10792823 DOI: 10.1186/s12887-023-04503-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/21/2023] [Indexed: 01/19/2024] Open
Abstract
The increasing prevalence of metabolic syndrome, type 2 diabetes, and insulin resistance are driven by complex interactions between genetic and environmental factors. One of the single nucleotide polymorphisms (SNPs) in the VDR gene associated with vitamin D levels is the rs1544410 SNP. This study examined the association of the rs1544410 polymorphism with insulin resistance to predict and screen for possible association with type 2 diabetes and target these individuals for appropriate treatment. This cross-sectional study examined 270 children and adolescents aged 9 to 18 years. Anthropometric and biochemical parameters were determined. Insulin resistance/sensitivity was determined using Quicki, HOMA-IR, MacAuley, Revised MacAuley, Bennetts, FIRI and insulin-to-glucose ratio. The BsmI single nucleotide polymorphism (rs1544410) was determined using the PCR-RFLP method after extracting DNA from peripheral blood collected from fasted subjects, and the resulting data were analyzed using SPSS software and statistical tests.According to linear regression analysis, a significant difference was found in Insulin to glucose ratio, FIRI and HOMA-IR indices between Bb / bb and BB genotypes and it was observed that individuals with BB genotype polymorphism of BsmI vitamin D receptor gene, after Adjustment of age, sex, BMI are at greater risk for insulin resistance and type 2 diabetes.This study demonstrated that those with the BB genotype of VDR BsmI polymorphism were at higher risk for insulin resistance and developing type 2 DM.
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Affiliation(s)
- Ahmad Gholami
- Biotechnology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nima Montazeri-Najafabady
- Endocrinology and Metabolism Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Iman Karimzadeh
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Elnaz Talei
- Biotechnology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Mousa H, Al Saei A, Razali RM, Zughaier SM. Vitamin D status affects proteomic profile of HDL-associated proteins and inflammatory mediators in dyslipidemia. J Nutr Biochem 2024; 123:109472. [PMID: 37863441 DOI: 10.1016/j.jnutbio.2023.109472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 10/02/2023] [Accepted: 10/05/2023] [Indexed: 10/22/2023]
Abstract
Vitamin D deficiency and dyslipidemia have substantial implications for human health globally. Vitamin D is essential for bone metabolism and immune modulation, and its insufficiency is linked to various chronic inflammatory conditions. Dyslipidemia, characterized by low levels of high-density lipoprotein (HDL) and elevated levels of low-density lipoprotein (LDL) and triglycerides, is also prevalent. Previous research has shown a connection between vitamin D deficiency and low HDL, but the precise mechanism by which vitamin D influences HDL production and its anti-inflammatory properties remains unclear. This study aimed to investigate the proteomic profiles of individuals with and without vitamin D deficiency and dyslipidemia, specifically focusing on the effects of vitamin D on HDL production, its anti-inflammatory potential, and the molecular pathways associated with vitamin D deficiency and dyslipidemia, particularly inflammation and cancer pathways. By analyzing the proteomic profiles of 274 participants from the Qatar Biobank database, we identified 1301 proteins. Our findings indicated a decrease in HDL-associated apolipoproteins (ApoM and ApoD) in individuals with both dyslipidemia and vitamin D deficiency. Conversely, participants with these conditions exhibited increased expression of acute-phase proteins (SAA1 and SOD1), which are associated with inflammation. Pathway enrichment analysis revealed heightened inflammatory activity in individuals with vitamin D deficiency and dyslipidemia, with notable enrichments in pathways such as MAPK, JAK-STAT, Ras signaling, cytokine-cytokine receptor interaction, AGE-RAGE, ErbB signaling, and cancer pathways. Overall, cases of vitamin D deficiency showed enrichment in inflammation pathways, while individuals with both vitamin D deficiency and dyslipidemia demonstrated enhanced activation of cancer and inflammation pathways.
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Affiliation(s)
- Hanaa Mousa
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Aisha Al Saei
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Rozaimi Mohamad Razali
- Department of Biomedical Sciences College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Susu M Zughaier
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar.
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Argano C, Mirarchi L, Amodeo S, Orlando V, Torres A, Corrao S. The Role of Vitamin D and Its Molecular Bases in Insulin Resistance, Diabetes, Metabolic Syndrome, and Cardiovascular Disease: State of the Art. Int J Mol Sci 2023; 24:15485. [PMID: 37895163 PMCID: PMC10607188 DOI: 10.3390/ijms242015485] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
In the last decade, an increasing awareness was directed to the role of Vitamin D in non-skeletal and preventive roles for chronic diseases. Vitamin D is an essential hormone in regulating calcium/phosphorous balance and in the pathogenesis of inflammation, insulin resistance, and obesity. The main forms of vitamin D, Cholecalciferol (Vitamin D3) and Ergocalciferol (Vitamin D2) are converted into the active form (1,25-dihydroxyvitamin D) thanks to two hydroxylations in the liver, kidney, pancreas, and immune cells. Some anti-inflammatory cytokines are produced at higher levels by vitamin D, while some pro-inflammatory cytokines are released at lower levels. Toll-Like Receptor (TLR) expression is increased, and a pro-inflammatory state is also linked to low levels of vitamin D. Regardless of how it affects inflammation, various pathways suggest that vitamin D directly improves insulin sensitivity and secretion. The level of vitamin D in the body may change the ratio of pro- to anti-inflammatory cytokines, which would impact insulin action, lipid metabolism, and the development and function of adipose tissue. Many studies have demonstrated an inverse relationship between vitamin D concentrations and pro-inflammatory markers, insulin resistance, glucose intolerance, metabolic syndrome, obesity, and cardiovascular disease. It is interesting to note that several long-term studies also revealed an inverse correlation between vitamin D levels and the occurrence of diabetes mellitus. Vitamin D supplementation in people has controversial effects. While some studies demonstrated improvements in insulin sensitivity, glucose, and lipid metabolism, others revealed no significant effect on glycemic homeostasis and inflammation. This review aims to provide insight into the molecular basis of the relationship between vitamin D, insulin resistance, metabolic syndrome, type 1 and 2 diabetes, gestational diabetes, and cardiovascular diseases.
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Affiliation(s)
- Christiano Argano
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico Di Cristina Benfratelli, 90127 Palermo, Italy; (L.M.); (S.A.); (V.O.); (A.T.); (S.C.)
| | - Luigi Mirarchi
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico Di Cristina Benfratelli, 90127 Palermo, Italy; (L.M.); (S.A.); (V.O.); (A.T.); (S.C.)
| | - Simona Amodeo
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico Di Cristina Benfratelli, 90127 Palermo, Italy; (L.M.); (S.A.); (V.O.); (A.T.); (S.C.)
| | - Valentina Orlando
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico Di Cristina Benfratelli, 90127 Palermo, Italy; (L.M.); (S.A.); (V.O.); (A.T.); (S.C.)
| | - Alessandra Torres
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico Di Cristina Benfratelli, 90127 Palermo, Italy; (L.M.); (S.A.); (V.O.); (A.T.); (S.C.)
| | - Salvatore Corrao
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico Di Cristina Benfratelli, 90127 Palermo, Italy; (L.M.); (S.A.); (V.O.); (A.T.); (S.C.)
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, [PROMISE], University of Palermo, 90127 Palermo, Italy
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Bohdanowicz-Pawlak A, Lwow F. Differences in Chronic Low-Grade Inflammation and Metabolic Disturbances between VDR Genotypes in an Ethnically Homogenous Postmenopausal Female Population from Poland. Nutrients 2023; 15:2737. [PMID: 37375641 DOI: 10.3390/nu15122737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Vitamin D deficiency and changes in the endocrine system may stimulate systemic inflammation. VDR expression and the vitamin D concentration decrease with age, which is important in postmenopausal women for whom estrogen deficiency causes rapid bone loss. This group is, moreover, particularly at risk of developing atherosclerosis and its adverse consequences, such as chronic inflammation. The aim of this study was to assess the differentiation by the VDR genotype of the risk factors for so-called chronic low-grade inflammation and metabolic disorders. (2) We studied the differences between the anthropometric, metabolic, and inflammation parameters of VDR genotypes for Apa-I, Bsm-I, Fok-I, and Taq-I in a sample of 321 women aged 50-60 from an ethnically homogeneous urban population in Poland. (3) The TT Taq-I genotype presented a significantly higher rate of insulin resistance (HOMA) and lower serum levels of adiponectin than the other two genotypes. The AA genotype of the Bsm-I polymorphism was associated with a more atherogenic serum profile and significantly higher LDL and LDL/HDL values and Castelli Index. (4) Chronic low-grade inflammation was associated with the TT Taq-I genotype and presented a higher rate of insulin resistance. The AA genotype of the Bsm-I polymorphism presented a more atherogenic serum lipid profile and, therefore, a higher risk of developing cardiovascular disease.
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Affiliation(s)
- Anna Bohdanowicz-Pawlak
- Department of Endocrinology, Diabetology and Isotope Therapy, Wroclaw Medical University, Pasteur 4, 50-367 Wroclaw, Poland
| | - Felicja Lwow
- Department of Massage and Physical Therapy, Faculty of Physiotherapy, Wrocław University of Health and Sport Sciences, Paderewskiego 35, 51-612 Wroclaw, Poland
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Yildiz AS, Ustundag FD, Tiber PM, Dogan B. The relationship between vitamin D receptor gene polymorphisms and periodontitis in turkish individuals with type 2 diabetes mellitus. Niger J Clin Pract 2022; 25:1163-1172. [PMID: 35859479 DOI: 10.4103/njcp.njcp_1894_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background and Aim Vitamin D receptor (VDR) gene polymorphisms have been implicated in the pathogenesis of many diseases, such as periodontitis and diabetes mellitus (DM). The present study aimed to evaluate the distributions of VDR polymorphisms in diabetic individuals with healthy periodontium (DMH), diabetic individuals with periodontitis (DMP), nondiabetic individuals with healthy periodontium (H), and nondiabetic individuals with periodontitis (P). Material and Methods A total of 200 individuals (DMH = 40, DMP = 60, H = 40, and P = 60) were recruited. All clinical periodontal parameters, demographical, and biochemical variables were recorded. Blood samples were collected, and genomic DNA was isolated by Purelink® Genomic DNA Mini Kit. Genotyping of VDR polymorphisms ApaI, BsmI, FokI, and TaqI were determined by real-time polymerase chain reaction (PCR) using allele-specific probes. Results The distribution of the BsmI variant showed differences between DMH and H groups (P = 0.034). In addition, carrying the GG genotype (OR = 0.317; 95% CI = 0.126-0.797; P = 0.013) and the G allele (OR = 2.373; 95% CI = 1.203-4.681; P = 0.012) increased the risk of type 2 DM. Moreover, it was determined that the frequency of CC genotype of FokI variant was higher in DMP compared to DMH (P = 0.046). It was determined that having the CC genotype (OR = 2.706; 95% CI = 1.185-6.176; P = 0.017) and the C allele (OR = 1.917; 95% CI = 0.995-3.694; P = 0.049) increased the risk of periodontitis among diabetic individuals. No differences were detected among groups in the genotype and allele distributions of ApaI and TaqI variants (P > 0.05). Conclusions The present study showed that the BsmI variant was a risk factor for DM among periodontally healthy individuals and the FokI variant for periodontitis among diabetic individuals.
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Affiliation(s)
- A Saatman Yildiz
- Department of Periodontology, Institute of Health Sciences, Marmara University, Istanbul, Turkey
| | - F D Ustundag
- Department of Biophysics, Institute of Health Sciences, Istanbul, Turkey
| | - P Mega Tiber
- Department of Biophysics, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - B Dogan
- Department of Periodontology, Faculty of Dentistry, Marmara University, Istanbul, Turkey
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Effects of Vitamin D on Fertility, Pregnancy and Polycystic Ovary Syndrome-A Review. Nutrients 2022; 14:nu14081649. [PMID: 35458211 PMCID: PMC9029121 DOI: 10.3390/nu14081649] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/09/2022] [Accepted: 04/11/2022] [Indexed: 02/06/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is one of the most common endocrine reproductive disorders in women. Vitamin D deficiency is also quite common in this condition. The degree of vitamin D deficiency correlates with the severity of PCOS. Both male and female vitamin D levels play a role in fertility and affect the outcomes of in vitro fertilization (IVF). Moreover, fertility and IVF indicators are improved by vitamin D not only in healthy women but in those diagnosed with PCOS. Both vitamin D deficiency and PCOS increase pregnancy-related complications. Vitamin D supplementation and optimal vitamin D levels decrease both maternal and fetal risk for complications and adverse events. Furthermore, vitamin D supplementation may ameliorate or even prevent pregnancy-related reversible bone loss in mothers. This review emphasizes the roles of vitamin D deficiency and vitamin D supplementation and their correlation with PCOS regarding reproductive health.
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Piña-Aguero MI, Maldonado-Hernández J, Sebastián-Medina L, Tejero-Barrera ME, Robledo-Pérez RM, Villalpando-Hernández S, Ventura-Bravo ZA, Morales-Ramírez LK. Vitamin D Receptor Gene Polymorphisms, β-cell Function, and Vitamin D Status in Non-obese Mexican Adults. Arch Med Res 2022; 53:416-422. [DOI: 10.1016/j.arcmed.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 03/24/2022] [Accepted: 04/06/2022] [Indexed: 11/02/2022]
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9
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de Assis CS, Diniz TG, Alcântara JOS, Brito VPADS, do Nascimento RAF, Nunes MKDS, Silva AS, de Queiroga Evangelista IW, Viturino MGM, de Lima RLFC, Persuhn DC. Metabolic impact of the VDR rs1544410 in diabetic retinopathy. PLoS One 2022; 17:e0263346. [PMID: 35213542 PMCID: PMC8880825 DOI: 10.1371/journal.pone.0263346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/15/2022] [Indexed: 11/18/2022] Open
Abstract
AIMS To investigate the association between BsmI and DM2 in patients with and without DR and to correlate with clinical parameters in a population in northeastern Brazil. METHODS Cross-sectional case-control study in which data were collected from 285 individuals, including 128 patients with DM2 and 157 with DR. Clinical, biochemical and anthropometric parameters were analyzed, in addition to the single nucleotide polymorphism (SNP) BsmI of the VDR gene (rs1544410), genotyped by PCR-RFLP. RESULTS In the DR group we found a greater number of patients using insulin therapy (p = 0.000) and with longer duration of DM2 (p = 0.000), in addition to higher serum creatinine values (p = 0.001). Higher fasting glucose levels and higher frequency of insulinoterapy were independently observed in patients with DR and b allele carriers, when compared to BB. CONCLUSION The association of the bb/Bb genotypes (rs1544410) of the VDR gene with increased blood glucose levels and insulinoterapy may represent worse glicemic control in rs1544410 b allele carriers in DR Latin American individuals.
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Affiliation(s)
| | - Tainá Gomes Diniz
- Post-Graduate Program in Nutrition Science, Federal University of Paraiba, Joao Pessoa, Brazil
| | | | | | | | - Mayara Karla dos Santos Nunes
- Post-Graduation Program in Development and Technological Innovation of Medicines (DITM), Federal University of Paraiba, Joao Pessoa, Brazil
| | | | | | - Marina Gonçalves Monteiro Viturino
- Ophthalmology, Otolaryngology and Oral and Maxillofacial Surgery Unit, Lauro Wanderley University Hospital, Federal University of Paraiba, Joao Pessoa, Brazil
| | | | - Darlene Camati Persuhn
- Department of Molecular Biology and Post-Graduation Program in Nutrition Science, Federal University of Paraiba, Joao Pessoa, Brazil
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Yu S, Feng Y, Qu C, Yu F, Mao Z, Wang C, Li W, Li X. Vitamin D receptor methylation attenuates the association between physical activity and type 2 diabetes mellitus: A case-control study. J Diabetes 2022; 14:97-103. [PMID: 34751501 PMCID: PMC9060074 DOI: 10.1111/1753-0407.13239] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 10/12/2021] [Accepted: 11/03/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Physical activity and vitamin D receptor (VDR) have been associated with type 2 diabetes mellitus (T2DM). However, the associations of VDR methylation with T2DM and physical activity remained unknown. We aimed to investigate whether VDR methylation was a link between physical activity and T2DM. METHODS A 1:1 matching case-control study was designed based on the Henan Rural Cohort Study, including 272 pairs of T2DM patients and nonpatients. Physical activity level was assessed using the International Physical Activity Questionnaire. The high-resolution melt method was applied to determine the methylation level of the promoter region of VDR. The association between physical activity and T2DM was analyzed with a conditional logistic regression model. The effect modification of VDR methylation levels on the association between physical activity and T2DM was conducted. A multivariate correlation analysis model was applied to investigate correlations of VDR methylation with insulin sensitivity. RESULTS Physical activity level was associated with T2DM risk (crude model: odds ratio [OR] 0.611; 95% CI, 0.416-0.897; adjusted model: OR 0.619; 95% CI, 0.418-0.917). In effect modification analysis, the effects of physical activity on T2DM were stronger for low VDR methylation levels than for high (P = .025). Moreover, VDR methylation levels were associated with insulin (r = -0.089, P = .039) as well as homeostatic model assessment of insulin resistance (r = -0.098, P = .022). CONCLUSIONS The methylation status of the VDR promoter is associated with the secretion and sensitivity of insulin. VDR methylation attenuates the association between physical activity and T2DM, indicating that proactively physical activity may reduce the risk of T2DM, especially in people with low VDR methylation level.
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Affiliation(s)
- Songcheng Yu
- College of Public HealthZhengzhou UniversityZhengzhouChina
| | - Yinhua Feng
- College of Public HealthZhengzhou UniversityZhengzhouChina
| | - Chenling Qu
- College of Grain Oil and Food ScienceHenan University of TechnologyZhengzhouChina
| | - Fei Yu
- College of Public HealthZhengzhou UniversityZhengzhouChina
| | - Zhenxing Mao
- College of Public HealthZhengzhou UniversityZhengzhouChina
| | - Chongjian Wang
- College of Public HealthZhengzhou UniversityZhengzhouChina
| | - Wenjie Li
- College of Public HealthZhengzhou UniversityZhengzhouChina
| | - Xing Li
- College of Public HealthZhengzhou UniversityZhengzhouChina
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Xu Z, Gong R, Luo G, Wang M, Li D, Chen Y, Shen X, Wei X, Feng N, Wang S. Association between vitamin D3 levels and insulin resistance: a large sample cross-sectional study. Sci Rep 2022; 12:119. [PMID: 34997087 PMCID: PMC8741779 DOI: 10.1038/s41598-021-04109-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/01/2021] [Indexed: 01/01/2023] Open
Abstract
Previous studies have shown that vitamin D3 may be a potential factor in insulin resistance, but the relationship between vitamin D3 and insulin resistance still remains controversial. At present, more research is needed to explore the relationship between vitamin D3 and insulin resistance. The samples from 2009 to 2018 in NHANES database were analyzed to Investigate the relationship and the potential mechanism. We performed a cross-sectional study of five periods in the NHANES database. Finally, 9298 participants were selected through strict inclusion and exclusion criteria, Multivariate logistic regression analysis and curve fitting were conducted to explore the relationship between vitamin D3 level and insulin resistance. Moreover, subgroup analysis was used to further prove the association. The results revealed that there was a strong association between vitamin D3 and insulin resistance (OR 0.82, 95% CI 0.72-0.93). However, subgroup analyses indicated that this correlation varied between individuals and races. There was a negative correlation between vitamin D3 level and insulin resistance, which provides a new proof for exploring the influencing factors of insulin resistance. More well-designed studies are still needed to further elaborate on these associations.
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Affiliation(s)
- Zixin Xu
- Shaanxi University of Chinese Medicine, Xi'an, 712046, Shaanxi, People's Republic of China
| | - Rongpeng Gong
- Medical College of Qinghai University, Xining, 810016, Qinghai, People's Republic of China
| | - Gang Luo
- College of Eco-Environmental Engineering, Qinghai University, Xining, 810016, Qinghai, People's Republic of China
| | - Mingxiang Wang
- Medical College of Qinghai University, Xining, 810016, Qinghai, People's Republic of China
| | - Da Li
- Xi'an Chang'an District Hospital of Traditional Chinese Medicine, Xi'an, 710100, Shaanxi, People's Republic of China
| | - Yue Chen
- Department of Clinical Medicine, School of the First Clinical Medicine, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Xiaofang Shen
- Department of Nephrology, Aerospace Center Hospital, 15 Yuquan Road, Beijing, 100049, People's Republic of China
| | - Xiaoxing Wei
- Medical College of Qinghai University, Xining, 810016, Qinghai, People's Republic of China.,College of Eco-Environmental Engineering, Qinghai University, Xining, 810016, Qinghai, People's Republic of China
| | - Niran Feng
- Tianjin University of Chinese Medicine, Tianjin, 301617, People's Republic of China
| | - Shuangquan Wang
- Shaanxi University of Chinese Medicine, Xi'an, 712046, Shaanxi, People's Republic of China. .,The Third Affiliated Hospital of Shaanxi University of Chinese Medicine, Xi'an XD Group Hospital, Xi'an, 710077, Shaanxi, People's Republic of China.
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12
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Chauhan GK, Medithi S. Polymorphisms of the Vitamin D Receptor (VDR) gene: A possible trigger for the onset of obesity, type 2 diabetes mellitus and other metabolic syndromes. GENE REPORTS 2021. [DOI: 10.1016/j.genrep.2021.101224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Melguizo-Rodríguez L, Costela-Ruiz VJ, García-Recio E, De Luna-Bertos E, Ruiz C, Illescas-Montes R. Role of Vitamin D in the Metabolic Syndrome. Nutrients 2021; 13:830. [PMID: 33802330 PMCID: PMC7999005 DOI: 10.3390/nu13030830] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/11/2022] Open
Abstract
The prevalence of hypovitaminosis D has risen in developed countries over the past few years in association with lifestyle changes and an increase in unhealthy habits. Vitamin D deficiency has been implicated in various diseases, including metabolic syndrome (MetS), which is clinically defined by a set of metabolic and vascular disorders. The objective of this study was to review scientific evidence on the relationship between MetS and vitamin D deficiency to support the development of prevention strategies and health education programs. An inverse relationship has been reported between plasma vitamin D concentrations and the features that define MetS, i.e., elevated serum concentrations of glucose, total cholesterol, low-density lipoproteins, triglycerides, glycosylated hemoglobin, and a high body mass index. Numerous studies have described the benefits of vitamin D supplementation to improve outcomes in individuals with MetS. Interventions to maintain optimal vitamin D concentrations are proposed as a preventive strategy against MetS.
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Affiliation(s)
- Lucía Melguizo-Rodríguez
- Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (L.M.-R.); (V.J.C.-R.); (E.G.-R.); (E.D.L.-B.); (R.I.-M.)
- Instituto Investigación Biosanitaria, ibs.Granada, 18012 Granada, Spain
| | - Víctor J. Costela-Ruiz
- Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (L.M.-R.); (V.J.C.-R.); (E.G.-R.); (E.D.L.-B.); (R.I.-M.)
- Instituto Investigación Biosanitaria, ibs.Granada, 18012 Granada, Spain
| | - Enrique García-Recio
- Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (L.M.-R.); (V.J.C.-R.); (E.G.-R.); (E.D.L.-B.); (R.I.-M.)
- Instituto Investigación Biosanitaria, ibs.Granada, 18012 Granada, Spain
| | - Elvira De Luna-Bertos
- Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (L.M.-R.); (V.J.C.-R.); (E.G.-R.); (E.D.L.-B.); (R.I.-M.)
- Instituto Investigación Biosanitaria, ibs.Granada, 18012 Granada, Spain
| | - Concepción Ruiz
- Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (L.M.-R.); (V.J.C.-R.); (E.G.-R.); (E.D.L.-B.); (R.I.-M.)
- Instituto Investigación Biosanitaria, ibs.Granada, 18012 Granada, Spain
- Institute of Neuroscience, University of Granada, 18016 Granada, Spain
| | - Rebeca Illescas-Montes
- Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (L.M.-R.); (V.J.C.-R.); (E.G.-R.); (E.D.L.-B.); (R.I.-M.)
- Instituto Investigación Biosanitaria, ibs.Granada, 18012 Granada, Spain
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Fronczek M, Strzelczyk JK, Osadnik T, Biernacki K, Ostrowska Z. VDR Gene Polymorphisms in Healthy Individuals with Family History of Premature Coronary Artery Disease. DISEASE MARKERS 2021; 2021:8832478. [PMID: 33564343 PMCID: PMC7867440 DOI: 10.1155/2021/8832478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 12/14/2020] [Indexed: 12/20/2022]
Abstract
AIM The gene encoding the vitamin D receptor (VDR) is considered in many studies to be a good candidate responsible for susceptibility to several diseases such as coronary artery disease (CAD). Epidemiological data show that cardiovascular disease is one of the major health problems in Polish society. Basic studies show that genetic factors play a significant role in the pathogenesis of CAD. We conducted this clinical study to determine if the VDR gene polymorphisms TaqI (rs731236), ApaI (rs7975232), and FokI (rs2228570) could predispose healthy individuals to an increased risk of premature CAD (P-CAD) incidents. METHODS We genotyped 845 subjects in a cohort consisting of 386 healthy volunteers with a documented P-CAD incident in their first-degree relatives and 459 healthy volunteers without family history (FH) of P-CAD. TaqI, ApaI, and FokI polymorphisms in VDR were genotyped using TaqMan assays and the endpoint genotyping method (qPCR). Statistical analyses were performed using the Power Analysis Software STATISTICA v.13.3. RESULTS Although no statistical significance was found for TaqI and ApaI genotype frequencies, the AA genotype of FokI polymorphism was significantly more frequent in the study group compared to the control group (24.61% vs. 16.99%). The results of logistic regression analysis suggested a significant association between FokI polymorphism and FH of P-CAD in heathy people under the recessive model (OR: 1.26 (1.07-1.49, p = 0.007)); however, the frequency of VDR haplotypes did not differ significantly between the control and study populations. CONCLUSIONS FokI polymorphism is may be associated with FH of P-CAD. FokI polymorphism may predispose to the development of P-CAD among healthy people over the next years.
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Affiliation(s)
- Martyna Fronczek
- Department of Medical and Molecular Biology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice 40-055, Poland
| | - Joanna Katarzyna Strzelczyk
- Department of Medical and Molecular Biology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice 40-055, Poland
| | - Tadeusz Osadnik
- Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice 40-055, Poland
- Second Department of Cardiology and Angiology, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Krzysztof Biernacki
- Department of Medical and Molecular Biology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice 40-055, Poland
| | - Zofia Ostrowska
- Department of Medical and Molecular Biology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice 40-055, Poland
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Wang D, Su K, Ding Z, Zhang Z, Wang C. Association of Vitamin D Receptor Gene Polymorphisms with Metabolic Syndrome in Chinese Children. Int J Gen Med 2021; 14:57-66. [PMID: 33469344 PMCID: PMC7812523 DOI: 10.2147/ijgm.s287205] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/25/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose To investigate the association between vitamin D receptor (VDR) gene polymorphisms and vitamin D deficiency, overweightness/obesity, and metabolic syndrome (MetS) in a cohort of Han children residing in Hangzhou, China. Patients and Methods This study assessed 106 overweight/obese and 86 healthy (control) children. Five single-nucleotide polymorphisms (SNPs) in the VDR gene, namely, TaqI (rs731236 T > C), ApaI (rs7975232 C > A), BsmI (rs1544410 G > A), FokI (rs2228570 G >A), and Cdx2 (rs11568820 G > A), were genotyped by sequencing the total polymerase chain reaction products. The distributions of different genotypes and alleles were compared among different groups. Results The serum 25-hydroxyvitamin D (25(OH)D) concentration was significantly lower in overweight/obese children, while the AA genotype of ApaI SNP exhibited higher frequencies in the overweight/obese group than in the control. Furthermore, children with the ApaI AA genotype showed higher levels of Glu-60min, Glu-90min, Glu-120min and triglyceride. The AA genotype of FokI SNP was significantly associated with MetS. However, no association was observed between the five VDR SNPs and the risk of vitamin D deficiency. Conclusion VDR ApaI polymorphisms appear to be correlated with overweightness/obesity and glucose intolerance. FokI polymorphisms may be linked to a higher susceptibility toward MetS in Chinese children.
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Affiliation(s)
- Di Wang
- Department of Pediatrics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.,Department of Pediatrics, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Kunkai Su
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Zhongxiang Ding
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Zhiqun Zhang
- Department of Pediatrics, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Chunlin Wang
- Department of Pediatrics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
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Ramezani N, Ostadsharif M, Nayeri H. Association of BsmI variant of vitamin D receptor gene with polycystic ovary syndrome: A case-control study. Int J Reprod Biomed 2020; 18:877-884. [PMID: 33134800 PMCID: PMC7569712 DOI: 10.18502/ijrm.v13i10.7772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 01/12/2020] [Accepted: 05/30/2020] [Indexed: 11/24/2022] Open
Abstract
Background Polycystic ovarian syndrome (PCOS) is an endocrine disorder that affects women's fertility and causes alterations such as obesity, insulin resistance, menstrual irregularities, and polycystic ovaries. The results of the studies show that the issue of vitamin D and vitamin D receptor (VDR) is controversial for PCOS susceptibility. Objective To investigate the association of BsmI polymorphism in the VDR gene with metabolic parameters in obese PCOS women. Materials and Methods In this case-control study, 38 obese subjects with PCOS and 40 unrelated obese individuals were evaluated to determine the allelic and genotypic frequency of BsmI variant by Polymerase Chain Reaction Restriction Fragment Length Polymorphism method. Body Mass Index, parathyroid hormone, phosphorus, and calcium were evaluated in all participants. Results BsmI (rs1544410), (A/G) AA, AG, GG, A, and G percentage of genotypic/allelic frequencies were 65.8, 26.3, 7.9, 78.9, and 21.1 in cases and 57.5, 40, 2.5, 77.5, and 22.5 in controls, respectively. Statistical analysis revealed that the differences in genotypic (p = 0.31)/allelic (p = 0.83) frequencies and dominant (p = 0.45)/recessive (p = 0.35) models between the cases and controls were not significant. This study indicates no association between the BsmI genotypes and metabolic parameters. Conclusion It can be concluded that VDR BsmI (rs1544410) Intron 8 (A > G) was not associated with obesity along with PCOS susceptibility in the studied groups.
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Affiliation(s)
- Nasim Ramezani
- Department of Biochemistry, Falavarjan Branch, Islamic Azad University, Isfahan, Iran
| | - Maryam Ostadsharif
- Department of Medical Basic Sciences, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran.,Department of Medical Biotechnology, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| | - Hashem Nayeri
- Department of Biochemistry, Falavarjan Branch, Islamic Azad University, Isfahan, Iran
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Shaat N, Katsarou A, Shahida B, Prasad RB, Kristensen K, Planck T. Association between the rs1544410 polymorphism in the vitamin D receptor (VDR) gene and insulin secretion after gestational diabetes mellitus. PLoS One 2020; 15:e0232297. [PMID: 32407388 PMCID: PMC7224565 DOI: 10.1371/journal.pone.0232297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 04/11/2020] [Indexed: 12/12/2022] Open
Abstract
Background and aims Genetic variants involved in vitamin D metabolism have been associated with diabetes and related syndromes/diseases. We wanted to investigate possible associations of polymorphisms in genes involved in vitamin D metabolism with indices of insulin resistance and insulin secretion, and also with development of diabetes after gestational diabetes mellitus (GDM). Materials and methods We have studied 376 women with previous GDM. Eight single nucleotide polymorphisms (SNPs) in the genes for vitamin D receptor (VDR) [rs731236, rs7975232, rs10735810, and rs1544410], vitamin D binding protein (DBP) [rs7041 and rs4588], and cytochrome P450 family 27 subfamily B member 1 (CYP27B1) [rs10877012 and rs4646536] were genotyped by TaqMan Allelic Discrimination Assay using the Quantstudio 7 Flex system. A 75-g oral glucose tolerance test (OGTT) was performed 1–2 years postpartum. The homeostasis model assessment of insulin resistance (HOMA-IR) and the disposition index [(insulinogenic index: I30/G30)/HOMA-IR] were used to calculate insulin resistance and insulin secretion, respectively. Serum samples for determination of 25(OH)D3 were collected at the time of the OGTT. Manifestation of diabetes was followed up to five years postpartum. Results After adjustment for BMI, age, and ethnicity, the A-allele of the VDR rs1544410 polymorphism was found to be associated with increased disposition index (difference per allele = 3.56, 95% CI: 0.4567–6.674; p = 0.03). The A-allele of the DBP rs7041 polymorphism was found to be associated with 25(OH)D3 levels (difference [in nmol/L] per allele = −5.478, 95% CI: -8.315 to −2.641; p = 0.0002), as was the T-allele of the DBP rs4588 polymorphism (OR = −6.319, 95% CI: −9.466 to −3.171; p = 0.0001). None of the SNPs were significantly associated with HOMA-IR or postpartum diabetes. Conclusions This study provides evidence that the rs1544410 polymorphism of the VDR gene may be associated with increased insulin secretion in women after pregnancy complicated by GDM. Further studies in other populations are needed to confirm the results.
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Affiliation(s)
- Nael Shaat
- Department of Clinical Sciences, Genomics, Diabetes and Endocrinology, Lund University, Malmö, Sweden
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- * E-mail:
| | - Anastasia Katsarou
- Department of Clinical Sciences, Genomics, Diabetes and Endocrinology, Lund University, Malmö, Sweden
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
| | - Bushra Shahida
- Department of Clinical Sciences, Genomics, Diabetes and Endocrinology, Lund University, Malmö, Sweden
| | - Rashmi B. Prasad
- Department of Clinical Sciences, Genomics, Diabetes and Endocrinology, Lund University, Malmö, Sweden
| | - Karl Kristensen
- Department of Clinical Sciences, Genomics, Diabetes and Endocrinology, Lund University, Malmö, Sweden
- Department of Obstetrics and Gynaecology, Skåne University Hospital, Malmö, Sweden
| | - Tereza Planck
- Department of Clinical Sciences, Genomics, Diabetes and Endocrinology, Lund University, Malmö, Sweden
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
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Flores Ruelas Y, Del Toro Equihua M, Alejandra Jiménez Solís N, Baltazar Rodríguez LM, Delgado Enciso I, Sánchez Ramírez CA. Vitamin D status and its relation to insulin resistance in a Mexican pediatric population. J Pediatr Endocrinol Metab 2020; 33:481-486. [PMID: 32112703 DOI: 10.1515/jpem-2019-0510] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/14/2020] [Indexed: 11/15/2022]
Abstract
Background Obesity in children and adolescents has increased alarmingly, placing them at a higher risk for impaired glucose tolerance and type 2 diabetes. The prevalence of vitamin D deficiency has increased as well. Vitamin D is critical for glucose homeostasis and insulin secretion. Studies on adults have reported an inverse association between vitamin D levels and insulin resistance (IR), but the results in children are inconsistent. The aim of our study was to determine the association between IR and serum vitamin D levels in obese Mexican children and adolescents. Methods A cross-sectional study was performed on 227 children and adolescents between 6 and 19 years of age. Obesity was diagnosed through body mass index (BMI) for age, according to the World Health Organization (WHO) criteria (2007). 25-Hydroxyvitamin D (25[OH]D) was measured using an immunoassay technique and the homeostatic model assessment of insulin resistance (HOMA-IR) was calculated using the Matthews equation. Student's t-test was carried out. Results The mean serum 25(OH)D level was 35.80 ng/mL, and 55.1% of the subjects had levels classified as sufficient, 33.5% as insufficient, and 11.5% as deficient. The mean level of HOMA-IR was 3.16, and 70% of the subjects were diagnosed with IR. Fasting insulin levels and HOMA-IR were significantly different in adolescents with hypovitaminosis, compared with adolescents in the vitamin D sufficiency group (p = 0.01 and p = 0.03, respectively). Conclusions The insulin levels and HOMA-IR were higher in adolescents with hypovitaminosis. The girls presented higher levels of insulin and HOMA-IR than the boys.
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Affiliation(s)
- Yunue Flores Ruelas
- Nutrition Laboratory. School of Medicine, Universidad de Colima, Colima, México
| | | | | | | | - Ivan Delgado Enciso
- Nutrition Laboratory. School of Medicine, Universidad de Colima, Colima, México
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Song DK, Lee H, Hong YS, Sung YA. Vitamin D receptor and binding protein polymorphisms in women with polycystic ovary syndrome: a case control study. BMC Endocr Disord 2019; 19:145. [PMID: 31870342 PMCID: PMC6929416 DOI: 10.1186/s12902-019-0477-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 12/17/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age, characterized by hyperandrogenism, oligomenorrhea, polycystic ovary morphology, and insulin resistance. Vitamin D deficiency and vitamin D receptor (VDR)/vitamin D binding protein (VDBP) gene variants could play an important role in susceptibility to PCOS and contribute to metabolic disturbances and menstrual dysfunction. We aimed to investigate the associations of VDR gene and VDBP gene polymorphisms with PCOS susceptibility and to elucidate the impacts of these polymorphisms on the hormonal and metabolic parameters of PCOS. METHODS We recruited 432 women with PCOS and 927 controls. Polymorphisms in the VDR gene (VDR Fok-I, Cdx2, Apa-I, and Bsm-I) and VDBP gene (VDBP rs4588, rs7041, and rs22822679) were genotyped. A 75-g oral glucose tolerance test was performed. RESULTS The distributions of genotypes and allele frequencies in VDR and VDBP genes did not differ between PCOS and control. In women with PCOS, compared to the VDR Fok-I GG genotype, the VDR Fok-I AG genotype was significantly associated with increased levels of total testosterone (β = 5.537, P = 0.005). Compared to the VDR Cdx2 AC genotype, the VDR Cdx2 CC genotype was associated with increased levels of fasting insulin and HOMA-IR in women with PCOS, however, the associations were not statistically significant. CONCLUSIONS This finding indicates that genetic variations in VDR and VDBP were not associated with increased risk for PCOS. In contrast, the VDR Fok-I polymorphism was associated with testosterone level and the Cdx2 polymorphism with insulin sensitivity in PCOS. However, the Cdx2 polymorphism was not significantly associated with increased insulin and insulin sensitivity in women with PCOS after multiple linear regression.
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Affiliation(s)
- Do Kyeong Song
- Department of Internal Medicine, Ewha Womans University School of Medicine, 25 Magokdong-ro 2-gil, Gangseo-gu, Seoul, 07804, South Korea.
| | - Hyejin Lee
- Department of Internal Medicine, Ewha Womans University School of Medicine, 25 Magokdong-ro 2-gil, Gangseo-gu, Seoul, 07804, South Korea
| | - Young Sun Hong
- Department of Internal Medicine, Ewha Womans University School of Medicine, 25 Magokdong-ro 2-gil, Gangseo-gu, Seoul, 07804, South Korea
| | - Yeon-Ah Sung
- Department of Internal Medicine, Ewha Womans University School of Medicine, 25 Magokdong-ro 2-gil, Gangseo-gu, Seoul, 07804, South Korea
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Shi XY, Huang AP, Xie DW, Yu XL. Association of vitamin D receptor gene variants with polycystic ovary syndrome: a meta-analysis. BMC MEDICAL GENETICS 2019; 20:32. [PMID: 30764792 PMCID: PMC6376757 DOI: 10.1186/s12881-019-0763-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 01/31/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a common endocrine disorder in reproductive-age women. Multiple susceptible gene as well as environmental factors and their interaction each other are contributed to the PCOS risk. Several case-control studies have researched the associations of the vitamin D receptor gene (VDR) polymorphisms with PCOS susceptibility, but the jury is still out. Here, we carried out a meta-analysis to clarify polymorphisms between ApaI (C/A) (rs7975232), BsmI (G/A) (rs1544410), FokI (C/T) (rs10735810), TaqI (T/C) (rs731236) and Tru9I (G/A) (rs757343) in the VDR gene and PCOS susceptibility based on relative lager sample size. METHODS English database of PubMed and Embase, and Chinese database of Wanfang and China National Knowledge Infrastructure (CNKI) databases were retrivaled for the relationship between VDR gene variates and PCOS susceptibility published before 31th, May 2018. Crude odds ratios (ORs) and its 95% confidence intervals (95% CIs) in different comparisons were used to detected the strength of the association. All the statistical analyses of the present meta-analysis were performed by STATA version 12.0 software. RESULTS Totally, 3587 (PCOS group 1922; control group 1665) participants from 13 studies were included which met our inclusion criteria. A statistically significant association between VDR ApaI (rs7975232) polymorphism and PCOS susceptibility (C vs. A: OR = 1.19, 95%CI = 1.06~1.34, P = 0.004) was found in the overall population. After stratified by ethnicity, we showed that there is a significant association between VDR ApaI (rs7975232) polymorphism and susceptibility to PCOS in the Asian (C vs. A: OR = 1.21, 95%CI = 1.04~1.42, P = 0.016) population, but this association was not found in the Caucasian population. Additionally, a significant relationship between VDR BsmI (rs1544410) variates with PCOS susceptibility in the Asian (G vs. A: OR = 1.27, 95%CI = 1.06~1.53, P = 0.011) population, but this association was not found in the Caucasian population. We didn't find any association between VDR FokI (rs2228570), VDR TaqI (rs731236), VDR Tru9I (rs757343) and PCOS susceptibility in the overall and the subgroup populations. CONCLUSIONS Our findings demonstrated that VDR ApaI (rs7975232) and VDR BsmI (rs1544410) polymorphisms are correlated with susceptibility to PCOS in the Asian population and VDR TaqI (rs731236), VDR FokI (rs2228570), VDR Tru9I (rs757343) did not reveal a relationship with the PCOS susceptibility.
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Affiliation(s)
- Xiao-Yuan Shi
- Lanzhou University Second Hospital, Medical Record Department, Lanzhou, 730030, Gansu Province, China
| | - Ai-Ping Huang
- Blood Center of Zhejiang Province, Blood Donation Service Department, Hangzhou, 310006, Zhejiang Province, China
| | - Duo-Wen Xie
- Lanzhou University Second Hospital, Intensive Care Unit 2, Lanzhou, 730030, Gansu Province, China
| | - Xiao-Long Yu
- Zhejiang Hospital, Department of nutrition, Hangzhou, 310013, Zhejiang Province, China.
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Zhu B, Huang K, Yan S, Hao J, Zhu P, Chen Y, Ye A, Tao F. VDR Variants rather than Early Pregnancy Vitamin D Concentrations Are Associated with the Risk of Gestational Diabetes: The Ma'anshan Birth Cohort (MABC) Study. J Diabetes Res 2019; 2019:8313901. [PMID: 31341914 PMCID: PMC6613005 DOI: 10.1155/2019/8313901] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/14/2019] [Accepted: 06/17/2019] [Indexed: 12/13/2022] Open
Abstract
AIM This study investigated the associations among early pregnancy vitamin D concentrations, seasonality, and vitamin D metabolic gene variants and how these variables related alone and in interaction with the risk of gestational diabetes mellitus (GDM). METHODS Research participants were women from the Ma'anshan birth cohort study in China. The overall study included 3110 women to explore the association between early pregnancy vitamin D concentrations and the risk of GDM. In the current analysis, a nested case-control study of 274 GDM cases and 380 controls was conducted to investigate seven vitamin D metabolic gene variants and the risk of GDM. Vitamin D concentrations were measured by radioimmunoassay. Genotypes were determined by improved multiple ligase detection reaction. Interactions between genetic variants and vitamin D as predictors of the risk of GDM were evaluated by a pair-wise analysis under a multiplicative interaction model. RESULTS Vitamin D concentrations were not significantly associated with the risk of GDM (OR = 0.79, 95% CI = 0.55-1.13) after adjusting for seasonality. Fall-winter conceptions had a 37% decreased risk of GDM compared with spring-summer conceptions (OR = 0.63, 95% CI = 0.49-0.81), independent of vitamin D concentrations. Two VDR gene variants rs1544410 (OR = 2.03, 95% CI = 1.17-3.51 for CT versus CC) and rs731236 (OR = 2.42, 95% CI = 1.29-4.55 for GA versus AA) were significantly associated with the risk of GDM. No interactions among genetic variants and vitamin D concentrations were detected. CONCLUSION Early pregnancy vitamin D insufficiency or deficiency was not significantly associated with the risk of GDM. The results of this study emphasize the importance of genetic variants in VDR and conception season as factors that affect the risk of GDM.
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Affiliation(s)
- Beibei Zhu
- Department of Maternal, Child & Adolescent Health, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, China
| | - Kun Huang
- Department of Maternal, Child & Adolescent Health, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, China
| | - Shuangqin Yan
- Ma'anshan Maternal and Child Health Care Center, Ma'anshan, China
| | - Jiahu Hao
- Department of Maternal, Child & Adolescent Health, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, China
| | - Peng Zhu
- Department of Maternal, Child & Adolescent Health, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, China
| | - Yao Chen
- Department of Maternal, Child & Adolescent Health, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, China
| | - Aoxing Ye
- Department of Maternal, Child & Adolescent Health, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, China
| | - Fangbiao Tao
- Department of Maternal, Child & Adolescent Health, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, China
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Bellan M, Marzullo P. New Insights on Low Vitamin D Plasma Concentration as a Potential Cardiovascular Risk Factor. Open Rheumatol J 2018. [DOI: 10.2174/1874312901812010261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The role of Vitamin D hormone in human health and disease is still debated. Recently, growing attention has been paid to its putative role in cardiovascular system homeostasis with several studies that suggested a correlation between low vitamin D levels and increased cardiovascular risk. Several mechanisms are involved in the development of cardiovascular diseases: systemic inflammation, endothelial dysfunction, arterial hypertension and insulin resistance. In the present paper, we have revised the current literature supporting a role for vitamin D in the development of these pathogenetic processes. Finally, we have evaluated the current evidence linking vitamin D to atherosclerosis and its natural consequence, cardiovascular diseases.
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Al Thomali A, Daghestani MH, Daghestani MH, Kaya N, Warsy A. Polymorphic Variations in VDR Gene in Saudi Women with and Without Polycystic Ovary Syndrome (PCOS) and Significant Influence of Seven Polymorphic Sites on Anthropometric and Hormonal Parameters. J Med Biochem 2018; 37:415-425. [PMID: 30584400 PMCID: PMC6298478 DOI: 10.2478/jomb-2018-0007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 02/28/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This study was designed to evaluate the associations between vitamin D receptor (VDR) gene polymorphisms and biochemical characteristics of Saudi women with polycystic ovary syndrome (PCOS). METHODS Serum levels of LH, FSH, and Vitamin D were measured in 33 women: 16 patients and 17 normal controls (18 to 36 years). DNA was extracted and used for sequencing of the exons of VDR gene using ABI PRISM 3730xi Genetic Analyzer. RESULTS Weight, BMI, Vit D, LH and FSH levels were higher in the PCOS patients compared to control group, where Vit D level correlated positively and significantly with FSH, in the control, but showed a negative and non-significant correlation in the PCOS patients. Sequencing results showed extensive polymorphisms in both groups, but the differences in the frequencies were not significant. Demographic and hormonal parameters were compared in the different genotypes of the SNPs. Significant differences were ob served in the values of the studied parameters in rs11168276, rs11168266, rs3858733, rs121909790, rs11168265 and rs731236. Vitamin D level was influenced significantly by the genotypes of rs11168265 (AA) (p=0.008), rs11168276 (AA; p=0.018) and rs731236 (CC; p=0.024). CONCLUSION Vitamin D deficiency does not associate with PCOS in Saudi females. Several SNPs are identified in the VDR gene, in normal and PCOS females, but there is no difference in their frequencies between the two groups. The results show that polymorphism in VDR gene influences certain anthropometric and hormonal parameters in PCOS patients. Further detailed studies are required to confirm the associations between VDR and PCOS.
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Affiliation(s)
- Arwa Al Thomali
- Department of Zoology, College of Science, King Saud University, RiyadhSaudi Arabia
- Central Laboratory, Center for Science and Medical Studies for Girls, King Saud University, Riyadh, Saudi Arabia
| | - Maha H. Daghestani
- Department of Zoology, College of Science, King Saud University, RiyadhSaudi Arabia
- Central Laboratory, Center for Science and Medical Studies for Girls, King Saud University, Riyadh, Saudi Arabia
| | - Mazin H. Daghestani
- Department of Obstetrics and Gynecology, Umm-Al-Qura University, Makkah, Saudi Arabia
| | - Namik Kaya
- Department of Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Arjumand Warsy
- Central Laboratory, Center for Science and Medical Studies for Girls, King Saud University, Riyadh, Saudi Arabia
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Wong HYQ, Li HWR, Lam KSL, Tam S, Shek CC, Lee CYV, Yeung WSB, Ho PC, Ng EHY. Independent association of serum vitamin D with anti-Mullerian hormone levels in women with polycystic ovary syndrome. Clin Endocrinol (Oxf) 2018; 89:634-641. [PMID: 30019416 DOI: 10.1111/cen.13816] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/10/2018] [Accepted: 07/12/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study aimed at investigating the association of serum vitamin D (25(OH)D) and anti-Mullerian hormone (AMH) levels in women with polycystic ovary syndrome (PCOS) as well as non-PCOS healthy ovulatory women and the possible confounding effects of adiposity and androgen. METHOD This was a cross-sectional study conducted on serum samples collected from 451 women diagnosed with PCOS as well as 244 age-matched healthy ovulatory women in a tertiary gynaecology out-patient clinic and a family planning clinic. RESULTS Serum 25(OH)D level was significantly higher in women recruited during summer and autumn than those recruited in winter and spring. Both serum 25(OH)D and AMH levels peaked during summer in women with PCOS. In ovulatory women, only serum 25(OH)D but not AMH level showed such seasonal variation. Serum 25(OH)D level in women with PCOS significantly correlated positively with AMH, AMH/antral follicle count (AFC) ratio, serum total testosterone, sex-hormone-binding globulin and quantitative insulin-sensitivity check index and inversely with body mass index (BMI), insulin, triglycerides and homeostatic model assessment of insulin resistance. After controlling for BMI, 25(OH)D level remained significantly correlated positively with serum AMH, AMH/AFC and total testosterone, and inversely with triglycerides. 25(OH)D level was an independent predictor of serum AMH level after controlling for age, BMI and free androgen index in women with PCOS. CONCLUSION Serum 25(OH)D level is an independent factor significantly associated with AMH level in women with PCOS but not in ovulatory women.
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Affiliation(s)
- Ho Yan Queenie Wong
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
- Department of Obstetrics and Gynaecology, Princess Margaret Hospital, Lai Chi Kok, Hong Kong
| | - Hang Wun Raymond Li
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Karen Siu Ling Lam
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Sidney Tam
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
- Department of Pathology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Chi Chung Shek
- Department of Pathology, Queen Elizabeth Hospital, Ho Man Tin, Hong Kong
| | - Chi Yan Vivian Lee
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - William Shu Biu Yeung
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Pak Chung Ho
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ernest Hung Yu Ng
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
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Santos BR, Lecke SB, Spritzer PM. Apa-I polymorphism in VDR gene is related to metabolic syndrome in polycystic ovary syndrome: a cross-sectional study. Reprod Biol Endocrinol 2018; 16:38. [PMID: 29669566 PMCID: PMC5907412 DOI: 10.1186/s12958-018-0355-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/06/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a common endocrine disorder determined by polygenic traits as well as environmental factors. Lower vitamin D levels have been detected in PCOS women and related to hormone and metabolic disturbances. Vitamin D acts in tissues through the vitamin D receptor (VDR). VDR gene variants have been associated with worse metabolic profile in the general population. We investigated the genotype and haplotype distribution of the Bsm-I (rs1544410), Apa-I (rs7975232), and Taq-I (rs731236) VDR gene polymorphisms in PCOS and non-hirsute women from southern Brazil. We further investigated the associations of these gene variants and their haplotypes with PCOS, vitamin D levels, and metabolic abnormalities, including the metabolic syndrome (MetS). METHODS A group of 191 women with PCOS (Rotterdam criteria) and 100 non-hirsute controls with regular ovulatory cycles were genotyped for all polymorphisms by real-time PCR, with allelic discrimination assays. MetS and the cutoffs for its isolated components were defined in accordance with the Joint Scientific Statement. RESULTS Women with PCOS were younger and had significantly higher BMI and total testosterone levels than controls (p < 0.05). The frequency of MetS in PCOS and controls was 26.5% and 4.8% respectively. The CC genotype of Apa-I entailed higher risk of MetS in PCOS (OR: 2.133; 95% CI 1.020-4.464, p = 0.042), and was associated with higher systolic blood pressure (p = 0.009), total cholesterol (p = 0.040), and LDL-cholesterol (p = 0.038) in both PCOS and control groups (two-way ANOVA). The frequencies of VDR haplotypes were similar in PCOS and control women. CONCLUSIONS The present results suggest that the Apa-I variant in VDR gene may be associated with MetS in southern Brazilian women with PCOS, and with blood pressure, total cholesterol, and LDL-c in women with and without PCOS.
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Affiliation(s)
- Betânia Rodrigues Santos
- 0000 0001 0125 3761grid.414449.8Division of Endocrinology, Gynecological Endocrinology Unit, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, RS 90035-003 Brazil
- 0000 0001 2200 7498grid.8532.cDepartment of Physiology, Laboratory of Molecular Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Sheila Bunecker Lecke
- 0000 0001 0125 3761grid.414449.8Division of Endocrinology, Gynecological Endocrinology Unit, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, RS 90035-003 Brazil
- 0000 0004 0444 6202grid.412344.4Department of Diagnostic Methods, Universidade Federal de Ciências Médicas de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Poli Mara Spritzer
- 0000 0001 0125 3761grid.414449.8Division of Endocrinology, Gynecological Endocrinology Unit, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, RS 90035-003 Brazil
- 0000 0001 2200 7498grid.8532.cDepartment of Physiology, Laboratory of Molecular Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Zaharan NL, Muhamad NH, Jalaludin MY, Su TT, Mohamed Z, Mohamed MNA, A. Majid H. Non-Synonymous Single-Nucleotide Polymorphisms and Physical Activity Interactions on Adiposity Parameters in Malaysian Adolescents. Front Endocrinol (Lausanne) 2018; 9:209. [PMID: 29755414 PMCID: PMC5934415 DOI: 10.3389/fendo.2018.00209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 04/13/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Several non-synonymous single-nucleotide polymorphisms (nsSNPs) have been shown to be associated with obesity. Little is known about their associations and interactions with physical activity (PA) in relation to adiposity parameters among adolescents in Malaysia. METHODS We examined whether (a) PA and (b) selected nsSNPs are associated with adiposity parameters and whether PA interacts with these nsSNPs on these outcomes in adolescents from the Malaysian Health and Adolescents Longitudinal Research Team study (n = 1,151). Body mass indices, waist-hip ratio, and percentage body fat (% BF) were obtained. PA was assessed using Physical Activity Questionnaire for Older Children (PAQ-C). Five nsSNPs were included: beta-3 adrenergic receptor (ADRB3) rs4994, FABP2 rs1799883, GHRL rs696217, MC3R rs3827103, and vitamin D receptor rs2228570, individually and as combined genetic risk score (GRS). Associations and interactions between nsSNPs and PAQ-C scores were examined using generalized linear model. RESULTS PAQ-C scores were associated with % BF (β = -0.44 [95% confidence interval -0.72, -0.16], p = 0.002). The CC genotype of ADRB3 rs4994 (β = -0.16 [-0.28, -0.05], corrected p = 0.01) and AA genotype of MC3R rs3827103 (β = -0.06 [-0.12, -0.00], p = 0.02) were significantly associated with % BF compared to TT and GG genotypes, respectively. Significant interactions with PA were found between ADRB3 rs4994 (β = -0.05 [-0.10, -0.01], p = 0.02) and combined GRS (β = -0.03 [-0.04, -0.01], p = 0.01) for % BF. CONCLUSION Higher PA score was associated with reduced % BF in Malaysian adolescents. Of the nsSNPs, ADRB3 rs4994 and MC3R rs3827103 were associated with % BF. Significant interactions with PA were found for ADRB3 rs4994 and combined GRS on % BF but not on measurements of weight or circumferences. Targeting body fat represent prospects for molecular studies and lifestyle intervention in this population.
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Affiliation(s)
- Nur Lisa Zaharan
- Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- *Correspondence: Nur Lisa Zaharan, ,
| | - Nor Hanisah Muhamad
- Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Tin Tin Su
- Centre for Population Health (CePH), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Zahurin Mohamed
- Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - M. N. A. Mohamed
- Sports Medicine Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hazreen A. Majid
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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