Association Between 25-Hydroxyvitamin D and Epicardial Adipose Tissue in Chinese Non-Obese Patients with Type 2 Diabetes

Perirenal fat differs in patients with chronic kidney disease receiving different vitamin D-based treatments: a preliminary study

INTRODUCTION

Chronic kidney disease (CKD) patients show high rates of cardiovascular disease (CVD) and mortality. In the general population, obesity, hypertension, and diabetes are known as the classical CVD risk factors. However, CKD patients have other predisposing CVD factors more associated with bone and mineral metabolism disorders (BMD). BMD originates from reduced 1,25-dihydroxy vitamin D and hypocalcemia, which lead to secondary hyperparathyroidism, with increased parathyroid hormone (PTH) levels and hyperphosphatemia as the progression of renal damage. Due to their pleiotropic effects, vitamin D and its analogs, such as cholecalciferol, calcitriol, or paricalcitol, have proven effective in controlling BMD and CVD. On the other hand, visceral adiposity has been shown to increase the risk for CVD in both the general and CKD populations via complex autocrine and paracrine hormonal mechanisms. This seems to be the case with fat surrounding the epicardium. Although it has not been widely evaluated, the fat surrounding the kidneys, or the perirenal adipose tissue (PAT), could also share similarities with the epicardial in terms of its potential contribution to the CVD risk observed in these patients. We conducted a preliminary study to assess differences in PAT on a sample of patients with CKD presenting diverse CVD history and who were receiving different vitamin D-receptor activators.

METHODS/RESULTS

An observational study was performed at UNIRENAL Center (Venezuela), from January to November 2015. Analytical and clinical parameters were evaluated. The PAT thickness was measured in centimeters through a B-mode ultrasound. Thus, we included 83 CKD patients treated with vitamin D or analogs (mean age 58.3 ± 16y); 57.83% were females. Nearly half of the sample was classified as CKD-G3 (n = 40). Prior history of CVD was present in 55.4% (N = 46) of participants. Must of the patients (n = 46;55.42%) receiving oral cholecalciferol (1000 IU/day) as part of the treatment for lower levels of vitamin D or BMD related to CKD (mainly elevated PTH), followed by those under calcitriol at 0.5 mcg/day (n = 27;32.53%), and around 12% (n = 10;12.05%) on paricalcitol (1 mcg/day). The mean treatment vintage was 20 ± 6 months for cholecalciferol, 18 ± 4 months for calcitriol, and 16 ± 2 months for paricalcitol. Those with a history of CVD (n = 46) showed higher levels of urea (mean 62.0vs45.2 mg/dl, p < 0.05), uric acid (mean 5.5vs4.3 mg/dl; p < 0.03), and iPTH (mean 186.2vs65.2pcg/dl; p < 0.05) than patients free of CVD events (n = 37). These findings were also in parallel with decreased renal function in the group with previous CVD history, as evidenced by a significantly lower eGFR (mean 53.55vs89.00 ml/min/1.73 m2,p < 0.001). Similarly, the mean PAT thickness was elevated in the group with a history of CVD in relation to those with no previous CVD events (0.99vs0.80 cm; SD ± 0.30;p ~ 0.05). The comparative analysis for the patients with prior cardiovascular events between the three treatments revealed that those on paricalcitol had lesser PAT accumulation than those treated with cholecalciferol or calcitriol (p < 0.05). In conclusion, our study shows that PAT thickness in CKD may be influenced by vitamin D analog-based treatment. Further research is needed to better understand the mechanistic links between PAT, BMD, and CVD in this population.

Epicardial adipose tissue, metabolic disorders, and cardiovascular diseases: recent advances classified by research methodologies

Epicardial adipose tissue (EAT) is located between the myocardium and visceral pericardium. The unique anatomy and physiology of the EAT determines its great potential in locally influencing adjacent tissues such as the myocardium and coronary arteries. Classified by research methodologies, this study reviews the latest research progress on the role of EAT in cardiovascular diseases (CVDs), particularly in patients with metabolic disorders. Studies based on imaging techniques demonstrated that increased EAT amount in patients with metabolic disorders is associated with higher risk of CVDs and increased mortality. Then, in-depth profiling studies indicate that remodeled EAT may serve as a local mediator of the deleterious effects of cardiometabolic conditions and plays a crucial role in CVDs. Further, in vitro coculture studies provided preliminary evidence that the paracrine effect of remodeled EAT on adjacent cardiomyocytes can promote the occurrence and progression of CVDs. Considering the important role of EAT in CVDs, targeting EAT might be a potential strategy to reduce cardiovascular risks. Several interventions have been proved effective in reducing EAT amount. Our review provides valuable insights of the relationship between EAT, metabolic disorders, and CVDs, as well as an overview of the methodological constructs of EAT-related studies.

Targeting epicardial adipose tissue: A potential therapeutic strategy for heart failure with preserved ejection fraction with type 2 diabetes mellitus

Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome with various comorbidities, multiple cardiac and extracardiac pathophysiologic abnormalities, and diverse phenotypic presentations. Since HFpEF is a heterogeneous disease with different phenotypes, individualized treatment is required. HFpEF with type 2 diabetes mellitus (T2DM) represents a specific phenotype of HFpEF, with about 45%-50% of HFpEF patients suffering from T2DM. Systemic inflammation associated with dysregulated glucose metabolism is a critical pathological mechanism of HFpEF with T2DM, which is intimately related to the expansion and dysfunction (inflammation and hypermetabolic activity) of epicardial adipose tissue (EAT). EAT is well established as a very active endocrine organ that can regulate the pathophysiological processes of HFpEF with T2DM through the paracrine and endocrine mechanisms. Therefore, suppressing abnormal EAT expansion may be a promising therapeutic strategy for HFpEF with T2DM. Although there is no treatment specifically for EAT, lifestyle management, bariatric surgery, and some pharmaceutical interventions (anti-cytokine drugs, statins, proprotein convertase subtilisin/kexin type 9 inhibitors, metformin, glucagon-like peptide-1 receptor agonists, and especially sodium-glucose cotransporter-2 inhibitors) have been shown to attenuate the inflammatory response or expansion of EAT. Importantly, these treatments may be beneficial in improving the clinical symptoms or prognosis of patients with HFpEF. Accordingly, well-designed randomized controlled trials are needed to validate the efficacy of current therapies. In addition, more novel and effective therapies targeting EAT are needed in the future.

Correlation analysis of epicardial adipose tissue thickness, C-reactive protein, interleukin-6, visfatin, juxtaposed with another zinc finger protein 1, and type 2 diabetic macroangiopathy

Background

To investigate the correlation between the thickness of epicardial adipose tissue (EAT), C-reactive protein (CRP), interleukin (IL) -6, visfatin, juxtaposed with another zinc finger protein 1 (JAZF1) and type 2 diabetic mellitus (T2DM) macroangiopathy.

Methods

The study enrolled 82 patients with T2DM with macroangiopathy (the Complication Group), and 85 patients with T2DM (the Diabetes Group) who were admitted to Shandong Provincial Third Hospital from February 2018 to February 2020. In addition, 90 healthy people who underwent physical examination at the same hospital during the same period were enrolled (the Healthy Control Group). Age, gender, height, weight, waist circumference (WC), hip circumference (HC), diabetic course and therapeutic drugs, waist hip ratio (WHR), and body mass index (BMI) were recorded and calculated.

Results

The baseline characteristics of the three groups were comparable, and the diabetic course of the Complication Group and the Diabetes Group was not significantly different (P > 0.05). The WHR of the Complication Group was higher than that of the Diabetes Group and the Healthy Control Group, with statistical significance (P < 0.05). The FPG, 2hPG, HbA1C, CRP, IL-6, Visfatin, JAZF1, HOMA-IR, EAT thickness, and baPWV of the Complication Group were all higher than those of the Diabetes Group and the Healthy Control Group (P < 0.05, respectively). The JAZF1 and FIns of the Complication Group and Diabetes Group were lower than those of the Healthy Control Group, and JAZF1 of the Complication Group was lower than the Diabetes Group with statistical significance (P<0.05, respectively). Pearson correlation analysis showed that the EAT thickness was positively correlated with CRP, IL-6, visfatin, and JAZF1 (r = 0.387, 0.451, 0.283, 0.301, respectively, all P<0.001). Pearson correlation analysis showed that baPWV was positively correlated with EAT thickness, CRP, IL-6, visfatin, and JAZF1 (r = 0.293, 0.382, 0.473, 0.286, respectively, all P < 0.001). Multivariate stepwise regression analysis showed that FPG, 2hPG, HbA1C, CRP, IL-6, visfatin, JAZF1, and EAT thickness were independent risk factors that affected T2DM macroangiopathy.

Conclusions

Clinical monitoring and treatment of T2DM macroangiopathy can use CRP, IL-6, Visfatin, JAZF1, and EAT thickness as new targets to delay the progression of the disease. Further research on the relationship between the above factors and the pathogenesis of T2DM macroangiopathy may be helpful provide new treatment strategies.

Evaluation of serum endocan levels in relation to epicardial fat tissue thickness in metabolic syndrome patients

Introduction

Metabolic syndrome has been recognized as a predictor of cardiovascular diseases. Epicardial fat tissue (EFT) thickness has recently been shown to be a predictor of cardiovascular diseases in metabolic syndrome patients. Endocan is a novel molecule which is considered to be an early marker of endothelial dysfunction. Our aim was to evaluate endocan serum levels for the first time in metabolic syndrome patients, in relation to EFT thickness.

Material and methods

The study included 44 patients with metabolic syndrome who had neither chronic kidney disease nor chronic inflammation and 26 healthy controls. Fasting blood samples were obtained from the groups. The serum levels of endocan were measured with a Sunred ELISA kit. EFT thickness of patients was measured by echocardiography.

Results

The serum endocan levels were significantly lower in the metabolic syndrome patients compared to the healthy controls (120.71 ±90.17 pg/ml vs. 414.59 ±277.57, p < 0.001). Metabolic syndrome patients demonstrated significantly higher EFT (p = 0.042). EFT thickness had a positive correlation with age (r = 0.397, p = 0.008) and weight (r = 0.010). However, there was no correlation with serum endocan (r = –0.021, p = 0.893) or other parameters. Regression analysis revealed that waist circumference is the parameter among metabolic syndrome criteria having the strongest relationship with serum endocan levels (β = –0.499, p = 0.21).

Conclusions

EFT thickness was high in metabolic syndrome patients and can be a useful marker for cardiovascular risk assessment. However, serum endocan levels were found to be low and there was no correlation with EFT thickness. Large sample sized prospective studies are needed to clarify the relation of endocan levels with the other clinical indicators of cardiovascular risk in metabolic syndrome.

Association Between Vitamin D and Uric Acid in Adults: A Systematic Review and Meta-Analysis

Association between vitamin D and uric acid is complex and might be bidirectional. Our study aimed to determine the bidirectional association between vitamin D and uric acid in adults. Using MEDLINE via PubMed and Scopus, we systematically searched for observational or interventional studies in adults, which assessed the association between serum vitamin D and serum uric acid, extracted the data, and conducted analysis by direct and network meta-analysis. The present review included 32 studies, of which 21 had vitamin D as outcome and 11 had uric acid as outcome. Meta-analysis showed a significant pooled beta coefficient of serum uric acid level on serum 25(OH)D level from 3 studies of 0.512 (95% confidence interval: 0.199, 0.825) and a significant pooled odds ratio between vitamin D deficiency and hyperuricemia of 1.496 (1.141, 1.963). The pooled mean difference of serum 25(OH)D between groups with hyperuricemia and normouricemia was non-significant at 0.138 (-0.430, 0.707) ng/ml, and the pooled mean difference of serum uric acid between categories of 25(OH)D were also non-significant at 0.072 (-0.153, 0.298) mg/dl between deficiency and normal, 0.038 (-0.216, 0.292) mg/dl between insufficiency and normal, and 0.034 (-0.216, 0.283) mg/dl between deficiency and insufficiency. In conclusion, increasing serum uric acid might be associated with increasing 25(OH)D level, while vitamin D deficiency is associated with hyperuricemia. These reverse relationships should be further evaluated in a longitudinal study.

A double burden of tuberculosis and diabetes mellitus and the possible role of vitamin D deficiency

Tuberculosis remains a major global health challenge, particularly in low-to-middle income countries such as China. At the same time, the country is facing a rapidly increasing diabetes incidence over the last 10 years. Diabetes aggravates the tuberculosis epidemic which poses a serious challenge in public health. In recent years, the high prevalence of vitamin D deficiency represents a global health problem, which is also associated with the risk of diabetes, and tuberculosis. Therefore, this review aims to provide an overall and updated understanding of the epidemiology of co-occurrence of tuberculosis and diabetes in China, and to elucidate the possible role of vitamin D deficiency. In conclusion, significant aggravation of the tuberculosis epidemic due to diabetes may exist in China for a relatively long period of time to come. Further, the double burden and its implications to public health in this country may be significantly influenced by the high prevalence of vitamin D deficiency. Bidirectional screening for tuberculosis and diabetes is recommended, and extra vitamin D may benefit especially in a situation of a heavy tuberculosis burden combined with prevalent vitamin D deficiency. Longitudinal studies to verify the role of vitamin D deficiency in the double burden, and trials on the effect of vitamin D supplementation are needed in the future.

Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths

The world is in the grip of the COVID-19 pandemic. Public health measures that can reduce the risk of infection and death in addition to quarantines are desperately needed. This article reviews the roles of vitamin D in reducing the risk of respiratory tract infections, knowledge about the epidemiology of influenza and COVID-19, and how vitamin D supplementation might be a useful measure to reduce risk. Through several mechanisms, vitamin D can reduce risk of infections. Those mechanisms include inducing cathelicidins and defensins that can lower viral replication rates and reducing concentrations of pro-inflammatory cytokines that produce the inflammation that injures the lining of the lungs, leading to pneumonia, as well as increasing concentrations of anti-inflammatory cytokines. Several observational studies and clinical trials reported that vitamin D supplementation reduced the risk of influenza, whereas others did not. Evidence supporting the role of vitamin D in reducing risk of COVID-19 includes that the outbreak occurred in winter, a time when 25-hydroxyvitamin D (25(OH)D) concentrations are lowest; that the number of cases in the Southern Hemisphere near the end of summer are low; that vitamin D deficiency has been found to contribute to acute respiratory distress syndrome; and that case-fatality rates increase with age and with chronic disease comorbidity, both of which are associated with lower 25(OH)D concentration. To reduce the risk of infection, it is recommended that people at risk of influenza and/or COVID-19 consider taking 10,000 IU/d of vitamin D₃ for a few weeks to rapidly raise 25(OH)D concentrations, followed by 5000 IU/d. The goal should be to raise 25(OH)D concentrations above 40-60 ng/mL (100-150 nmol/L). For treatment of people who become infected with COVID-19, higher vitamin D₃ doses might be useful. Randomized controlled trials and large population studies should be conducted to evaluate these recommendations.

Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths

The world is in the grip of the COVID-19 pandemic. Public health measures that can reduce the risk of infection and death in addition to quarantines are desperately needed. This article reviews the roles of vitamin D in reducing the risk of respiratory tract infections, knowledge about the epidemiology of influenza and COVID-19, and how vitamin D supplementation might be a useful measure to reduce risk. Through several mechanisms, vitamin D can reduce risk of infections. Those mechanisms include inducing cathelicidins and defensins that can lower viral replication rates and reducing concentrations of pro-inflammatory cytokines that produce the inflammation that injures the lining of the lungs, leading to pneumonia, as well as increasing concentrations of anti-inflammatory cytokines. Several observational studies and clinical trials reported that vitamin D supplementation reduced the risk of influenza, whereas others did not. Evidence supporting the role of vitamin D in reducing risk of COVID-19 includes that the outbreak occurred in winter, a time when 25-hydroxyvitamin D (25(OH)D) concentrations are lowest; that the number of cases in the Southern Hemisphere near the end of summer are low; that vitamin D deficiency has been found to contribute to acute respiratory distress syndrome; and that case-fatality rates increase with age and with chronic disease comorbidity, both of which are associated with lower 25(OH)D concentration. To reduce the risk of infection, it is recommended that people at risk of influenza and/or COVID-19 consider taking 10,000 IU/d of vitamin D₃ for a few weeks to rapidly raise 25(OH)D concentrations, followed by 5000 IU/d. The goal should be to raise 25(OH)D concentrations above 40-60 ng/mL (100-150 nmol/L). For treatment of people who become infected with COVID-19, higher vitamin D₃ doses might be useful. Randomized controlled trials and large population studies should be conducted to evaluate these recommendations.

A Potential Linking between Vitamin D and Adipose Metabolic Disorders

Vitamin D has been discovered centuries ago, and current studies have focused on the biological effects of vitamin D on adipogenesis. Besides its role in calcium homeostasis and energy metabolism, vitamin D is also involved in the regulation of development and process of metabolic disorders. Adipose tissue is a major storage depot of vitamin D. This review summarized studies on the relationship between vitamin D and adipogenesis and furthermore focuses on adipose metabolic disorders. We reviewed the biological roles and functionalities of vitamin D, the correlation between vitamin D and adipose tissue, the effect of vitamin D on adipogenesis, and adipose metabolic diseases. Vitamin D is associated with adipogenesis, and vitamin D supplements can reduce the burden caused by metabolic diseases. The review provides new insights and basis for medical therapy on adipose metabolic diseases.

Directional Relationship Between Vitamin D Status and Prediabetes: A New Approach from Artificial Neural Network in a Cohort of Workers with Overweight-Obesity

Objective: Despite the increasing literature on the association of diabetes with inflammation, cardiovascular risk, and vitamin D (25(OH)D) concentrations, strong evidence on the direction of causality among these factors is still lacking. This gap could be addressed by means of artificial neural networks (ANN) analysis.Methods: Retrospective observational study was carried out by means of an innovative data mining analysis-known as auto-contractive map (AutoCM)-and semantic mapping followed by Activation and Competition System on data of workers referring to an occupational-health outpatient clinic. Parameters analyzed included weight, height, waist circumference, body mass index (BMI), percentage of fat mass, glucose, insulin, glycated hemoglobin (HbA1c), creatinine, total cholesterol, low- and high-density lipoprotein cholesterol, triglycerides, uric acid, fibrinogen, homocysteine, C-reactive protein (CRP), diastolic and systolic blood pressure, and 25(OH)D.Results: The study included 309 workers. Of these, 23.6% were overweight, 40.5% were classified into the first class of obesity, 23.3% were in the second class, and 12.6% were in the third class (BMI > 40 kg/m ). All mean biochemical values were in normal range, except for total cholesterol, low- and high-density lipoprotein cholesterol, CRP, and 25(OH)D. HbA1c was between 39 and 46 mmol/mol in 51.78%. 25(OH)D levels were sufficient in only 12.6%. Highest inverse correlation for hyperglycemia onset was with BMI and waist circumference, suggesting a protective role of 25(OH)D against their increase. AutoCM processing and the semantic map evidenced direct association of 25(OH)D with high link strength (0.99) to low CRP levels and low high-density lipoprotein cholesterol levels. Low 25(OH)D led to changes in glucose, which affected metabolic syndrome biomarkers, first of which was homeostatic model assessment index and blood glucose, but not 25(OH)D.Conclusions: The use of ANN suggests a key role of 25(OH)D respect to all considered metabolic parameters in the development of diabetes and evidences a causation between low 25(OH)D and high glucose concentrations.

Epicardial fat tissue in patients with diabetes mellitus: a systematic review and meta-analysis

Background

Epicardial fat tissue (EFT) is the visceral fat distributed along the coronary arteries between the pericardium and the myocardium. Increases in EFT are closely related to the occurrence of diabetes mellitus (DM) and cardiovascular disease. To further understand the link between EFT and DM, we conducted a meta-analysis of the relevant literature.

Methods

We systematically searched electronic databases for studies on EFT performed in DM patients and published up to 30 September 2018. We included data on EFT in a DM patient group and a non-DM control group. We then assessed the effect of DM on EFT by meta-analysis and trial sequential analysis (TSA). All statistical analyses were performed using Stata 12.0 and TSA software.

Results

A total of 13 studies (n = 1102 patients) were included in the final analysis. Compared with the control group, DM patients had significantly higher EFT (SMD: 1.23; 95% CI 0.98, 1.48; P = 0.000; TSA-adjusted 95% CI 0.91, 2.13; P < 0.0001). The TSA indicated that the available samples were sufficient and confirmed that firm evidence was reached. According to the regression analysis and subgroup analyses, DM typing, EFT ultrasound measurements, total cholesterol (TC) and triglyceride (TG) levels were confounding factors that significantly affected our results.

Conclusions

Our meta-analysis suggests that the amount of EFT is significantly higher in DM patients than in non-DM patients.