Relationship between 25 hydroxyvitamin D and lipid profile in Lebanese school children

Longitudinal Associations Between Vitamin D Status and Cardiometabolic Risk Markers Among Children and Adolescents

CONTEXT

Vitamin D status has previously been associated with cardiometabolic risk markers in children and adolescents. In particular, it has been suggested that children with obesity are more prone to vitamin D deficiency and unfavorable metabolic outcomes compared with healthy-weight children.

OBJECTIVE

To conduct a longitudinal study assessing this association in children and stratify by body mass index (BMI) category.

METHODS

Children from the pan-European IDEFICS/I.Family cohort with at least one measurement of serum 25-hydroxyvitamin D [25(OH)D] at cohort entry or follow-up (n = 2171) were included in this study. Linear mixed-effect models were used to assess the association between serum 25(OH)D as an independent variable and z-scores of cardiometabolic risk markers (waist circumference, systolic [SBP] and diastolic blood pressure [DBP], high- [HDL] and low-density lipoprotein, non-HDL, triglycerides [TRG], apolipoprotein A1 [ApoA1] and ApoB, fasting glucose [FG], homeostatic model assessment for insulin resistance [HOMA-IR], and metabolic syndrome score) as dependent variables.

RESULTS

After adjustment for age, sex, study region, smoking and alcohol status, sports club membership, screen time, BMI, parental education, and month of blood collection, 25(OH)D levels were inversely associated with SBP, DBP, FG, HOMA-IR, and TRG. The HOMA-IR z-score decreased by 0.07 units per 5 ng/mL increase in 25(OH)D. The 25(OH)D level was consistently associated with HOMA-IR irrespective of sex or BMI category.

CONCLUSION

Low serum 25(OH)D concentrations are associated with unfavorable levels of cardiometabolic markers in children and adolescents. Interventions to improve vitamin D levels in children with a poor status early in life may help to reduce cardiometabolic risk.

Adiposity Metabolic Consequences for Adolescent Bone Health

Infancy and adolescence are crucial periods for bone health, since they are characterized by intense physical growth and bone development. The unsatisfactory acquisition of bone mass in this phase has consequences in adult life and increases the risk of developing bone diseases at more advanced ages. Nutrient deficiencies, especially calcium and vitamin D, associated with a sedentary lifestyle; lack of sun exposure; and epigenetic aspects represent some of the main risk factors for poor bone quality. In addition, recent studies relate childhood obesity to impaired bone health; however, studies on the adiposity effects on bone health are scarce and inconclusive. Another gap concerns the implications of obesity on child sexual maturity, which can jeopardize their genetic potential bone mass and increase fracture risk. Therefore, we reviewed the analyzed factors related to bone health and their association with obesity and metabolic syndrome in adolescents. We concluded that obesity (specifically, accumulated visceral fat) harms bones in the infant–juvenile phase, thereby increasing osteopenia/osteoporosis in adults and the elderly. Thus, it becomes evident that forming and maintaining healthy eating habits is necessary during infancy and adolescence to reduce the risk of fractures caused by bone-metabolic diseases in adulthood and to promote healthy ageing.

Vitamin D is negatively associated with triglyceride in overweight/obese patients with type 2 diabetes

PURPOSE

Vitamin D has been identified to have a relation to the development of insulin resistance-related diseases, such as type 2 diabetes (T2D). T2D is often associated with obesity and dyslipidemia. Our study aimed to analyze the relationship between vitamin D and lipid profile in patients with T2D.

METHODS

A total of 446 T2D patients who were hospitalized from January 2015 to December 2016 were recruited. Baseline characteristics were recorded, including body mass index (BMI), serum level of 25 hydroxy vitamin D (25(OH)D), and other biochemical indicators. T2D patients were divided into normal-weight group and overweight/obese group according to their BMI. Subgroup analysis was conducted after patients were subdivided using the quartet-method according to serum level of 25(OH)D. Differences in glucose and lipid metabolism indicators were analyzed. The correlation between serum 25(OH)D and lipid profiles was assessed by the multiple linear regression.

RESULTS

The levels of serum 25(OH)D and high-density lipoprotein cholesterol in T2D patients of overweight/obesity group were significantly lower than those in normal-weight group, while the levels of triglyceride (TG) and HOMA-IR were significantly higher (P < 0.05). Subgroup analysis uncovered that total cholesterol (TC) and TG levels were lower with higher 25(OH)D in normal weight T2D patients. In overweight/obese T2D patients, TG level was lower in patients with higher 25(OH)D (P < 0.05). There were no significant differences in low-density lipoprotein cholesterol (LDL-C), fasting blood glucose (FBG), fasting insulin (FINS), and hemoglobin Alc (HbAlc) among Q1-Q4 in both normal weight and overweight/obese groups. Pearson test showed that serum 25(OH)D was positively correlated with high density lipoprotein cholesterol (HDL-C), and negatively correlated with TC and TG. Serum 25(OH)D was unrelated to low density lipoprotein cholesterol (LDL-C) in both groups. Multiple linear regression analysis only demonstrated an independent negative correlation between 25(OH)D and TG levels in the overweight/obese group (P < 0.01).

CONCLUSIONS

In overweight/obese patients with T2D, serum 25(OH)D was independently, negatively correlated with TG. Vitamin D supplementation should be guaranteed in patients with diabetes, especially with obese T2D.

Vitamin D supplementation reduces serum lipids of children with hypertriacylglycerolemia: A randomized, triple-masked, placebo-controlled crossover trial

OBJECTIVES

This study aimed to evaluate the effect of cholecalciferol supplementation on the body composition and metabolic profile of children with hypertriacylglycerolemia.

METHODS

This is a randomized, triple-masked, placebo-controlled, crossover trial of 44 Brazilian children with hypertriacylglycerolemia, age 4 to 11 y. The sample included eutrophic and overweight/obese children according to body mass index for age, with sufficient and insufficient vitamin D basal levels. The intervention lasted 34 wk, with two periods of 12 wk each separated by a 10-wk washout. The two groups, supplemented and placebo, received five drops of cholecalciferol (equivalent to 1000 international unit/d) and five drops of sunflower oil, respectively, daily for 12 wk. Sociodemographic, economic, sunscreen use, percentage of body surface area daily exposed to sun, physical activity, anthropometry (body mass and height), body composition (waist circumference, body fat percentage, fat-free mass, triceps, and subscapular skinfolds), biochemical profile (25-hydroxyvitamin D, fasting glucose, and lipid fractions), blood pressure, and food intake data were collected.

RESULTS

Of the 44 children who concluded the study, 56.80% were female, 54.50% were of brown race, 81.82% had sufficient serum 25-hydroxyvitamin D (≥75 nmol/L), and 50.00% were overweight/obese according to body mass index for age. There was a reduction in serum total cholesterol (P < 0.001), low-density lipoprotein cholesterol (P < 0.001), nonhigh-density lipoprotein cholesterol (P < 0.001), total cholesterol/high-density lipoprotein cholesterol (P = 0.001), and low/high-density lipoprotein cholesterol ratios (P < 0.001) in the supplemented group compared with the placebo group.

CONCLUSIONS

Cholecalciferol supplementation improved the lipid profile of children with hypertriacylglycerolemia without altering body composition.

Comprehensive Review of Cardiovascular Diseases, Diabetes, and Hypercholesterolemia in Lebanon.Cardiol Rev. 2020;28:73-83. [PMID: 31985525 DOI: 10.1097/CRD.0000000000000290]

The Middle East and North Africa regions, including Lebanon, have recently witnessed rapid urbanization and modernization over the last couple of decades that has led to a dramatic transformation affecting lifestyle and diet. The World Health Organization reports that the leading cause of death in Lebanon is due to cardiovascular disease (CVD) at 47% of all-cause mortality. Over the last 30 years, especially the last 10, the population of Lebanon has changed dramatically due to the effect of wars in the region and refugees seeking asylum. With a population of around 4.5 million and a relatively high rate of consanguinity in Lebanon, a variety of novel mutations have been discovered explaining several familial causes of hypercholesterolemia, diabetes mellitus, congenital heart disease, and cardiomyopathies. Due to the Syrian civil war, 1.5 million Syrian refugees now reside in Lebanon in either low-income housing or tented settlements. A National Institutes of Health study is examining diabetes and CVD in Syrian refugees in comparison to native Lebanese. We provide the first review of CVD in Lebanon in its metabolic component including coronary artery disease and its risk factors, mainly hyperlipidemia and diabetes mellitus, and its structural component, including congenital heart disease, valvular heart disease, cardiomyopathies, and heart failure. The knowledge in this review has been compiled to guide clinicians and assist researchers in efforts to recognize risk factors for disease, improve delivery of health care, and prevent and treat CVDs in Lebanon, both for the native Lebanese and Syrian refugees.

Vitamin D screening

At present, there is no need and no sufficient evidence to support universal screening for vitamin D status. There are four categories of subjects in whom there is no requirement for screening, since a number of studies indicate beneficial effects of vitamin D supplementation; these are represented by children and adolescents, pregnant women, patients taking bone active drugs and subjects with documented hypovitaminosis D. In the remaining subjects, the utilization of adequate questionnaires will target with sufficient sensitivity and specificity those with hypovitaminosis D. These must be first supplemented and, at a later time, serum 25(OH)D assay should be requested to confirm attainment of sufficiency, independently of the threshold chosen. This strategy will cut costs deriving from both widespread use of vitamin D assays and vitamin D supplementation.