The Relationship between 25-Hydroxyvitamin D3 and CRP Levels …

[Pages:7]International Journal of Research Studies in Medical and Health Sciences Volume 4, Issue 3, 2019, PP 04-10 ISSN : 2456-6373

The Relationship between 25-Hydroxyvitamin D3 and CRP Levels in Obese Adolescents with Insulin Resistance

Huseyin Dag1, Okan Dikker2 1University of Health Sciences, Istanbul Okmeydani Training and Research Hospital, Department of

Pediatrics, Istanbul, Turkey. 2University of Health Sciences, Istanbul Okmeydani Training and Research Hospital, Department of

Medical Biochemistry, Istanbul, Turkey.

*Corresponding Author: Dr. Huseyin DAG, University of Health Sciences, Istanbul Okmeydani Training and Research Hospital, Department of Pediatrics, Istanbul, Turkey.

ABSTRACT

Background: Vitamin D3 has been shown to be useful in the prevention of cancer, autoimmunity, cardiovascular disease and infections as well as bone development. Decreased levels of vitamin D3 have been associated with many non-skeletal diseases, including inflammation, insulin resistance, and diabetes. Obesity has a low-grade inflammation and is associated with decreased vitamin D3 levels. CRP is the most widely studied biomarker of low-grade systemic inflammation. In our study; we aimed to evaluate 25hydroxyvitamin D3 levels in obese adolescents with insulin resistance and to evaluate its effects on CRP levels.

Method: A total of 70 adolescents were included in our study, with age ranging from 10 to 16 years. Among study participants 38 were obese with insulin resistance, and 32 of them were healthy and having normalweight. The adolescents having body mass index (BMI) on 95% percentile and over according to their age and sex were defined as obese. Obese adolescents with a homeostatic model of assessment- insulin resistance (HOMA-IR) value of over 2.5 were regarded as obese adolescents with insulin resistance; while healthy control group consisted of normal weight adolescents without insulin resistance and obesity. The obese adolescents with insulin resistance were divided into two groups according to 25-hydroxyvitamin D3 levels as 0-20 ug / L and > 20 ug / L. Laboratory tests, gender, age and BMI were statistically compared between groups.

Results: BMI, HbA1c, ALT, CRP, triglyceride, insulin and HOMA-IR levels of the obese group were found to be significantly higher than the control group (p 0.05).

Conclusion: In obese adolescents with insulin resistance, we found 25-hydroxyvitamin D3 levels similar to healthy controls. We found high CRP levels in obese adolescents with insulin-resistant and decreased 25hydroxyvitamin D3 levels. Routine administration of vitamin D3 prophylaxis may reduce inflammation and prevent potential complications in these patients.

Keywords: Insulin resistance, obesity, adolescent, 25-hydroxyvitamin D3, CRP

INTRODUCTION

Vitamin D3 acts on the bone, intestine, kidney and parathyroid glands and regulates the metabolism of calcium and phosphorus (1). In addition to healthy bone development, in the prevention of many cancers, autoimmunity, cardiovascular diseases and infection vitamin D3 has been shown to benefit in previous studies (2). If 25-hydroxyvitamin D3 level is lower than 20 ug / L, vitamin D3 deficiency is mentioned (3). In vitamin D3 deficiency, the

mineral content of bone decreases due to the decrease in calcium absorption, leading to rickets in children (2). Decreased levels of vitamin D3 can lead to inflammation (4). This reduction has also been associated with many non-skeletal diseases including insulin resistance and diabetes (5). In obese patients, vitamin D3 is stored in adipose tissue and it is reported that vitamin D3 levels are lower in obese patients than in normal weight as it cannot be used systemically (6).

International Journal of Research Studies in Medical and Health Sciences V4 I3 2019

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The Relationship between 25-Hydroxyvitamin D3 and CRP Levels in Obese Adolescents with Insulin esistance

Obesity is an important public health problem with an increasing frequency worldwide and affecting about 25-30% of children (7). It was observed that 50% of obese adolescents were also obese in their adulthood (8). There is a lowgrade inflammation due to an increase in proinflammatory cytokine levels in obesity characterized by excessive accumulation of lipids and adipose tissue that form ectopic fat accumulation in different tissues (9, 10).

C-reactive protein (CRP) is an acute phase reactive protein that elevates in inflammatory conditions (11). CRP is the most widely studied biomarker of low-grade systemic inflammation because it has a well-known relationship with the disease and has a stable half-life and has well-known cut-off values (12). An inverse relationship between vitamin D3 and CRP levels is mentioned, and vitamin D3 supplementation has been reported to reduce CRP concentrations (13, 14). The aim of this study was to investigate the levels of 25-hydroxy vitamin D3 in obese adolescents with insulin resistance and to evaluate its effects on CRP levels.

MATERIAL AND METHODS

In this study, the hospital records of 70 patients, aged between 10 and 16 years, who were admitted to the pediatric outpatient clinic between July and December 2018, 38 of whom were obese and having insulin-resistance and 32 were normal-weighted healthy controls, were retrospectively reviewed. The body mass index (BMI) was obtained by division of weight of the patient in kg to the square of the height in meters. Adolescents having BMI on 95% percentile and over according to their age and sex were defined as obese (15). For insulin resistance, Homeostatic model of assessment mg (HOMA-IR) was calculated with the formula (insulin IU / L x glucose mg / dL) / 40 (16). The obese adolescents with HOMA-IR value over 2.5 are defined as obese adolescents with insulin resistance. The normal weight adolescents without insulin resistance and obesity were included in the healthy control group. Then, obese adolescents with insulin resistance were divided into two groups according to their 25-hydroxyvitamin D3 levels as 0-20 ug / L and> 20 ug / L sub-groups. Between groups, laboratory tests [HbA1c, glucose, urea, creatinine, aspartate amino transferase (AST), alanine amino transferase (ALT), total cholesterol, triglyceride, calcium, 25-hydroxy vitamin D3, insulin, HOMA-IR, red

blood cell ( RBC), white blood cell (WBC), platelet (PLT) levels], sex, age and BMI were compared. Correlations between 25-hydroxy vitamin D3 and other laboratory parameters were investigated in the obese adolescent group.

Adolescents without insulin resistance were not included in obese group and adolescents with insulin resistance were not included in the healthy group. Patients with a history of smoking and/or drinking alcohol, patients with chronic diseases, infections, metabolic and endocrinological diseases, those who received drug treatments such as corticosteroids, and those with malignancy were not included in the study.

HbA1c was studied in auto analyser (Biorad, Variant II turbo, Japan) with High performance liquid chromatography method; glucose, urea, creatinine, AST, ALT, total cholesterol, triglyceride and calcium tests were studied in autoanalyser (Beckman Coulter Brand, AU 5800 model, USA) by colorimetric method, 25hydroxyvitamin D3 and insulin levels were measured in autoanalyser (Beckman Coulter Brand, DXI 800 model, USA) by immune comiluminescence method. RBC, WBC and PLT levels were studied in the hemogram autoanalyser (Mindray brand, BC6800 model, China).

Ethical Committee Approval

The study was approved by the ethics committee of University of Health Sciences, Istanbul Okmeydani Training and Research Hospital.

Statistical Analysis

IBM SPSS Statistics 22 (IBM SPSS, Turkey) program was performed. The conformity of the parameters to the normal distribution was evaluated by Shapiro Wilks test. Together with the descriptive statistical methods (mean, standard deviation, frequency), in the comparison of the quantitative data, Oneway Anova test was used to compare the normally distributed parameters between groups and the Tukey HDS test and Tamhane's T2 test were used for the determination of the group that caused the difference. The Kruskal Wallis test was used for the comparison of the parameters that did not show normal distribution and Mann Whitney U test was performed for the determination of groups causing difference. Student t-test was used to compare normal distributing parameters and Mann-Whitney U test was used to compare the parameters that did

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International Journal of Research Studies in Medical and Health Sciences V4 I3 2019

The Relationship between 25-Hydroxyvitamin D3 and CRP Levels in Obese Adolescents with Insulin Resistance

not show normal distribution between two groups. Chi square test and Continuity (Yates) Correction were used to compare qualitative data. Pearson correlation analysis was used to examine the relationships between parameters which are compatible with normal distribution. Spearman's rho correlation analysis was performed to examine the relationships between parameters which are not compatible with normal distribution. Significance was set at p ................
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