Prevalence of Cardio-metabolic Risk Factors among Young Saudi Women with Vitamin D Deficiency

Main Article Content

H. A. Al Kadi
E. Alissa

Abstract

Aims: The aim of this study was to determine the prevalence of cardio-metabolic risk factors in apparently healthy Saudi women with vitamin D deficiency.

Study Design: A retrospective chart review.

Place and Duration of Study: This study was conducted in the Center of Excellence for Osteoporosis Research (CEOR), King Abdulaziz University, Jeddah, Saudi Arabia, between June 2015 to October 2015.

Methodology: Healthy women 20–40 years old, with no history of previous illnesses and not on any medications were included in this study. Data on anthropometric measurements as well as blood pressure (BP) were obtained. Body mass index (BMI) was calculated. Laboratory results including fasting blood glucose (FBG), fasting lipid profile, 25-hydroxyvitamin D3 (25(OH)D3) and parathyroid hormone (PTH) were also obtained. Vitamin D deficiency was defined as 25(OH)D3 concentration <50 nmol/l. Modified NCEP:ATPIII criteria were used to define cardio-metabolic risk factor cutoff points.

Results: A total of 305 women were included in the current analysis. Mean (± S.D.) age of the study group was 28.4±6.1 years and median (IQR) 25(OH)D3 was 17.8 (11.9–28.2) nmol/l. Almost 97% of the study participants were vitamin D deficient and 70% had values below 25 nmol/l. 25(OH)D3 was significantly inversely associated with waist circumference, systolic and diastolic BP and PTH (P=0.011, <0.0001, <0.0001, <0.0001, respectively). Prevalence of cardio-metabolic risk factors were higher among participants who fell in the lowest tertile of 25(OH)D3 except total cholesterol and low density lipoprotein cholesterol, however only higher PTH was statistically significant (P=0.022).

Conclusion: The results of the present study confirm the high prevalence of vitamin D deficiency among otherwise healthy Saudi women. The results also suggest that the prevalence of selected cardio-metabolic risk factors is higher among those with low vitamin D status. Prospective studies are needed to determine whether such deficiency will be of clinical significance with advancing age in this population, and whether vitamin D supplementation has beneficial effects.

Keywords:
Vitamin D deficiency, cardio-metabolic, risk factors, Saudi.

Article Details

How to Cite
Kadi, H. A. A., & Alissa, E. (2020). Prevalence of Cardio-metabolic Risk Factors among Young Saudi Women with Vitamin D Deficiency. Journal of Advances in Medicine and Medical Research, 32(11), 46-55. https://doi.org/10.9734/jammr/2020/v32i1130532
Section
Original Research Article

References

Roth GA, Johnson C, Abajobir A, Abd-Allah F, Abera SF, et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll Cardiol. 2017;70(1):1-25.

Scragg R. Seasonality of cardiovascular disease mortality and the possible protective effect of ultra-violet radiation. Int J Epidemiol. 1981;10:337–41.

Palacios C, Gonzalez L. Is vitamin D deficiency a major global public health problem? The Journal of Steroid Biochemistry and Molecular Biology. 2014; 144:138-45.

Lanske B, Razzaque MS. Vitamin D and aging: old concepts and new insights. J Nutr Biochem. 2007;18(12):771-7

AlQuaiz AM, Kazi A, Fouda M, Alyousefi N. Age and gender differences in the prevalence and correlates of vitamin D deficiency. Arch Osteoporos. 2018;13(1): 49.

Bassil D, Rahme M, Hoteit M, Fuleihan Gel H. Hypovitaminosis D in the Middle East and North Africa: Prevalence, risk factors and impact on outcomes. Dermato-endocrinology. 2013;5(2):274-98.

Pittas AG, Chung M, Trikalinos T, Mitri J, Brendel M, Patel K, et al. Systematic review: Vitamin D and cardiometabolic outcomes. Ann Intern Med. 2010;152(5): 307-14.

Apostolakis M, Armeni E, Bakas P, Lambrinoudaki I. Vitamin D and cardiovascular disease. Maturitas. 2018; 115:1-22.

Kayaniyil S, Vieth R, Retnakaran R, Knight JA, Qi Y, Gerstein HC, et al. Association of vitamin D with insulin resistance and beta-cell dysfunction in subjects at risk for type 2 diabetes. Diabetes Care. 2010;33(6): 1379-81.

Cheng S, Massaro JM, Fox CS, Larson MG, Keyes MJ, McCabe EL, et al. Adiposity, cardiometabolic risk, and vitamin D status: The Framingham Heart Study. Diabetes. 2010;59(1):242-8.

Alissa EM AW, Alama N, Ferns G. Relationship between Vitamin D and cardio-metabolic biomarkers among Saudi postmenopausal women. Journal of Nutritional Therapeutics. 2014;3:18-25.

Al-Daghri NM, Al-Saleh Y, Aljohani N, Alokail M, Al-Attas O, Alnaami AM, et al. Vitamin D deficiency and cardiometabolic risks: A juxtaposition of Arab adolescents and adults. PloS One. 2015;10(7): 0131315.

Alloubani A A-ZL, Samara R, Abdulhafiz I, Saleh A, Altowijri A. Relationship between vitamin D deficiency, diabetes, and obesity. Diabetes Metab Syndr. 2019; 13(2): 1457-61.

Alkhatatbeh MJ, Abdul-Razzak KK, Khasawneh LQ, Saadeh NA. High prevalence of vitamin D deficiency and correlation of serum vitamin D with cardiovascular risk in patients with metabolic Syndrome. Metab Syndr Relat Disord. 2017;15(5):213-9.

Oladipo I, Adedokun A. Comparison of the average of five readings with averages from fewer readings for automated oscillometric blood pressure measurement in an outpatient clinic. Korean Circ J. 2013; 43(5):329-35.

Obesity: Preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894(1-12):1-253.

Friedewald WT LR, Fredrickson DS. Estimation of the concentration of low density lipoprotein cholesterol in plasma without the use of the preparative ultracentrifuge. Clinical Chemistry. 1972; 18:499-501.

Lips P. Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev. 2001;22(4):477-501.

Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: An American heart association/national heart, lung, and blood institute scientific statement. Circulation. 2005;112(17):2735-52.

Lemieux I, Lamarche B, Couillard C, Pascot A, Cantin B, et al. Total cholesterol/HDL cholesterol ratio vs LDL cholesterol/HDL cholesterol ratio as indices of ischemic heart disease risk in men: the Quebec Cardiovascular Study. Arch Intern Med. 2001;161(22):2685-92.

Baygi F, Herttua K, Jensen OC, Djalalinia S, Mahdavi Ghorabi A, et al. Global prevalence of cardiometabolic risk factors in the military population: A systematic review and meta-analysis. BMC Endocr Disord. 2020;20(1):8.

Elsammak MY, Al-Wossaibi AA, Al-Howeish A, Alsaeed J. High prevalence of vitamin D deficiency in the sunny Eastern region of Saudi Arabia: A hospital-based study. East Mediterr Health J. 2011;17(4): 317-22.

Alsuwadia AO, Farag YM, Al Sayyari AA, Mousa DH, Alhejaili FF, Al-Harbi AS, et al. Prevalence of vitamin D deficiency in Saudi adults. Saudi Medical Journal. 2013; 34(8):814-8.

Sanghera DK, Sapkota BR, Aston CE, Blackett PR. Vitamin D Status, Gender Differences, and Cardiometabolic Health Disparities. Annals of Nutrition & Metabolism. 2017;70(2):79-87.

Chen CH, Liu LK, Chen MJ, Lee WJ, Lin MH, Peng LN, et al. Associations between vitamin D deficiency, musculoskeletal health, and cardiometabolic risk among community-living people in Taiwan: Age and sex-specific relationship. Medicine (Baltimore). 2018;97(52):13886.

Holick MF. Vitamin D deficiency. The New England Journal of Medicine. 2007;357(3): 266-81.

Kunutsor SK, Apekey TA, Steur M. Vitamin D and risk of future hypertension: Meta-analysis of 283,537 participants. European Journal of Epidemiology. 2013;28(3):205-21.

Parker J, Hashmi O, Dutton D, Mavrodaris A, Stranges S, Kandala NB, et al. Levels of vitamin D and cardiometabolic disorders: Systematic review and meta-analysis. Maturitas. 2010;65(3):225-36.

Song Y, Wang L, Pittas AG, Del Gobbo LC, Zhang C, Manson JE, et al. Blood 25-hydroxy vitamin D levels and incident type 2 diabetes: A meta-analysis of prospective studies. Diabetes Care. 2013;36(5):1422-8.

Li YC, Qiao G, Uskokovic M, Xiang W, Zheng W, Kong J. Vitamin D: A negative endocrine regulator of the renin-angiotensin system and blood pressure. The Journal of steroid biochemistry and molecular biology. 2004;89-90(1-5):387-92.

Kota SK, Kota SK, Jammula S, Meher LK, Panda S, Tripathy PR, et al. Renin-angiotensin system activity in vitamin D deficient, obese individuals with hypertension: An urban Indian study. Indian J Endocrinol Metab. 2011;15(4): 395-401.

Beveridge LA, Struthers AD, Khan F, Jorde R, Scragg R, Macdonald HM, et al. Effect of Vitamin D Supplementation on Blood Pressure: A Systematic Review and Meta-analysis Incorporating Individual Patient Data. JAMA Intern Med. 2015;175(5):745-54.

Zagami RM, Di Pino A, Urbano F, Piro S, Purrello F, Rabuazzo AM. Low circulating vitamin D levels are associated with increased arterial stiffness in prediabetic subjects identified according to HbA1c. Atherosclerosis. 2015;243(2):395-401.

Yilmaz S, Sen F, Ozeke O, Temizhan A, Topaloglu S, Aras D, et al. The relationship between vitamin D levels and nondipper hypertension. Blood Press Monit. 2015; 20(6):330-4.

Kendrick J, Targher G, Smits G, Chonchol M. 25-Hydroxyvitamin D deficiency is independently associated with cardiova-scular disease in the Third National Health and Nutrition Examination Survey. Atherosclerosis. 2009;205(1):255-60.

Wimalawansa SJ. Associations of vitamin D with insulin resistance, obesity, type 2 diabetes, and metabolic syndrome. The Journal of steroid biochemistry and molecular biology. 2018;175:177-89.

Larsson S, Jones HA, Goransson O, Degerman E, Holm C. Parathyroid hormone induces adipocyte lipolysis via PKA-mediated phosphorylation of hormone-sensitive lipase. Cell Signal. 2016;28(3):204-13.

Rosen CJAJ, Bikle DD, Black DM, Demay MB, Manson JE, Murad MH, Kovacs CS. The Nonskeletal Effects of Vitamin D: An Endocrine Society Scientific Statement. Endocr Rev. 2012;33(3):456-92.

Martins D, Wolf M, Pan D, Zadshir A, Tareen N, Thadhani R, et al. Prevalence of cardiovascular risk factors and the serum levels of 25-hydroxyvitamin D in the United States: Data from the Third National Health and Nutrition Examination Survey. Archives of Internal Medicine. 2007;167(11):1159-65.

Rocha LMDBD, Souza AL, Chaim EA, Pavin EJ, Alegre SM. Body composition and metabolic profile in adults with vitamin D deficiency. Rev Nutr Campinas. 2017; 30(4):419-30.

Karhapää P, Pihlajamäki J, Pörsti I, Kastarinen M, Mustonen J, Niemelä O, Kuusisto J. Diverse associations of 25-hydroxyvitamin D and 1,25-dihydroxy-vitamin D with dyslipidaemias. J Intern Med. 2010;268:604–610.

Skaaby T, Husemoen LL, Pisinger C, Jørgensen T, Thuesen BH, et al. Vitamin D status and changes in cardiovascular risk factors: A prospective study of a general population. Cardiology. 2012;123(1):62-70.

Ponda MP HX, Odeh MA, Breslow JL, Kaufman HW. Vitamin D may not improve lipid levels: a serial clinical laboratory data study. Circulation. 2012;126(3):270-7.

Walsh JS, Bowles S, Evans AL. Vitamin D in obesity. Current Opinion in Endocrino-logy, Diabetes and Obesity. 2017;24(6): 389-94.

Vanlint S. Vitamin D and obesity. Nutrients. 2013;5(3):949-56.

Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. The American Journal of Clinical nutrition. 2000;72(3):690-3.

Elshafie DE, Al-Khashan HI, Mishriky AM. Comparison of vitamin D deficiency in Saudi married couples. Eur J Clin Nutr. 2012;66(6):742-5.

Targher G, Bertolini L, Scala L, Cigolini M, Zenari L, Falezza G, et al. Associations between serum 25-hydroxyvitamin D3 con-centrations and liver histology in patients with non-alcoholic fatty liver disease. Nutrition, Metabolism, and Cardiovascular Diseases: NMCD. 2007; 17(7):517-24.