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Vitamin D Deficiency in Obese Children an Its Relationship to Glucose Homeostasis. Olson, M.L., et al. J Clin Endocrinol Metab , 97, 279-285, 2012. Researchers. 5.967 Impact Factor Internal Medicine Pediatric Endocrinology. Background. Obesity has tripled in U.S. children since 1980

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vitamin d deficiency in obese children an its relationship to glucose homeostasis

Vitamin D Deficiency in Obese Children an Its Relationship to Glucose Homeostasis

Olson, M.L., et al

J ClinEndocrinolMetab, 97, 279-285, 2012

researchers
Researchers
  • 5.967 Impact Factor
  • Internal Medicine
  • Pediatric Endocrinology
background
Background
  • Obesity has tripled in U.S. children since 1980
    • 19% of 6-19yr olds are obese
  • The rise in obesity has paralleled increases in childhood hypertension, hyperlipidemia, and Type 2 Diabetes.
  • Childhood obesity is associated with increase prevalence of cardiovascular events and Type 2 Diabetes in adulthood.
supporting evidence
Supporting Evidence
  • Hypovitaminosis D in obese children and adolescents: relationship with adiposity, insulin sensitivity, ethnicity, and season
    • Metabolism 57:183-91
  • Prevalence of vitamin D insufficiency in obese children and adolescents
    • J ClinEndocrinolMetab 92:2017-29
objectives
Objectives
  • The aim of this study was to examine the relationship between dietary habits and 25(OH)D status in obese children.
  • Examine the relationship between 25(OH)D and glucose homeostasis.
  • Cross-sectional observational study
selection of subjects
Selection of Subjects
  • 411 obese children (BMI >95th percentile for age group) ages 6-16
    • Recruited from Center of Obesity and its Consequences on Health in Dallas, Texas
  • 89 non overweight children
    • Recruited from Endocrinology Center after being treated for hypothyroidism or GH deficiency, but otherwise healthy
  • Exclusion criteria: use of anticonvulsant, vitamin D supplement more than 400 IU/day, other relevant disorders
data collected
Data collected
  • Age, sex, ethnicity, height, weight, blood pressure, dietary habits
  • Laboratory data
    • Serum 25(OH)D
    • HbgA1C
    • Fasting glucose and insulin
    • OGTT
    • HOMA-IR
statistical analysis
Statistical Analysis
  • Prevalence of Vit D insufficiency determined for obese and non-overweight populations within each ethnic group and season
    • Data collected in summer, fall, winter, spring
    • Sufficiency: 75 nmol/L
    • Insufficiency: < 75 nmol/L
    • Deficiency: < 50 nmol/L
    • χ squared to determine prevalence rate
statistical analysis cont
Statistical Analysis cont.
  • Two way ANOVA to compare 25(OH)D between groups and assess interaction btw obesity and season; gender and ethnicity
  • Pearson coefficients used to determine relationship btw 25(OH)D and:
    • 2h glucose
    • HbbA1c
    • HOMA-IR
    • Blood pressure
results1
Results

Vitamin D deficiency + inadequacy

study objective
Study Objective
  • To compare prevalence of vitamin D deficiency in obese versus non-overweight children.
  • Examine relationships between:
    • Dietary habits and serum 25(OH)D levels
    • Abnormal glucose metabolism and obesity in children
  • Cross-sectional observational study- no intervention was implemented
subjects
Subjects
  • 411 obese and 89 non-overweight children (aged 6-16 years) residing in North Texas
    • Grouping based on BMI percentile-for-age: Obese= >95th percentile, non= <85th percentile
    • Adequate sample size, but could have included more non-overweight to better compare
    • Convenience sample of non-overweight subjects from Endocrinology Center for Hyperthyroidism
      • No known relationship between thyroid and vitamin D status
  • Same exclusion criteria for both groups
    • Meds: anticonvulsant, glucocorticoid, and/or vitamin D supplement
    • Health Status: Hepatic dz, renal dz, malabsorptive disorder, bone metabolism disorder, hypothalamic dz, genetic predisposition to obesity
accounted for multiple subject characteristics
Accounted for multiple subject characteristics
  • Age
  • BMI
  • Gender
  • Ethnicity
  • Season
  • Dietary practices
test procedures
Test Procedures
  • Used common, standard procedures determined to be reliable and valid:
    • Serum 25(OH)D
    • Diabetes Risk Factors (validated by Amer Diabetes Assoc)
      • OGTT
      • Fasting plasma glucose and insulin
      • HgbA1C
      • HOMA-IR (insulin resistance and beta-cell function)
  • All measurements taken in same way in both groups
  • Result evaluation based to gender, race, and season in both groups
study design valid
Study Design- valid
  • Used standardized, accurate measures of glucose metabolism and vitamin D status
  • Included variety of subjects: different genders, races, ages
  • Matched non-overweight subjects to obese based on age, race, and season  more accurate comparison
author s conclusions
Author’s Conclusions
  • Study results show a negative relationship between vitamin D status and BMI in children
  • Glucose metabolism is related to vitamin D status
  • Limitation: unable to account for physical activity or sun-light exposure
    • Could aid in better understanding differences in vitamin D status between the 2 groups
relevant outcomes
Relevant Outcomes
  • Obese had less seasonal variation in vitamin D status (p<0.03)
  • Breakfast skipping and high soda intakes were associated with lower vitamin D status (p<0.001)
  • When adjusted for age and BMI, vitamin D status negatively correlated with HOMA-IR and OGTT (p=0.001 and p=0.04)
    • Lower vitamin D status is associated with T2D risk factors in obese children
implications for practice
Implications for Practice
  • Nutrition Professionals:
    • Raise awareness of dietary factors negatively affecting vitamin D status in children (breakfast skipping, soda consumption)
    • Highlight need for early dietary interventions
  • Clinical Professionals:
    • Suggests need for further study of vitamin D supplementation as a potential treatment for conditions such as insulin resistance
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