Vitamin d deficiency in obese children an its relationship to glucose homeostasis
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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 to Glucose Homeostasis

  • 5.967 Impact Factor

  • Internal Medicine

  • Pediatric Endocrinology


Background
Background to Glucose Homeostasis

  • 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 to Glucose Homeostasis

  • 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 to Glucose Homeostasis

  • 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 to Glucose Homeostasis

  • 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


Calculating pediatric bmi
Calculating Pediatric BMI to Glucose Homeostasis


Data collected
Data collected to Glucose Homeostasis

  • 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 to Glucose Homeostasis

  • 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. to Glucose Homeostasis

  • 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


Study subject analysis
Study Subject Analysis to Glucose Homeostasis


Study subject analysis1
Study Subject Analysis to Glucose Homeostasis


Study subject analysis2
Study Subject Analysis to Glucose Homeostasis


Results
Results to Glucose Homeostasis


Results1
Results to Glucose Homeostasis

Vitamin D deficiency + inadequacy


Results2
Results to Glucose Homeostasis


Results3
Results to Glucose Homeostasis


Discussion

Discussion to Glucose Homeostasis


Study objective
Study Objective to Glucose Homeostasis

  • 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 to Glucose Homeostasis

  • 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 to Glucose Homeostasis

  • Age

  • BMI

  • Gender

  • Ethnicity

  • Season

  • Dietary practices


Test procedures
Test Procedures to Glucose Homeostasis

  • 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 to Glucose Homeostasis

  • 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 to Glucose Homeostasis

  • 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 to Glucose Homeostasis

  • 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 to Glucose Homeostasis

  • 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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