ORIGINAL ARTICLE

The Frequency of Vitamin D Deficiency in Obese Patients on Bariatric Surgery Wait List: Is there any Association with Co-existence of Prediabetes or Diabetes?
Bariyatrik Cerrahi Bekleme Listesindeki Obez Hastalarda Vitamin D Eksikliğinin Sıklığı: Eşlik Eden Prediyabet veya Diyabet ile İlişkili mi?
Received Date : 15 Jul 2019
Accepted Date : 14 Nov 2019
Available Online : 13 Dec 2019
Doi: 10.25179/tjem.2019-70735 - Makale Dili: EN
Turk J Endocrinol Metab 2019;23:229-239
Bu makale, CC BY-NC-SA altında lisanslanmış açık erişim bir makaledir.
ABSTRACT
Objective: The impact of co-existence of prediabetes on 25 (OH)D3 deficiency is less known. We investigated the prevalence and predictors of 25(OH)D3 deficiency in obese adults on the bariatric surgery waitlist. Material and Methods: One hundred ninety-nine patients without known chronic diseases including diabetesmellitus (DM) and hypertension were included. Anthropometric, biochemical, and hormonal [fasting insulin, C-peptide, 25(OH)D3] parameters were analyzed. Insulin resistance (IR) was calculated using the homeostasis model assessment of IR (HOMA-IR). Patients having HOMA-IR of ≥2.5 were considered insulin resistant. Patients were divided into subgroups according to body mass index (BMI), fasting blood glucose, HOMA-IR, glycated hemoglobin A1c (HbA1c), and 25(OH)D3 levels. Results: According to HbA1c levels, prediabetes and DM were diagnosed in 39.6% (n=79) and 27.1% (n=54) of patients. The 25(OH)D3 levels were severely deficient, deficient, and insufficient in 47.2%, 36.7%, and 10.6%of patients; however, the levels were sufficient (≥30 ng/mL) only in 5.5%. The mean 25(OH)D3 level was 9.59, 9.76, and 12.08 ng/mL in nondiabetic, prediabetic, and diabetic patients (p>0.05). BMI and 25(OH)D3 levels were negatively correlated (p=0.045, r=-0.142). HOMA-IR was not correlated with 25(OH)D3 levels (p=0.98); it was similar in patients with different 25(OH)D3 levels. Age ≥40 years andmale gender were significant predictors for severe 25(OH)D3 deficiency, but IR, prediabetes, and DM were not significant predictors. Conclusion: Increased BMI was associated with decreased 25(OH)D3 levels. The co-existence of prediabetes does not seem to affect 25(OH)D3 levels. Age ≥40 years and male gender were significant predictors for severe 25(OH)D3 deficiency. Severe 25(OH)D3 deficiency was frequent in obese patients on the bariatric surgery waitlist. Vitamin D deficiency was also shown in other studies on obesity. 25(OH)D3 levels should be measured in all patients undergoing bariatric surgery and managed accordingly. The effect of preoperative vitamin D replacement on postoperative weight loss will clarify the association between vitamin D levels and obesity.
ÖZET
Amaç: Eşlik eden prediyabetin 25(OH)D3 eksikliği üzerindeki etkisi az bilinmektedir. Bariyatrik cerrahi bekleme listesindeki obez hastalarda, 25(OH)D3 eksikliğinin prevalansı ve prediktörlerini araştırmayı amaçladık. Gereç ve Yöntemler: Diabetes mellitus (DM) ve hipertansiyon gibi bilinen kronik hastalıkları olmayan 199 hasta dâhil edildi. Antropometrik, biyokimyasal ve hormonal [açlık insülin, C-peptid, 25(OH)D3] parametreler analiz edildi. İnsülin direnci, “homeostasis model assessment of IR (HOMA-IR)” ile hesaplandı. HOMA-IR≥2,5 olan hastalarda insülin direnci [insulin resistance (IR)] varlığı kabul edildi. Hastalar beden kitle indeksi (BKİ), açlık kan şekeri, HOMA-IR, hemoglobin A1c (HbA1c) ve 25(OH)D3 düzeyine göre gruplandırıldı. Bulgular: HbA1c düzeyine göre, hastaların %39,6 (n=79)’sında prediyabet, %27,1 (n=54)’inde DM saptandı. 25(OH)D3 düzeyi hastaların %47,2’sinde ciddi eksik, %36,7’sinde eksik, %10,6’sında yetersiz, yalnızca %5,5’inde yeterliydi (≥30 ng/mL). Diyabetik olmayan, prediyabetik ve diyabetik gruplarda ortalama 25(OH)D3 düzeyi 9,59, 9,76 ve 12,08 ng/mL saptandı (p>0,05). BKİ ile 25(OH)D3 arasında negatif korelasyon saptandı (p=0,045, r=-0,142). HOMA-IR ile 25(OH)D3 korele değildi (p=0,98). Farklı 25(OH)D3 kategorilerinde HOMA-IR değerleri benzerdi. İleri yaş (≥40) ve erkek cinsiyet ciddi 25(OH)D3 eksikliği için önemli birer prediktör olarak bulundu. İR, prediyabet veya DM ciddi 25(OH)D3 eksikliği için önemli bir prediktör değildi. Sonuç: Artmış BKİ, düşük 25(OH)D3 düzeyiyle ilişkiliydi. Eşlik eden prediyabetin 25(OH)D3 düzeyi üzerinde önemli bir etkisi yoktu. İleri yaş ve erkek cinsiyet ciddi 25(OH)D3 eksikliği için önemli prediktörlerdi. Bariyatrik cerrahi bekleme listesindeki obez hastalarda, ciddi 25(OH)D3 eksikliğinin sık görüldüğü akılda tutulmalıdır. Obezitede vitamin D eksikliği başka çalışmalarda da gösterilmiştir. 25(OH)D3 düzeyi, bariyatrik cerrahi yapılacak tüm hastalarda ölçülmelidir ve gerektiğinde uygun bir şekilde replase edilmelidir. Preoperatif vitamin D replasmanının postoperatif kilo kaybına etkisinin araştırılması, obezite ve vitamin D arasındaki ilişkiyi daha net ortaya koyacaktır.
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