Diabetes, Adipositas und Vitamin D Status hängen zusammen

Adiposity, Cardiometabolic Risk, and Vitamin D Status: The Framingham Heart Study Susan Cheng, Massachusetts; Radiology Department, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; 10Nutritional Epidemiology Program, Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts; 11Epidemiology Department, Boston University School of Public Health, Boston, Massachusetts; 12Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida. Corresponding author: Thomas J. Wang, tjwang@partners.org.

Abstract

OBJECTIVE Because vitamin D deficiency is associated with a variety of chronic diseases, understanding the characteristics that promote vitamin D deficiency in otherwise healthy adults could have important clinical implications. Few studies relating vitamin D deficiency to obesity have included direct measures of adiposity. Furthermore, the degree to which vitamin D is associated with metabolic traits after adjusting for adiposity measures is unclear.

RESEARCH DESIGN AND METHODS We investigated the relations of serum 25-hydroxyvitamin D (25[OH]D) concentrations with indexes of cardiometabolic risk in 3,890 nondiabetic individuals; 1,882 had subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) volumes measured by multidetector computed tomography (CT).

RESULTS In multivariable-adjusted regression models, 25(OH)D was inversely associated with winter season, waist circumference, and serum insulin (P < 0.005 for all). In models further adjusted for CT measures, 25(OH)D was inversely related to SAT (−1.1 ng/ml per SD increment in SAT, P = 0.016) and VAT (−2.3 ng/ml per SD, P < 0.0001). The association of 25(OH)D with insulin resistance measures became nonsignificant after adjustment for VAT. Higher adiposity volumes were correlated with lower 25(OH)D across different categories of BMI, including in lean individuals (BMI <25 kg/m2). The prevalence of vitamin D deficiency (25[OH]D <20 ng/ml) was threefold higher in those with high SAT and high VAT than in those with low SAT and low VAT (P < 0.0001).

CONCLUSIONS Vitamin D status is strongly associated with variation in subcutaneous and especially visceral adiposity. The mechanisms by which adiposity promotes vitamin D deficiency warrant further study.
Am J Clin Nutr 91: 1627-1633, 2010. First published April 14, 2010; doi:10.3945/ajcn.2009.28441
American Journal of Clinical Nutrition, doi:10.3945/ajcn.2009.28441
Vol. 91, No. 6, 1627-1633, June 2010

Articles by Jacques, P. F. © 2010 American Society for Clinical Nutrition

ORIGINAL RESEARCH COMMUNICATIONPredicted 25-hydroxyvitamin D score and incident type 2 diabetes in the Framingham Offspring Study1,2,3,4Enju Liu, James B Meigs, Anastassios G Pittas, Christina D Economos, Nicola M McKeown, Sarah L Booth and Paul F Jacques 1 From the Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University Boston MA (EL NMM SLBPFJ); the General Medicine DivisionDepartment of Medicine Massachusetts General HospitalHarvard Medical School Boston MA (JBM); the Division of Endocrinology DiabetesMetabolism Tufts Medical Center Boston MA (AGP);the Friedman School of Nutrition SciencePolicy Tufts University Boston MA (CDE NMM SLBPFJ).

2 None of the sponsors had any role in the design of the study; the design was exclusively the work of the authors. 3 Supported in part by the US Department of Agriculture, under agreement no. 58-1950-7-707, National Institute of Aging (AG14759), and the Framingham Heart Study of the National Heart, Lung, and Blood Institute of the National Institutes of Health (contract no. N01-HC-25195); and by an American Diabetes Association Career Development Award (JBM), NIDDK K24 DK080140 (JBM), R01DK076092 and R21DK078867 (AGP), and the Beverage Institute for Health and Wellness (CDE). 4 Address correspondence to PF Jacques, Epidemiology Program, Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, 711 Washington Street, Boston, MA 02111. E-mail: paul.jacques@tufts.edu .

Background: Accumulating evidence suggests that vitamin D is involved in the development of type 2 diabetes (T2D).

Objective: Our objective was to examine the relation between vitamin D status and incidence of T2D.

Design: We used a subsample of 1972 Framingham Offspring Study participants to develop a regression model to predict plasma 25-hydroxyvitamin D [25(OH)D] concentrations from age, sex, body mass index, month of blood sampling, total vitamin D intake, smoking status, and total energy intake. Using this model, we calculated the predicted 25(OH)D score for each nondiabetic participant at the cohort's fifth examination to assess the association between the predicted 25(OH)D score and incidence of T2D by using Cox proportional hazards models.

Results: A total of 133 T2D cases were identified over a 7-y average follow-up. In comparison with individuals in the lowest tertile of the predicted 25(OH)D score at baseline, those in the highest tertile had a 40% lower incidence of T2D after adjustment for age, sex, waist circumference, parental history of T2D, hypertension, low HDL cholesterol, elevated triglycerides, impaired fasting glucose, and Dietary Guidelines for Americans Adherence Index score (hazard ratio: 0.60; 95% CI: 0.37, 0.97; P for trend = 0.03).

Conclusions: Our findings suggest that higher vitamin D status is associated with decreased risk of T2D. Maintaining optimal 25(OH)D status may be a strategy to prevent the development of T2D.