The study of inter-relationship among secondary hyperparathyroidism and vitamin D3 deficiency in obese diabetics and obese non-diabetic patients
Main Article Content
Keywords
Obesity; vitamin D3; parathyroid hormone; type 2 diabetes
Abstract
Background: Adiposity is connected to vitamin D3 (Vit. D3) deficiency and hyperthyroidism. Type 2 diabetes (T2D) is associated with Vit. D3 deficiency. Our study aims to assess the inter-relationship among Vit. D3 deficiency and secondary hyperparathyroidism in obese diabetic and non-diabetic patients.
Methods: Our study included 90 patients (45 obese type 2 diabetics and 45 obese non-diabetics as control). Serum Vit. D3, serum parathyroid hormone (PTH), calcium, leptin, fasting blood sugar (FBS), serum insulin, insulin resistance (HOMA-IR), hemoglobin A1C (HbA1c), and body mass index (BMI) were measured.
Results: The levels of Vit. D3 deficiency were 100% in obese diabetics and non-diabetic patients 17.43 ±3.94 and 13.95 ±4.60, respectively. The association was inversely related to BMI in the obese diabetic patients (r=-0.36, P=0.01) and non-diabetic (r=-0.18, P=0.23). While the correlation was positive as well as significant (r=0.49, P<0.001) between PTH levels with BMI in obese diabetic
subjects with a mean of 44.10 ±14.01, 13.3% have elevated PTH levels, the correlation was positive and no significant with BMI (r=0.06, P<0.6) through obese non-diabetics the mean was 57.19 ±17.71, and 35.5% of them had a high level of PTH. Our results showed a very weak and no significant negative correlation between Vit. D3 and PTH in each of the obese diabetics and obese non-diabetic groups (r=-0.12, P=0.4) and (r=-0.24, P=0.1), respectively. Serum concentration of leptin has significantly associated with body mass index (r=0.94, P<0.001) in obese diabetic through (r=0.3, P=0.04) in control. The most surprising finding is the very strong association between HOMA-IR with BMI in non-diabetics (r=0.87, P <0.001).
Conclusion: Adiposity is a risk factor for T2D related to Vit. D3 deficiency and high level of PTH. The correlation between Vit. D3 deficiency and PTH is inverse and insignificant
References
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type 2 diabetes mellitus. Saudi Journal of Biological Sciences, 2018. 25(1): p. 31-36.
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p. 215-225.
52. Alnori, H., et al., Vitamin D and immunoglobulin E status in allergic rhinitis patients compared to healthy people. Journal of Medicine and Life,2020. 13(4): p. 463.
53. Al-Horani, H., et al., Nationality, gender, age, and body mass index influences on vitamin D concentration among elderly patients and young Iraqi and Jordanian in Jordan. Biochemistry research international, 2016. 2016.
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55. Zaki, M., et al., Association of vitamin D receptorgene polymorphism (VDR) with vitamin D deficiency, metabolic and inflammatory markers
in Egyptian obese women. Genes Dis, 2017. 4(3):p. 176-182.
56. Li, J., et al., 1α, 25-Dihydroxyvitamin D hydroxylase in adipocytes. The Journal of steroid biochemistry and molecular biology, 2008.
112(1-3): p. 122-126.
57. Reis, J.P., et al., Parathyroid hormone is associated with incident diabetes in white, but not black adults: the Atherosclerosis Risk in
Communities (ARIC) Study. Diabetes & metabolism, 2016. 42(3): p. 162-169.
58. Rahimi, Z., Parathyroid hormone, glucose metabolism and diabetes mellitus. Mol Cell Endocrinol, 2009. 307: p. 77-82.
59. Jumaahm, M.K., A.H.A. Alhamza, and A.A. Mansour, The Study of the Association of Serum Parathyroid Hormone Level with Obesity in
Patients Admitted to a Tertiary Care Center in Basrah. Dubai Diabetes and Endocrinology Journal, 2021. 27(4): p. 143-149.
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61. Querfeld, U., et al., Antagonistic effects of vitamin D and parathyroid hormone on lipoprotein lipase in cultured adipocytes. Journal
of the American Society of Nephrology, 1999. 10(10): p. 2158-2164.
62. Hewitt, S., et al., Relationships of serum 25‐ hydroxyvitamin D, ionized calcium and parathyroid hormone after obesity surgery.
Clinical endocrinology, 2018. 88(3): p. 372-379.
63. Fish, E., et al., Vitamin D status of morbidly obese bariatric surgery patients. Journal of Surgical Research, 2010. 164(2): p. 198-202.
64. Grethen, E., et al., Vitamin D and hyperparathyroidism in obesity. The Journal of Clinical Endocrinology & Metabolism, 2011.
96(5): p. 1320-1326.
65. Lotito, A., et al., Serum parathyroid hormone responses to vitamin D supplementation in overweight/obese adults: a systematic review andmeta-analysis of randomized clinical trials. Nutrients, 2017. 9(3): p. 241.
66. Hoang, D., et al., Leptin is produced by parathyroid glands and stimulates parathyroid hormone secretion. Annals of Surgery, 2017.
266(6): p. 1075-1083.
67. Kumar, R., et al., Association of leptin with obesity and insulin resistance. Cureus, 2020. 12(12).
68. Ekmen, N., et al., Leptin as an important link between obesity and cardiovascular risk factors in men with acute myocardial infarction. Indian Heart Journal, 2016. 68(2): p. 132-137.
69. Obradovic, M., et al., Leptin and obesity: role and clinical implication. Frontiers in Endocrinology, 2021. 12: p. 585887.
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4222.
74. Pannu, P.K., E.K. Calton, and M.J. Soares, Calcium and vitamin D in obesity and related chronic disease. Advances in food and nutrition
research, 2016. 77: p. 57-100.
75. Song, Q. and I.N. Sergeev, Calcium and vitamin D in obesity. Nutrition research reviews, 2012. 25(1): p. 130-141.
2. Bluher, M., Obesity: global epidemiology and pathogenesis. Nat Rev Endocrinol, 2019. 15(5): p. 288-298.
3. Maddahi, N., et al., Association of serum levels of vitamin D and vitamin D binding protein with mental health of overweight/obese women: A cross sectional study. Clin Nutr ESPEN, 2022. 47: p. 260-266.
4.
5. Chooi, Y.C., C. Ding, and F. Magkos, The epidemiology of obesity. Metabolism, 2019. 92: p. 6-10.
6. Tinkov, A.A., et al., Adipotropic effects of heavy metals and their potential role in obesity. Faculty Reviews, 2021. 10.
7. He, X., et al., Chlorogenic acid ameliorates obesity by preventing energy balance shift in high-fat diet induced obese mice. J Sci Food
Agric, 2021. 101(2): p. 631-637.
8. Pan, M.H., et al., Antiobesity molecular mechanisms of action: Resveratrol and pterostilbene. Biofactors, 2018. 44(1): p. 50-60.
9. Dhurandhar, N.V., K.S. Petersen, and C. Webster, Key Causes and Contributors of Obesity: A Perspective. Nursing Clinics, 2021.
56(4): p. 449-464.
10. Dhurandhar, N.V., What is obesity? : Obesity Musings. Int J Obes (Lond), 2022.
11. Al-Goblan, A.S., M.A. Al-Alfi, and M.Z. Khan, Mechanism linking diabetes mellitus and obesity. Diabetes, metabolic syndrome and obesity:
targets and therapy, 2014. 7: p. 587.
12. Pignolo, A., et al., Vitamin D and Parkinson's Disease. Nutrients, 2022. 14(6).
13. Migliaccio, S., et al., Vitamin D deficiency: a potential risk factor for cancer in obesity? International Journal of Obesity, 2022: p. 1-11.
14. Galușca, D., et al., Vitamin D Implications and Effect of Supplementation in EndocrineDisorders: Autoimmune Thyroid Disorders
(Hashimoto’s Disease and Grave’s Disease), Diabetes Mellitus and Obesity. Medicina, 2022. 58(2): p. 194.
15. Amini, S., et al., The effect of vitamin D and calcium supplementation on inflammatory biomarkers, estradiol levels and severity of
symptoms in women with postpartum depression: a randomized double-blind clinical trial. Nutr Neurosci, 2022. 25(1): p. 22-32.
16. Chauss, D., et al., Autocrine vitamin D signaling switches off pro-inflammatory programs of TH1 cells. Nat Immunol, 2022. 23(1): p. 62-74.
17. Fletcher, J., et al., Autoimmune disease and interconnections with vitamin D. Endocrine connections, 2022. 11(3).
18. Wimalawansa, S.J., Associations of vitamin D with insulin resistance, obesity, type 2 diabetes, and metabolic syndrome. J Steroid Biochem Mol Biol, 2018. 175: p. 177-189.
19.
20. Rafiq, S. and P.B. Jeppesen, Body Mass Index, Vitamin D, and Type 2 Diabetes: A Systematic Review and Meta-Analysis. Nutrients, 2018.
10(9).
21. De-la-O, A., et al., Relationship between 1, 25- Dihydroxyvitamin D and body composition in middle-aged sedentary adults: The FIT-AGEING
Study. Nutrients, 2019. 11(11): p. 2567.
22. Sharma, D.K., et al., Acute C-Terminal Crosslinking Telopeptide of Type I Collagen (CTX-1) Suppression with Milk Calcium or
Calcium Carbonate Is Independent of Visceral Fat in a Randomized Crossover Study in Lean and Overweight Postmenopausal Women. The
Journal of Nutrition, 2022. 152(4): p. 1006-1014.
23. Pojednic, R.M., et al., Vitamin D deficiency associated with risk of prediabetes among older adults: Data from the National Health and
Nutrition Examination Survey (NHANES),2007–2012. Diabetes/Metabolism Research and Reviews, 2022. 38(3): p. e3499.
24. Zhao, H., et al., The relationship between vitamin D status and islet function in patients with type 2 diabetes mellitus. BMC endocrine disorders, 2021. 21(1): p. 1-7.
25. Rey, D., et al., Astragalin augments basal calcium influx and insulin secretion in rat pancreatic islets. Cell Calcium, 2019. 80: p. 56-62.
26. Manna, P., A.E. Achari, and S.K. Jain, 1, 25 (OH) 2-vitamin D3 upregulates glucose uptake mediated by SIRT1/IRS1/GLUT4 signaling
cascade in C2C12 myotubes. Molecular and cellular biochemistry, 2018. 444(1): p. 103-108.
27. Babić Leko, M., et al., Environmental Factors That Affect Parathyroid Hormone and Calcitonin Levels. International Journal of Molecular
Sciences, 2021. 23(1): p. 44.
28. Lombardi, G., et al., Physical activity-dependent regulation of parathyroid hormone and calciumphosphorous metabolism. International journal of molecular sciences, 2020. 21(15): p. 5388.
29. Jawaid, I. and S. Rajesh, Hyperparathyroidism (primary) NICE guideline: diagnosis, assessment, and initial management. The British Journal of General Practice, 2020. 70(696): p. 362.
30. Ministrini, S., et al., Determinants of high parathyroid hormone levels in patients with severe obesity and their relationship with the
cardiometabolic risk factors, before and after a laparoscopic sleeve gastrectomy intervention. Obesity Surgery, 2020. 30(6): p. 2225-2232.
31. Mohammed, M.S., et al., Systems and WBANs for controlling obesity. Journal of Healthcare Engineering, 2018. 2018.
32. Premanath, M., et al., Occurrence of diabetes mellitus in obese nondiabetic patients, with correlative analysis of visceral fat, fasting insulin,
and insulin resistance: A 3-year follow-up study (Mysore visceral adiposity in diabetes follow-up study). Indian Journal of Endocrinology and
Metabolism, 2017. 21(2): p. 308.
33. Chobot, A., et al., Obesity and diabetes—Not only a simple link between two epidemics. Diabetes/metabolism research and reviews, 2018.
34(7): p. e3042.
34. Jia, X., et al., Clinical Significance of Lifetime Maximum Body Mass Index in Predicting the Development of T2DM: A Prospective Study in
Beijing. Frontiers in Endocrinology, 2022. 13.
35. Qatanani, M. and M.A. Lazar, Mechanisms of obesity-associated insulin resistance: many choices on the menu. Genes & development,
2007. 21(12): p. 1443-1455.
36. Wondmkun, Y.T., Obesity, insulin resistance, and type 2 diabetes: associations and therapeutic implications. Diabetes, metabolic syndrome and obesity: targets and therapy, 2020. 13: p. 3611.
37. Kraakman, M.J., et al., Macrophage polarization in obesity and type 2 diabetes: weighing down our understanding of macrophage function? Frontiers in immunology, 2014. 5: p. 470.
38. Johnson, L., et al., Impact of gender on vitamin D deficiency in morbidly obese patients: a crosssectional study. European journal of clinical
nutrition, 2012. 66(1): p. 83-90.
39. Abudawood, M., et al., Assessment of genderrelated differences in vitamin D levels andcardiovascular risk factors in Saudi patients with
type 2 diabetes mellitus. Saudi Journal of Biological Sciences, 2018. 25(1): p. 31-36.
40. Taheri, E., et al., The relationship between serum 25-hydroxy vitamin D concentration and obesity in type 2 diabetic patients and healthy subjects. Journal of Diabetes & Metabolic Disorders, 2012. 11(1): p. 1-5.
41. Rafiq, S. and P.B. Jeppesen, Body mass index, vitamin D, and type 2 diabetes: a systematic review and meta-analysis. Nutrients, 2018. 10(9):
p. 1182.
42. <6dd2cad19dcb79fa.pdf>.
43. Jean, G., J.C. Souberbielle, and C. Chazot, Vitamin D in chronic kidney disease and dialysis patients. Nutrients, 2017. 9(4): p. 328.
44. Migliaccio, S., et al., Obesity and hypovitaminosis D: causality or casualty? International Journal of Obesity Supplements,
2019. 9(1): p. 20-31.
45. Van Etten, E., et al., Regulation of vitamin D homeostasis: implications for the immune system. Nutrition reviews, 2008. 66(suppl_2): p.
S125-S134.
46. Lips, P., et al., Vitamin D and type 2 diabetes. The Journal of steroid biochemistry and molecular biology, 2017. 173: p. 280-285.
47. Rafiq, S. and P.B. Jeppesen, Is hypovitaminosis D related to incidence of type 2 diabetes and high fasting glucose level in healthy subjects: A systematic review and meta-analysis of observational studies. Nutrients, 2018. 10(1): p.59.
48. Kabadi, S.M., et al., Multivariate path analysis of serum 25-hydroxyvitamin D concentration, inflammation, and risk of type 2 diabetes mellitus. Disease markers, 2013. 35(3): p. 187-193.
49. Khodabakhshi, A., M. Mahmoudabadi, and F. Vahid, The role of serum 25 (OH) vitamin D level in the correlation between lipid profile, body
mass index (BMI), and blood pressure. Clinical Nutrition ESPEN, 2022.
50. Karampela, I., et al., Vitamin D and obesity:current evidence and controversies. Current obesity reports, 2021. 10(2): p. 162-180.
51. Savastano, S., et al., Low vitamin D status and obesity: Role of nutritionist. Reviews in Endocrine and Metabolic Disorders, 2017. 18(2):
p. 215-225.
52. Alnori, H., et al., Vitamin D and immunoglobulin E status in allergic rhinitis patients compared to healthy people. Journal of Medicine and Life,2020. 13(4): p. 463.
53. Al-Horani, H., et al., Nationality, gender, age, and body mass index influences on vitamin D concentration among elderly patients and young Iraqi and Jordanian in Jordan. Biochemistry research international, 2016. 2016.
54. Walsh, J.S., S. Bowles, and A.L. Evans, Vitamin D in obesity. Current Opinion in Endocrinology & Diabetes and Obesity, 2017. 24(6): p. 389-394.
55. Zaki, M., et al., Association of vitamin D receptorgene polymorphism (VDR) with vitamin D deficiency, metabolic and inflammatory markers
in Egyptian obese women. Genes Dis, 2017. 4(3):p. 176-182.
56. Li, J., et al., 1α, 25-Dihydroxyvitamin D hydroxylase in adipocytes. The Journal of steroid biochemistry and molecular biology, 2008.
112(1-3): p. 122-126.
57. Reis, J.P., et al., Parathyroid hormone is associated with incident diabetes in white, but not black adults: the Atherosclerosis Risk in
Communities (ARIC) Study. Diabetes & metabolism, 2016. 42(3): p. 162-169.
58. Rahimi, Z., Parathyroid hormone, glucose metabolism and diabetes mellitus. Mol Cell Endocrinol, 2009. 307: p. 77-82.
59. Jumaahm, M.K., A.H.A. Alhamza, and A.A. Mansour, The Study of the Association of Serum Parathyroid Hormone Level with Obesity in
Patients Admitted to a Tertiary Care Center in Basrah. Dubai Diabetes and Endocrinology Journal, 2021. 27(4): p. 143-149.
60. Ha, J., et al., Parathyroid hormone and vitamin D are associated with the risk of metabolic obesity in a middle-aged and older Korean population with preserved renal function: A cross-sectional study. PLoS One, 2017. 12(4): p. e0175132.
61. Querfeld, U., et al., Antagonistic effects of vitamin D and parathyroid hormone on lipoprotein lipase in cultured adipocytes. Journal
of the American Society of Nephrology, 1999. 10(10): p. 2158-2164.
62. Hewitt, S., et al., Relationships of serum 25‐ hydroxyvitamin D, ionized calcium and parathyroid hormone after obesity surgery.
Clinical endocrinology, 2018. 88(3): p. 372-379.
63. Fish, E., et al., Vitamin D status of morbidly obese bariatric surgery patients. Journal of Surgical Research, 2010. 164(2): p. 198-202.
64. Grethen, E., et al., Vitamin D and hyperparathyroidism in obesity. The Journal of Clinical Endocrinology & Metabolism, 2011.
96(5): p. 1320-1326.
65. Lotito, A., et al., Serum parathyroid hormone responses to vitamin D supplementation in overweight/obese adults: a systematic review andmeta-analysis of randomized clinical trials. Nutrients, 2017. 9(3): p. 241.
66. Hoang, D., et al., Leptin is produced by parathyroid glands and stimulates parathyroid hormone secretion. Annals of Surgery, 2017.
266(6): p. 1075-1083.
67. Kumar, R., et al., Association of leptin with obesity and insulin resistance. Cureus, 2020. 12(12).
68. Ekmen, N., et al., Leptin as an important link between obesity and cardiovascular risk factors in men with acute myocardial infarction. Indian Heart Journal, 2016. 68(2): p. 132-137.
69. Obradovic, M., et al., Leptin and obesity: role and clinical implication. Frontiers in Endocrinology, 2021. 12: p. 585887.
70. Meek, T.H. and G.J. Morton, The role of leptin in diabetes: metabolic effects. Diabetologia, 2016. 59(5): p. 928-932.
71. Ahn, C., J.-H. Kang, and E.-B. Jeung, Calcium homeostasis in diabetes mellitus. Journal of veterinary science, 2017. 18(3): p. 261-266.
72. Song, Q. and I.N. Sergeev, Calcium and vitamin D in obesity. Nutr Res Rev, 2012. 25(1): p. 130- 41.
73. Osei, K., 25-OH vitamin D: is it the universal panacea for metabolic syndrome and type 2 diabetes? 2010, Oxford University Press. p. 4220-
4222.
74. Pannu, P.K., E.K. Calton, and M.J. Soares, Calcium and vitamin D in obesity and related chronic disease. Advances in food and nutrition
research, 2016. 77: p. 57-100.
75. Song, Q. and I.N. Sergeev, Calcium and vitamin D in obesity. Nutrition research reviews, 2012. 25(1): p. 130-141.
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Imad Jassim Mohammad, Soheila Kashanian, Ronak Rafipour, Husam Aljwaid, & Sadegh Hashemi. (2023). The study of inter-relationship among secondary hyperparathyroidism and vitamin D3 deficiency in obese diabetics and obese non-diabetic patients. Journal of Population Therapeutics and Clinical Pharmacology, 30(4), 249-262. https://doi.org/10.47750/jptcp.2023.30.04.024
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All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Imad Jassim Mohammad, Soheila Kashanian, Ronak Rafipour, Husam Aljwaid, & Sadegh Hashemi. (2023). The study of inter-relationship among secondary hyperparathyroidism and vitamin D3 deficiency in obese diabetics and obese non-diabetic patients. Journal of Population Therapeutics and Clinical Pharmacology, 30(4), 249-262. https://doi.org/10.47750/jptcp.2023.30.04.024