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Sanguin, Francesca (2012) Vitamina D e tessuto adiposo: quali possibili interazioni? [Ph.D. thesis]

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Abstract (english)

Introduction: Recent studies have suggested the existence of a correlation between fat mass and serum levels of 25OH vitamin D [Vit D o 25(OH)D]. It is not yet known, however, if the type of body fat, subcutaneous or visceral, can interfere with vitamin D status. Excess central adiposity is associated sometimes to insulin resistance (IR), which in turn appears to be conditioned by the levels of Vit D. The aim of our study is to assess the levels of vitamin D and the index of IR , HOMA, after oral loading of cholecalciferol in subjects with varying body mass index (BMI) and different distribution of body fat.
Case Study: We have recruited 61 healthy women not taking therapy interfering with bone metabolism, divided according to BMI in N (= 20, BMI <25, age 48.6 +/-10, 8), S (= 21 BMI> 25 <30 mean age: 50.2 +/-12.1), O (= 20, BMI> 30, mean age 51.8 +/-7.4). Every patient was supplemented with 300,000 U of oral cholecalciferol in the winter season and subjected to analysis of body composition by x-ray densitometer with assessment of sub-abdominal region (R1), questionnaire of calcium intake and sun exposure; at baseline (T0) and after 7 (T1), 30 (T2) and 90 days (T3) from the load serum Vit D, 1.25 di-hydroxyvitamin D [(1,25(OH)2D)], Parathyroid hormone (PTH), glucose and insulin (for calculating HOMA index) were determined.
Results: Baseline values of Vit D were reduced in the 3 groups but significantly lower in O (p = 0.04), in O group PTH was significantly higher (p = 0.04) and 1,25(OH)2D was lower (p = 0.004). WC and R1 were significantly different between the 3 groups, the levels of blood glucose, insulin and HOMA index were higher in overweight and obese patients. After loading, Vit D levels increased significantly in T1 and T2 (p <0.0001, p = 0.002), reaching a peak higher in the N and S with respect to O, in T3 Vit D was reduced compared to T1 and T2 but still increased from baseline. PTH was significantly reduced in N and S at time T1 (p=0,03; p=0,05), while in O remained fairly stable. The levels of 1,25(OH)2D after loading increased significantly in all groups at T1 (p=0,008; p<0,0001) with the achievement of higher levels in N. There was an inverse relationship between PTH and Vitamin D to the limits of statistical significance (p = 0.07) at baseline, that became statistically significant after loading. Analyzing the performance of 25(OH)D after load, R1was the better index to predict the response of vitamin D to the load with the respect to BMI and WC.
The HOMA index after loading behaved differently according to BMI, decreasing significantly
in obese subjects, with a nadir in T2 (p=0,007) and then return to similar baseline levels at T3.
Conclusions: In conclusion our work shows that vitamin D levels depend not only on the total amount (BMI) of fat but also on its distribution (R1), being most seized and/or consumed at the visceral fat sites. The index of insulin resistance improves after load only in obese subjects, where vitamin D deficiency is more evident.

Abstract (italian)

Introduzione: Recenti ricerche hanno suggerito l'esistenza di una correlazione fra massa grassa e livelli sierici di 25OH Vitamina D [Vit D o 25(OH)D]. Non è ancora noto invece se il tipo di grasso corporeo, sottocutaneo o viscerale, possa interferire con lo stato vitaminico D. L’eccesso di adiposità centrale talora si associa all’ insulino-resistenza (IR), la quale a sua volta sembra essere condizionata anche dai livelli di Vitamina D. Scopo del nostro studio è valutare i livelli di Vit D ed l’indice di IR, HOMA, dopo carico orale di colecalciferolo in soggetti con diverso Body Mass Index (BMI) e diversa distribuzione del grasso corporeo.
Casistica: sono state reclutate 61 donne sane che non assumevano terapie interferenti con il metabolismo osseo, suddivise in base al BMI in N (= 20, BMI < 25, età 48,6+/-10, 8), S (= 21, BMI > 25<30 età media: 50,2+/-12,1), O (= 20, BMI> 30, età media 51,8+/-7,4). Ogni paziente è stata supplementata con 300.000 U di colecalciferolo per os nella stagione invernale e sottoposta ad analisi della composizione corporea con densitometro a raggi X con valutazione della sub-regione addominale R1, questionario alimentare e dosaggio di Vit D, 1,25 di-idrossivitamina D [(1,25(OH)2D)], Paratormone (PTH), glicemia e insulinemia, per calcolo dell’indice HOMA, al basale (T0) e dopo 7 (T1), 30 (T2) e 90 giorni (T3) dal carico.
Risultati: i valori della Vit D basali erano ridotti nei tre gruppi ma significativamente più bassi in O (p=0,04), nel gruppo O il PTH risultava significativamente più elevato (p=0,04) e la 1,25(OH)2D più bassa (p=0,004). WC e R1 erano significativamente differenti nei 3 gruppi; i livelli di glicemia, insulinemia e l’HOMA IR risultavano più elevati nei soggetti in sovrappeso e obesi.
Dopo il carico, la Vit D aumentava significativamente in T1 e T2 (p<0,0001; p=0,002) raggiungendo un picco maggiore nei gruppi N ed S rispetto ad O, in T3 la Vit D era ridotta rispetto a T1 e T2 ma ancora aumentata rispetto al basale. Il PTH si riduceva significativamente in N ed S al tempo T1 (p=0,03; p=0,05), mentre in O i livelli rimanevano pressoché stabili.
La 1,25 (OH)2D dopo il carico aumentava significativamente in tutti i gruppi in T1 (p=0,008; p<0,0001), raggiungendo livelli più elevati in N. Vi era una relazione inversa fra PTH e Vit D ai limiti della significatività statistica (p=0,07) al basale, mentre diventava statisticamente significativa dopo carico. Analizzando l’andamento della 25(OH)D dopo carico, l’R1 si è dimostrato l’indice predittivo migliore per determinare la risposta della Vitamina D al carico rispetto a BMI e WC. L’HOMA IR dopo il carico aveva un comportamento differente in base al BMI, riducendosi significativamente nei soggetti obesi, con nadir in T2 (p=0,007) per poi tornare a livelli simili al basale in T3.
Conclusioni: In conclusione il nostro lavoro mostra come i livelli di vitamina D dipendano non solo dalla quantità totale (BMI) di grasso ma anche dalla sua distribuzione (R1) essendo maggiormente sequestrata e/o consumata a livello di grasso viscerale. L’indice di insulino-resistenza migliora dopo carico solo nei soggetti obesi, dove il deficit di Vitamina D è più manifesto.

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EPrint type:Ph.D. thesis
Tutor:Mantero, Franco
Supervisor:Luisetto, Giovanni and Camozzi, Valentina
Ph.D. course:Ciclo 24 > Scuole 24 > SCIENZE MEDICHE, CLINICHE E SPERIMENTALI > METODOLOGIA CLINICA E SCIENZE ENDOCRINOLOGICHE
Data di deposito della tesi:14 January 2012
Anno di Pubblicazione:January 2012
Key Words:vitamina D/vitamin D tessuto adiposo/adipose tissue grasso viscerale/visceral tissue insulino-resistenza/insulin resistance
Settori scientifico-disciplinari MIUR:Area 06 - Scienze mediche > MED/13 Endocrinologia
Struttura di riferimento:Dipartimenti > pre 2012 - Dipartimento di Scienze Mediche e Chirurgiche
Codice ID:4366
Depositato il:07 Nov 2012 12:38
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