Fazla Kilolu ve Obeziteli Çocuklarda D Vitamini Düzeyi ile İnsülin Direnci Arasındaki Korelasyonunun Değerlendirilmesi

Yıl 2023, Cilt: 25 Sayı: 1, 38 - 44, 30.04.2023

Esra Tunçer , Alev Keser , Emine Nüket Ünsal , Sevinç Odabaşı Güneş , Onur Akın

https://doi.org/10.18678/dtfd.1197615

Öz

Amaç: Bu çalışmada fazla kilo ve obezitesi olan çocuklarda D vitamini düzeyleri ile insülin direnci parametreleri arasındaki ilişkinin değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntemler: Çalışmaya 6-17 yaş aralığında, %64,4% (n=112) kız ve %35,6 (n=62) erkek, toplam 174 çocuk dahil edilmiştir. Katılımcılar, Dünya Sağlık Örgütü beden kitle indeksi (BKİ) sınıflaması kriterlerine göre normal (%29,9; n=52), fazla kilolu (%23,6; n=41) ve obezite (%46,5; n=81) olmak üzere üç gruba ayrılmıştır. Katılımcıların insülin direnci durumları, insülin direncinin homeostatik model değerlendirmesi (homeostatic model assessment of insulin resistance, HOMA-IR), açlık glikozunun insüline oranı (fasting glucose to insulin ratio, FGIR) ve kantitatif insülin duyarlılığı kontrol indeksi (quantitative insulin sensitivity check index, QUICKI) ile değerlendirilmiştir.
Bulgular: HOMA-IR, fazla kilolu (2,2±1,0) ve normal kilolu (1,5±1,0) gruplara göre obezite grubunda (3,2±2,1) yüksek bulunmuştur (p<0,001). Fazla kilolu (0,34±0,03) ve obezite (0,33±0,03) gruplarının QUICKI değerlerinin normal kilolu (0,37±0,03) gruptan daha düşük olduğu görülmüştür (p<0,001). FGIR, normal kilolu grupta (16,8±10,4), fazla kilolu (10,6±6,0) ve obezite (8,5±5,5) gruplarına göre daha yüksek saptanmıştır (p<0,001). Çocuk ve adölesanların ortalama serum 25-hidroksivitamin D [25(OH)D] düzeyi 19,6±10,7 ng/mL olup, gruplar arasında istatistiksel olarak anlamlı bir farklılık bulunmamıştır (p=0,153). Serum 25(OH)D ile HOMA-IR değerleri arasında anlamlı, zayıf negatif (r=-0,170; p=0,025) bir korelasyon bulunmuştur. Buna ek olarak, serum 25(OH)D düzeyi ile QUICKI ve FGIR değerleri arasında zayıf pozitif istatistiksel olarak anlamlı (sırasıyla, r=0,173; p=0,022 ve r=0,173, p=0,023) bir korelasyon bulunmuştur.
Sonuç: D vitamini düzeyleri insülin direnci parametrelerini etkileyebilir.

Anahtar Kelimeler

insülin direnci, pediatrik obezite, D vitamini

Evaluation of the Correlation Between Vitamin D Level and Insulin Resistance in Children with Overweight and Obesity

Öz

Aim: This study aimed to evaluate the relationship between vitamin D levels and insulin resistance parameters in children with overweight and obesity.
Material and Methods: A total of 174 children, 64.4% (n=112) female, and 35.6% (n=62) male, aged between 6-17 years were included in the study. The participants were divided into three groups as normal (29.9%, n=52), overweight (23.6%, n=41), and obesity (46.5%, n=81) based on the criteria of the World Health Organization body mass index (BMI) classification. The insulin resistance status of the participants was evaluated by homeostatic model assessment of insulin resistance (HOMA-IR), fasting glucose to insulin ratio (FGIR), and quantitative insulin sensitivity check index (QUICKI).
Results: HOMA-IR was found higher in the obesity group (3.2±2.1) compared to the overweight (2.2±1.0) and the normal weight (1.5±1.0) groups (p<0.001). It was observed that QUICKI values of the overweight (0.34±0.03) and the obesity (0.33±0.03) groups were lower than the normal weight (0.37±0.03) group (p<0.001). FGIR was noticed as higher in the normal weight (16.8±10.4) group compared to the overweight (10.6±6.0) and the obesity (8.5±5.5) groups (p<0.001). The mean serum 25-hydroxyvitamin D [25(OH)D] levels of the children and adolescents were 19.6±10.7 ng/mL, and no statistically significant difference was found between the groups (p=0.153). A significant weak negative correlation between serum 25(OH)D and HOMA-IR values was found (r=-0.170, p=0.025). Additionally, a weak positive statistically significant correlation was found between serum 25(OH)D level and QUICKI and FGIR values (r=0.173, p=0.022, and r=0.173, p=0.023, respectively).
Conclusion: Vitamin D levels can affect insulin resistance parameters.

Anahtar Kelimeler

insulin resistance, pediatric obesity, vitamin D

Kaynakça

• van der Aa MP, Fazeli Farsani S, Knibbe CA, de Boer A, van der Vorst MM. Population-based studies on the epidemiology of insulin resistance in children. J Diabetes Res. 2015;2015:362375.
• Petersen MC, Shulman GI. Mechanisms of insulin action and insulin resistance. Physiol Rev. 2018;98(4):2133-223.
• Ho M, Garnett SP, Baur LA. Childhood obesity and insulin resistance: how should it be managed? Curr Treat Options Cardiovasc Med. 2014;16(12):351.
• Levy-Marchal C, Arslanian S, Cutfield W, Sinaiko A, Druet C, Marcovecchio ML, et al. Insulin resistance in children: consensus, perspective, and future directions. J Clin Endocrinol Metab. 2010;95(12):5189-98.
• Altieri B, Grant WB, Della Casa S, Orio F, Pontecorvi A, Colao A, et al. Vitamin D and pancreas: The role of sunshine vitamin in the pathogenesis of diabetes mellitus and pancreatic cancer. Crit Rev Food Sci Nutr. 2017;57(16):3472-88.
• Al-Shoumer KA, Al-Essa TM. Is there a relationship between vitamin D with insulin resistance and diabetes mellitus? World J Diabetes. 2015;6(8):1057-64.
• Szymczak-Pajor I, Śliwińska A. Analysis of association between vitamin D deficiency and insulin resistance. Nutrients. 2019;11(4):794.
• Saglam D, Samur G, Turan S. Assessment of vitamin D status in Turkish adolescents: its relation to obesity, cardiometabolic risk factors and nutritional status. Prog Nutr. 2019;21(4):762-8.
• Torun E, Gönüllü E, Ozgen IT, Cindemir E, Oktem F. Vitamin D deficiency and insufficiency in obese children and adolescents and its relationship with insulin resistance. Int J Endocrinol. 2013;2013:631845.
• Wang L, Wang H, Wen H, Tao H, Zhao X. Relationship between HOMA-IR and serum vitamin D in Chinese children and adolescents. J Pediatr Endocrinol Metab. 2016;29(7):777-81.
• Pramono A, Jocken JWE, Blaak EE. Vitamin D deficiency in the aetiology of obesity-related insulin resistance. Diabetes Metab Res Rev. 2019;35(5):e3146.
• de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007;85(9):660-7.
• WHO AnthroPlus for personal computers Manual: Software for assessing growth of the world's children and adolescents. Geneva: WHO, 2009.
• Keskin M, Kurtoglu S, Kendirci M, Atabek ME, Yazici C. Homeostasis model assessment is more reliable than the fasting glucose/insulin ratio and quantitative insulin sensitivity check index for assessing insulin resistance among obese children and adolescents. Pediatrics. 2005;115(4):e500-3.
• Andrade MI, Oliveira JS, Leal VS, Lima NM, Costa EC, Aquino NB, et al. Identification of cutoff points for homeostatic model assessment for insulin resistance index in adolescents: systematic review. Rev Paul Pediatr. 2016;34(2):234-42. Portuguese.
• Kurtoğlu S, Hatipoğlu N, Mazıcıoğlu M, Kendirici M, Keskin M, Kondolot M. Insulin resistance in obese children and adolescents: HOMA-IR cut-off levels in the prepubertal and pubertal periods. J Clin Res Pediatr Endocrinol. 2010;2(3):100-6.
• Vuguin P, Saenger P, Dimartino-Nardi J. Fasting glucose insulin ratio: a useful measure of insulin resistance in girls with premature adrenarche. J Clin Endocrinol Metab. 2001;86(10):4618-21.
• Pastucha D, Talafa V, Malincikova J, Cihalik C, Hyjanek J, Horakova D, et al. Obesity, hypertension and insulin resistance in childhood--a pilot study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2010;154(1):77-81.
• Munns CF, Shaw N, Kiely M, Specker BL, Thacher TD, Ozono K, et al. Global consensus recommendations on prevention and management of nutritional rickets. J Clin Endocrinol Metab. 2016;101(2):394-415.
• Zeybek U. Regulation of metabolism. In: Ulukaya E, editor. Lippincott's Illustrated Reviews: Biochemistry. İstanbul: Nobel Medical Publishers; 2019. p. 307-56.
• Gün E, Uzun H, Bolu S, Arslanoğlu İ, Kocabay K. Serum 25-hydroxyvitamin D is associated with insulin resistance independently of obesity in children ages 5-17. Prim Care Diabetes. 2020;14(6):741-6.
• Kloppenborg JT, Fonvig CE, Nielsen TRH, Mollerup PM, Bøjsøe C, Pedersen O, et al. Impaired fasting glucose and the metabolic profile in Danish children and adolescents with normal weight, overweight, or obesity. Pediatr Diabetes. 2018;19(3):356-65.
• Xu C, Zhou G, Zhao M, Zhang X, Fang L, Guan Q, et al. Bidirectional temporal relationship between obesity and hyperinsulinemia: longitudinal observation from a Chinese cohort. BMJ Open Diabetes Res Care. 2021;9(1):e002059.
• Lee SH, Ahn MB, Choi YJ, Kim SK, Kim SH, Cho WK, et al. Comparison of different criteria for the definition of insulin resistance and its relationship to metabolic risk in children and adolescents. Ann Pediatr Endocrinol Metab. 2020;25(4):227-33.
• Jurkovičová J, Hirošová K, Vondrová D, Samohýl M, Štefániková Z, Filová A, et al. The prevalence of insulin resistance and the associated risk factors in a sample of 14-18-year-old Slovak adolescents. Int J Environ Res Public Health. 2021;18(3):909.
• Ertaş Öztürk Y, Bozbulut R, Döğer E, Bideci A, Köksal E. The relationship between diet quality and insulin resistance in obese children: adaptation of the Healthy Lifestyle-Diet Index in Turkey. J Pediatr Endocrinol Metab. 2018;31(4):391-8.
• Gülmez R, Demirel F, Emir S. Endocrinologic and metabolic abnormalities and related factors in obese children and adolescents. Turkish J Pediatr Dis. 2015;9(2):104-12. Turkish.
• Al-Mansoori L, Al-Jaber H, Prince MS, Elrayess MA. Role of inflammatory cytokines, growth factors and adipokines in adipogenesis and insulin resistance. Inflammation. 2022;45(1):31-44.
• Fox C, Bernardino L, Cochran J, Essig M, Bridges KG. Inappropriate use of homeostasis model assessment cutoff values for diagnosing insulin resistance in pediatric studies. J Am Osteopat Assoc. 2017;117(11):689-96.
• Hu Y, Chen J, Wang R, Li M, Yun C, Li W, et al. Vitamin D nutritional status and its related factors for Chinese children and adolescents in 2010-2012. Nutrients. 2017;9(9):1024.
• Yakarış AB, Öner C, Çetin H, Şimşek EE. Frequency of vitamin D deficiency in children admitted to pediatrics outpatient clinics: A hospital-based study. Jour Turk Fam Phy. 2022;13(1):12-20. Turkish.
• Hocaoğlu-Emre FS, Sarıbal D, Oğuz O. Vitamin D deficiency and insufficiency according to the current criteria for children: Vitamin D status of elementary school children in Turkey. J Clin Res Pediatr Endocrinol. 2019;11(2):181-8.
• Azizi S, Tariq TM. Vitamin D deficiency among Afghan adolescents in Kabul. J Coll Physicians Surg Pak. 2019;29(11):1072-7.
• Chlebna-Sokół D, Konstantynowicz J, Abramowicz P, Kulik-Rechberger B, Niedziela M, Obuchowicz A, et al. Evidence of a significant vitamin D deficiency among 9-13-year-old Polish children: results of a multicentre study. Eur J Nutr. 2019;58(5):2029-36.
• Khadilkar A, Kajale N, Oza C, Oke R, Gondhalekar K, Patwardhan V, et al. Vitamin D status and determinants in Indian children and adolescents: a multicentre study. Sci Rep. 2022;12(1):16790.
• Siddiqee MH, Bhattacharjee B, Siddiqi UR, Rahman MM. High burden of hypovitaminosis D among the children and adolescents in South Asia: a systematic review and meta-analysis. J Health Popul Nutr. 2022;41(1):10.
• Holick MF. The vitamin D deficiency pandemic: Approaches for diagnosis, treatment and prevention. Rev Endocr Metab Disord. 2017;18(2):153-65.
• Denova-Gutiérrez E, Muñoz-Aguirre P, López D, Flores M, Medeiros M, Tamborrel N, et al. Low serum vitamin D concentrations are associated with insulin resistance in Mexican children and adolescents. Nutrients. 2019;11(9):2109.
• Fraemke A, Ferrari N, Friesen D, Haas F, Klaudius M, Mahabir E, et al. HOMA index, vitamin D levels, body composition and cardiorespiratory fitness in juvenile obesity: data from the CHILT III programme, Cologne. Int J Environ Res Public Health. 2022;19(4):2442.
• Wang H, Chen W, Li D, Yin X, Zhang X, Olsen N, et al. Vitamin D and chronic diseases. Aging Dis. 2017;8(3):346-53.
• Contreras-Bolívar V, García-Fontana B, García-Fontana C, Muñoz-Torres M. Mechanisms involved in the relationship between vitamin D and insulin resistance: impact on clinical practice. Nutrients. 2021;13(10):3491.