Osama Moharram

Modest reversal of metabolic syndrome manifestations with vitamin D status correction: a 12-month prospective study.

Numerous cross-sectional studies have noted significant negative associations between circulating levels of 25-hydroxyvitamin D and cardiometabolic risk factors, highlighting potential extraskeletal functions of this sterol hormone. Prospective studies, however, have been limited; and hence, no cause-and-effect relations can be inferred. This study aims to determine whether vitamin D status correction can reverse already established manifestations of the metabolic syndrome (MetS). A total of 59 adult nondiabetic, overweight, and obese Saudis (31 male, 28 female) were prospectively enrolled in this 1-year interventional study. Anthropometry and biochemical evaluation were performed, including determination of serum 25-hydroxyvitamin D, calcium, and phosphorous concentrations, as well as fasting blood glucose and lipid profile. Subjects were advised to regularly expose themselves to sunlight and increase intake of vitamin D-rich foods. All measurements were repeated 6 and 12 months later. At the initial baseline visit, the prevalence of both low high-density lipoprotein cholesterol and hypertension was significantly increased among patients with 25-vitamin D deficiency (P < .05), even after adjusting for sex and body mass index. Overall prevalence of MetS patients by the modified National Health and Nutrition Examination Survey Adult Treatment Panel III definition decreased from 25.2% to 13.0%; and this was largely due to a parallel decrease in the prevalence of low high-density lipoprotein cholesterol, triglycerides, and hypertension. Optimization of vitamin D status through sun exposure and increased intake of a vitamin D-rich diet can lead to an improved cardiometabolic profile, offering a promising nonpharmacologic approach in the prevention of MetS manifestations.

Retinopathy as a predictor of other diabetic complications

Purpose: Early predictors of diabetic complications may aid in the prevention and/or management of these complications. The aim of this cross-sectional study was to determine the predictive value of retinopathy for the presence of other diabetic complications.Methods: The population studied comprised 648 patients with diabetes mellitus assessed by our service. There were 210 patients (32.4%) with insulin-dependent diabetes mellitus (IDDM), and 438 patients (67.6%) with non-insulin-dependent diabetes mellitus (NIDDM).Results: Univariate analyses revealed that retinopathy significantly predicted the presence of neuropathy (odds ratio [OR] = 2.23; 95% confidence interval [CI] = 1.56–3.18; p < 0.00l), nephropathy (OR = 5.68; 95% CI = 3.06–10.62; p < 0.00l), and cerebrovascular disease (OR = 6.6; 95% CI = 1.16–67.21; p = 0.0239) in the total group. Similar associations were observed both in subjects with IDDM and NIDDM. The associations between retinopathyseverity level and the prevalence rate of nephropathy were significant in the total group (p = 0.0001), in patients with IDDM (p = 0.0113), and in patients with NIDDM (p = 0.01). In patients with mild to moderate non-proliferative retinopathy (NPDR), nephropathy was present in 17.2% of patients with IDDM, and in 11.4% of patients with NIDDM. In patients with severe NPDR, nephropathy was present in 23.3% in patients with IDDM, and in 11.8% of patients with NIDDM. In patients with proliferative retinopathy (PDR), nephropathy was present in 50% in patients with IDDM, and in 45.5% in patients with NIDDM. In multivariate logistic regression analyses, nephropathy was the only significant complication to be independently associated with retinopathy in patients with IDDM (OR = 8.02; 95% CI = 1.95–33), and in patients with NIDDM (OR = 2.48;95% CI = 1.02–6.03).Conclusions: Retinopathy, especially the presence of PDR, is an independent predictor for nephropathy. The predictive value of retinopathy for nephropathy is stronger in patients with IDDM than in those with NIDDM. Ophthalmologists should refer patients with retinopathy for regular medical evaluations.

Vitamin D supplementation as an adjuvant therapy for patients with T2DM: an 18-month prospective interventional study

BackgroundVitamin D deficiency has been associated with impaired human insulin action, suggesting a role in the pathogenesis of diabetes mellitus type 2 (T2DM). In this prospective interventional study we investigated the effects of vitamin D3 supplementation on the metabolic profiles of Saudi T2DM subjects pre- and post-vitamin D supplementation over an 18-month period.MethodsT2DM Saudi subjects (men, N = 34: Age: 56.6 ± 8.7 yr, BMI, 29.1 ± 3.3 kg/m2; women, N = 58: Age: 51.2 ± 10.6 yr, BMI 34.3 ± 4.9 kg/m2;) were recruited and given 2000 IU vitamin D3 daily for 18 months. Anthropometrics and fasting blood were collected (0, 6, 12, 18 months) to monitor serum 25-hydroxyvitamin D using specific ELISA, and to determine metabolic profiles by standard methods.ResultsIn all subjects there was a significant increase in mean 25-hydroxyvitamin D levels from baseline (32.2 ± 1.5 nmol/L) to 18 months (54.7 ± 1.5 nmol/L; p  < 0.001), as well as serum calcium (baseline = 2.3 ± 0.23 mmol/L vs. 18 months = 2.6 ± 0.1 mmol/L; p = 0.003). A significant decrease in LDL- (baseline = 4.4 ± 0.8 mmol/L vs. 18 months = 3.6 ± 0.8 mmol/L, p  < 0.001] and total cholesterol (baseline = 5.4 ± 0.2 mmol/L vs. 18 months = 4.9 ± 0.3 mmol/L, p < 0.001) were noted, as well as a significant improvement in HOMA-β function ( p  = 0.002). Majority of the improvements elicited were more prominent in women than men.ConclusionIn the Saudi T2DM population receiving oral Vitamin D3 supplementation (2000 IU/day), circulating 25-hydroxyvitamin D levels remained below normal 18 months after the onset of treatment. Yet, this “suboptimal” supplementation significantly improved lipid profile with a favorable change in HDL/LDL ratio, and HOMA-β function, which were more pronounced in T2DM females.

Effect of physical activity and sun exposure on vitamin D status of Saudi children and adolescents

BackgroundAccumulating evidence suggests an increased prevalence of vitamin D deficiency in the Middle East. In this context, we aimed to determine whether the prevalence of vitamin D deficiency is related to degree of physical activity and sun exposure among apparently healthy Saudi children and adolescents, a little studied population.MethodsA total of 331 Saudi children aged 6–17 years (153 boys and 178 girls) were included in this cross sectional study. Levels of physical activity and sun exposure were determined using a standard questionnaire. Anthropometry, serum calcium and 25-(OH) vitamin D were analyzed.ResultsAll subjects were vitamin D deficient, the majority being moderately deficient (71.6%). Age was the single most significant predictor affecting 25 (OH) Vitamin D levels, explaining 21% of the variance perceived (p = 1.68 x 10-14). Age-matched comparisons revealed that for groups having the same amount of sun exposure, those with moderate or are physically active will have higher levels of vitamin D status, though levels in across groups remained deficient.ConclusionVitamin D deficiency is common among Saudi children and adolescents, and is influenced by both sun exposure and physical activity. Promotion of an active outdoor lifestyle among Saudi children in both homes and schools may counteract the vitamin D deficiency epidemic in this vulnerable population. Vitamin D supplementation is suggested in all groups, including those with the highest sun exposure and physical activity.

RISK FACTORS FOR DIABETIC RETINOPATHY AMONG SAUDI DIABETICS

Purpose: To describe the incidence of, and risk factors associated with, diabetic retinopathy in diabetic persons assessed at a Saudi diabetes centre. Methods: Five hundred and two patients with diabetes mellitus assessed by our service were studied. There were 174 patients (34.7%) with insulin-dependent diabetes mellitus (IDDM) and 328 patients (65.3%) with non-insulin-dependent diabetes mellitus (NIDDM). Results: The incidence of retinopathy was 157/502 (31.3%). The incidence was 42.5% in patients with IDDM and 25.3% in those with NIDDM. By logistic regression analysis, it was shown that old age (>60 years), insulin use, long duration of diabetes (>10 years), poor diabetes control, and the presence of nephropathy were significantly associated with the incidence of retinopathy. On the basis of the magnitudes of the regression coefficients in the hazard function, long duration of diabetes was the most important independent risk factor for the development of retinopathy; the presence of nephropathy, age >60 years, poor diabetes control, and use of insulin were less important (regression coefficients: 1.9, 1.71, 1.331, 0.8508 and 0.6178, respectively). The incidence of macular oedema was significantly associated with the presence of hypertension and high cholesterol levels in patients with IDDM. Polycotomous regression analysis showed that the presence of nephropathy was the only factor significantly associated with the severity of retinopathy. Conclusions: The significant associations with poor control and duration of diabetes provide further strong evidence for the benefits of optimal glycaemic control. Other potentially modifiable risk factors for retinopathy may be important, including elevated blood pressure and serum cholesterol.

Tea and coffee consumption in relation to vitamin D and calcium levels in Saudi adolescents.

BackgroundCoffee and tea consumption was hypothesized to interact with variants of vitamin D-receptor polymorphisms, but limited evidence exists. Here we determine for the first time whether increased coffee and tea consumption affects circulating levels of 25-hydroxyvitamin D in a cohort of Saudi adolescents.MethodsA total of 330 randomly selected Saudi adolescents were included. Anthropometrics were recorded and fasting blood samples were analyzed for routine analysis of fasting glucose, lipid levels, calcium, albumin and phosphorous. Frequency of coffee and tea intake was noted. 25-hydroxyvitamin D levels were measured using enzyme-linked immunosorbent assays.ResultsImproved lipid profiles were observed in both boys and girls, as demonstrated by increased levels of HDL-cholesterol, even after controlling for age and BMI, among those consuming 9–12 cups of coffee/week. Vitamin D levels were significantly highest among those consuming 9–12 cups of tea/week in all subjects (p-value 0.009) independent of age, gender, BMI, physical activity and sun exposure.ConclusionThis study suggests a link between tea consumption and vitamin D levels in a cohort of Saudi adolescents, independent of age, BMI, gender, physical activity and sun exposure. These findings should be confirmed prospectively.