Regular consumption of vitamin D-fortified yogurt drink (Doogh) improved endothelial biomarkers in subjects with type 2 diabetes: a randomized double-blind clinical trial

Abstract

BackgroundEndothelial dysfunction has been proposed as the underlying cause of diabetic angiopathy that eventually leads to cardiovascular disease, the major cause of death in diabetes. We recently demonstrated the ameliorating effect of regular vitamin D intake on the glycemic status of patients with type 2 diabetes (T2D). In this study, the effects of improvement of vitamin D status on glycemic status, lipid profile and endothelial biomarkers in T2D subjects were investigated.MethodsSubjects with T2D were randomly allocated to one of the two groups to receive either plain yogurt drink (PYD; containing 170 mg calcium and no vitamin D/250 mL, n1 = 50) or vitamin D3-fortified yogurt drink (FYD; containing 170 mg calcium and 500 IU/250 mL, n2 = 50) twice a day for 12 weeks. Anthropometric measures, glycemic status, lipid profile, body fat mass (FM) and endothelial biomarkers including serum endothelin-1, E-selectin and matrix metalloproteinase (MMP)-9 were evaluated at the beginning and after the 12-week intervention period.ResultsThe intervention resulted in a significant improvement in fasting glucose, the Quantitative Insulin Check Index (QUICKI), glycated hemoglobin (HbA1c), triacylglycerols, high-density lipoprotein cholesterol (HDL-C), endothelin-1, E-selectin and MMP-9 in FYD compared to PYD (P < 0.05, for all). Interestingly, difference in changes of endothelin-1, E-selectin and MMP-9 concentrations in FYD compared to PYD (-0.35 ± 0.63 versus -0.03 ± 0.55, P = 0.028; -3.8 ± 7.3 versus 0.95 ± 8.3, P = 0.003 and -2.3 ± 3.7 versus 0.44 ± 7.1 ng/mL, respectively, P < 0.05 for all), even after controlling for changes of QUICKI, FM and waist circumference, remained significant for endothelin-1 and MMP-9 (P = 0.009 and P = 0.005, respectively) but disappeared for E-selectin (P = 0.092). On the contrary, after controlling for serum 25(OH)D, the differences disappeared for endothelin-1(P = 0.066) and MMP-9 (P = 0.277) but still remained significant for E-selectin (P = 0.011).ConclusionsAmeliorated vitamin D status was accompanied by improved glycemic status, lipid profile and endothelial biomarkers in T2D subjects. Our findings suggest both direct and indirect ameliorating effects of vitamin D on the endothelial biomarkers.Trial registrationClinicalTrials.gov: NCT01236846

MANAGEMENT OF ENDOCRINE DISEASE: The effect of vitamin D supplementation on glycaemic control in patients with type 2 diabetes mellitus: a systematic review and meta-analysis

“…Of the 23 studies that were included in the systematic review, 13 reported fasting glucose as primary or secondary outcome measure (19,20,21,22,23,24,26,27,28,32,35,36,39). Three studies reported a significant reduction in fasting glucose level after vitamin D supplementation (21,28,39).…”

“…The quality assessment of the studies resulted in 14 out of 23 studies having a good quality (Appendix 1, see section on Appendix given at the end of this article) (12,19,20,21,22,23,24,25,26,27,28,29,30,31). The main characteristics and main outcomes of the included studies are given in Table 1.…”

“…Three studies reported a significant reduction in fasting glucose level after vitamin D supplementation (21,28,39).…”

“…The main characteristics and main outcomes of the included studies are given in Table 1. All studies had a randomized controlled trial design, of which 18 studies used a placebo for control (12,19,20,22,23,24,25,27,29,30,31,32,33,34,35,36,37,38), three studies compared vitamin D fortified yoghurt versus plain yoghurt (21,28,39), one study used oral calcium supplementation for control (26), and one study used vitamin C supplementation for control (40). Apart from two studies, which solely included post-menopausal women (21,33), all studies included both men and women.…”

Increased matrix metalloproteinase-9 in male elderly with low 25-hydroxy-vitamin D

“…The study of Wasse et al (13) reported the finding of a significant inverse correlation between 25(OH)D concentration and MMP-9 concentration in patients with terminal renal failure. Another study by Shab-Bidar et al (15) reported that regular consumption of vitamin D-fortified yogurt drink (doogh) for 12 weeks resulted in a significant improvement in endothelin-1, endothelial selectin and MMP-9 in subjects with type 2 diabetes. The study of Baker et al (16) showed a significant inverse correlation between MMP-9 and vitamin D levels (r=-0.41; p=0.01).…”