Vitamin D Insufficiency Is Associated with Lower Physical Function in Patients with Heart Failure and Diabetes

Lopes, Maristela Resch; Ribeiro, Paula Aver Bretanha; Ledur, Priscila dos Santos; Souza, Gabriela Corrêa; Clausell, Nadine Oliveira; Schaan, Beatriz D.

doi:10.1155/2014/320930

Cited by 12 publications

(12 citation statements)

References 47 publications

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“…The percentage of our patients who had an optimal 25(OH)D concentration was 41.5% in comparison to only 8.8% in a study on the population of Israel [ 20 ], 25% in a Dutch study [ 11 ], and 29.5% in a Brazilian population study [ 21 ]. In the Israeli study, some patients with normal 25(OH)D concentration had previously received vitamin D supplementation [ 20 ].…”

Section: Discussioncontrasting

confidence: 56%

Clinical and laboratory determinants of 25-hydroxyvitamin D deficiency during pharmacotherapeutic escalation in heart failure patients

Myrda¹,

Rozentryt²,

Niedziela³

et al. 2015

kitp

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IntroductionThe activation of the renin-angiotensin-aldosterone (RAA) system is a main element of the pathophysiology of chronic heart failure (CHF), determining its symptoms and prognosis. Vitamin D is an RAA inhibitor, and its deficiency frequently accompanies CHF. The factors determining the concentration of 25-hydroxyvitamin D [25(OH)D] in CHF are not well understood, although an association has been suggested between the deficiency and the advancement of CHF. Also unknown is the influence of therapeutic escalation using recommended agents on the serum level of 25(OH)D. The aim of this study was to examine the incidence of abnormal 25(OH)D concentrations in CHF patients and to establish the clinical and laboratory determinants of low activity of this metabolite.Material and methodsThe retrospective analysis included the data of 412 CHF patients not receiving optimal pharmacological treatment who were initially in NYHA (New York Heart Association) class III or IV. Over the period of 3 months the therapy was escalated until reaching maximum tolerated doses or those recommended by the current guidelines. After optimizing the therapy, the incidence of 25(OH)D deficiency (< 30 ng/ml) and insufficiency (< 20 ng/ml) was established, and clinical and laboratory determinants for these abnormal concentrations were analyzed.ResultsNormal serum level, insufficiency, and deficiency of 25(OH)D were observed in, respectively, 41.5%, 26.0% and 32.5% of patients. The NYHA class improved by at least 1 class in 63.6% of patients, remained unchanged in 32.8% of patients, and deteriorated in 3.6% of patients. In multivariables analysis, low availability of natural ultraviolet B (UVB) radiation, loss of body mass during the CHF, higher concentrations of phosphates and albumins, and the presence of diabetes increased the risk of 25(OH)D deficiency, while higher concentrations of uric acid reduced this risk. In patients with a positive response to therapy, the concentration of 25(OH)D was borderline significantly higher (p = 0.055), while insufficiency and deficiency were less frequent (p = 0.02) than in patients without a treatment response, but this pertained only to patients with higher exposure to UVB. These differences were not observed in patients with low UVB exposure.ConclusionsThe concentration of 25(OH)D in CHF patients is not associated with the advancement of the disease, but is strongly determined by the potential availability of UVB radiation. A positive response to therapy increases the concentration of 25(OH)D only in the case of high UVB exposure; other determinants of 25(OH)D level include the patient's metabolic profile and the presence of diabetes.

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Section: Discussioncontrasting

confidence: 56%

Clinical and laboratory determinants of 25-hydroxyvitamin D deficiency during pharmacotherapeutic escalation in heart failure patients

Myrda¹,

Rozentryt²,

Niedziela³

et al. 2015

kitp

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“…Low levels of vitamin D are associated with a decrease in muscle strength , and vitamin D supplementation has been shown to improve muscle strength and gait, with a reduction in falls . Severe vitamin D deficiency can lead to a reduction in proximal muscle strength and size as well as increased IMNCT . Several randomized studies have recently shown significant improvements in both muscle volume and strength after treatment with vitamin D .…”

Section: Discussionmentioning

confidence: 99%

Distal lower limb strength is reduced in subjects with impaired glucose tolerance and is related to elevated intramuscular fat level and vitamin D deficiency

et al. 2016

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Aim To quantify muscle strength and size in subjects with impaired glucose tolerance (IGT) in relation to intramuscular non-contractile tissue, the severity of neuropathy and vitamin D level. Methods A total of 20 subjects with impaired glucose tolerance and 20 control subjects underwent assessment of strength and size of knee extensor, flexor and ankle plantar and dorsi-flexor muscles, as well as quantification of intramuscular non-contractile tissue and detailed assessment of neuropathy and serum 25-hydroxy vitamin D levels. Results In subjects with impaired glucose tolerance, proximal knee extensor strength (P=0.17) and volume (P=0.77), and knee flexor volume (P=0.97) did not differ from those in control subjects. Ankle plantar flexor strength was significantly lower (P=0.04) in the subjects with impaired glucose tolerance, with no difference in ankle plantar flexor (P=0.62) or dorsiflexor volume (P=0.06) between groups. Intramuscular non-contractile tissue level was significantly higher in the ankle plantar flexors and dorsiflexors (P=0.03) of subjects with impaired glucose tolerance compared with control subjects, and it correlated with the severity of neuropathy. Ankle plantar flexor muscle strength correlated significantly with corneal nerve fibre density (r= 0.53; P=0.01), a sensitive measure of small fibre neuropathy, and was significantly lower in subjects with vitamin D deficiency (P=0.02). Conclusions People with impaired glucose tolerance have a significant reduction in distal but not proximal leg muscle strength, which is not associated with muscle atrophy, but with increased distal intramuscular non-contractile tissue, small fibre neuropathy and vitamin D deficiency.

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“…Several experimental and clinical studies have demonstrated that, besides its well-known effects on calcium homeostasis and bone metabolism, vitamin D has many other important functions [1,2]. Accumulating evidence has implicated vitamin D deficiency as a risk factor for several diseases [1][2][3][4][5][6]. Low level of vitamin D is proposed to be associated with insulin resistance and insulin secretion derangements resulting in the development of T2DM [7].…”

Section: Introductionmentioning

confidence: 99%

The relationship between vitamin D status, physical activity and insulin resistance in overweight and obese subjects

Kavadar¹,

Demircioğlu

Özgönenel

et al. 2015

Biomol Biomed

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Type 2 diabetes mellitus (T2DM) incidence has been increasing worldwide along with the rise of obesity and sedantery lifestyle. Decreased physical activity (PA) and obesity have also been associated with the low vitamin D levels. We aimed to determine the association between PA, vitamin D status and insulin resistance in overweight and obese subjects. A total of 294 (186 female, 108 male) overweight or obese subjects were included in this cross-sectional study. 25-hydroxy vitamin D (25(OH)D), insulin, fasting plasma glucose (FPG) and HbA1c levels were measured in blood samples. Body mass index (BMI), HOMA-index and total score of International Physical Activity Questionnaire-long form (IPAQ) were calculated. Insulin resistant subjects were compared with the non-resistant group. The mean age of the participants was 45 ± 12.25 and 41.39 ± 10.32; 25(OH)D levels were 8.91 ± 4.30 and 17.62 ± 10.47 ng/dL; BMIs were 31.29 ± 4.48 and 28.2 ± 3.16 kg/m², IPAQ total scores were 548.71 ± 382.81 and 998 ± 486.21 in the insulin resistant and nonresistant subjects, respectively. There was a statistically significant difference in terms of 25(OH)D, FPG, insulin levels, IPAQ total score and BMI between the two groups (p = 0.001, p = 0.001, p = 0.001, p = 0.001, p = 0.001).Significantly low 25(OH)D levels, high BMI and low PA in insulin resistant subjects confirm the importance of active lifestyle and the maintenance of normal vitamin D levels in overweight and obese subjects in prevention of T2DM.

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Vitamin D Insufficiency Is Associated with Lower Physical Function in Patients with Heart Failure and Diabetes

Cited by 12 publications

References 47 publications

Clinical and laboratory determinants of 25-hydroxyvitamin D deficiency during pharmacotherapeutic escalation in heart failure patients

Clinical and laboratory determinants of 25-hydroxyvitamin D deficiency during pharmacotherapeutic escalation in heart failure patients

Distal lower limb strength is reduced in subjects with impaired glucose tolerance and is related to elevated intramuscular fat level and vitamin D deficiency

The relationship between vitamin D status, physical activity and insulin resistance in overweight and obese subjects

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