Experience of vitamin D supplementation — is it possible to influence the metabolic and cardiovascular risk in obese children?

Background. Obese adolescents are at a greater risk of vitamin D deficiency, which is related to bone and metabolic changes. Vitamin D deficiency is associated with a higher prevalence of metabolic syndrome, type 2 diabetes mellitus in children and adolescents.

Objective. To evaluate efficacy and safety of 3‑and 6‑month therapy with 1500 IU and 2000 vitamin D months in obese children and adolescents, and to assess whether increased circulating 25‑hydroxyvitamin D (25 (OH)D) level is associated with improved markers ofinsulin sensitivity and resistance, serum leptin and adiponectin levels and reduction of body mass index (BMI).

Design and methods. Altogether 66 obese children and adolescents (mean age — 12,6 ± 2,2 years; BMI — 32 ± 6,22 kg/m2 , 25 (OH)D: 16,7 ± 5,58 ng/ml) were recruited from the Pediatric Endocrinology Unit from Almazov North-West Medical Research Centre and were assigned to receive either vitamin D3 (1500 IU/day and then 2000 IU/day) as a part of their standard care. Anthropometric parameters, adipokines (leptin, adiponectin), fasting glucose, insulin, triglyceride levels and HOMA-IR (Homeostasis Model Assessment of Insulin Resistance) were measured at baseline and at 2 follow-up visits at 3 and 6 months.

Results. Vitamin D deficiency has a high prevalence in both obese and non-obese children from St Petersburg. Vitamin D 1500 IU per day was prescribed to obese children for 3 months followed by 2000 IU per day during subsequent 3 months. At 3 and 6 months vitamin D supplementation was associated with an increase in the serum levels of 25 (OH)D, adiponectin and insulin sensitivity. However, BMI and serum leptin level remained unchanged in the majority of children. The unfavourable changes in some of the indices in 6 month might be due to the decreased adherence to treatment.

Conclusions. Diet vitamin D supplement (1500 and 2000 IU/day) is effective to normalize plasma level of 25 (ОН)D in 40% of children. It leads to an increase in adiponectin level and a decrease in HOMA-IR and triglyceride level, but it does not affect BMI. Diet vitamin D supplement may be an effective additional approach to obesity management associated with the favourable metabolic and cardiovascular effects.

1. Blum M, Dolnikowski G, Seyoum E, Harris SS, Booth SL, Peterson J et al. Vitamin D(3) in fat tissue. Endocr Rev. 2008;33 (1):90–94.

2. Kull M, Kallikorm R, Lember M. Body mass index determines sunbathing habits: implications on vitamin D levels. Intern Med J. 2009;39(4):256–258.

3. De Paula FJA, Rosen CJ. Vitamin D and fat in vitamin D. Eds. D Feldman, JW Pike, JS Adams. Academic Press. 2011:769–776.

4. Каронова Т. Л., Гринёва Е. Н., Михеева Е. П., Беляева О. Д., Красильникова Е. И., Никитина И. Л. Уровень витамина D и его взаимосвязь с количеством жировой ткани и содержанием адипоцитокинов у женщин репродуктивного возраста. Проблемы эндокринологии. 2012;58(6):19–23. [Karonova TL, Grineva EN, Mikheeva EP, Belyaeva OD, Krasilnikova EI, Nikitina IL. Vitamin D and its association with fat volume and adipokine levels in women of reproductive age. Problemy Endokrinologii = Endocrinology issues. 2012;58 (6):19–23. In Russian].

5. Koszowska AU, Nowak J, Dittfeld A, Bronczyk-Puzon A, Kulpok A, Zubelewicz-Szkodzinska B. Obesity, adipose tissue function and the role of vitamin D. Cent Eur J Immunol, 2014;39 (2):260–264.

6. Gannagé-Yared MH, Chedid R, Khalifie S, Azzi E, Zoghbi F, Halaby G. Vitamin D in relation to metabolic risk factors, insulin sensitivity and adiponectin in a young Middle-Eastern population. Eur J Endocrinol. 2009;160(6):965–971.

7. Walker GE, Rocotti R, Roccio M, Moia S, Bellone S, Prodam F et al. Pediatric obesity and vitamin D deficiency: a proteomic approach identifies multimeric adiponectin as a key link between these conditions. PLoS One, 2014;9(1): e83685. doi:10.1371/journal.pone.0083685

8. Lechnik L, Register TC, Hsu FC, Lohman K, Nicklas BJ, Freedman BI et al. Adiponectin as a novel determinant of bone mineral density and visceral fat. Bone. 2003;33(4):646–651.

9. Belenchia AM, Tosh AK, Hillman LS, Peterson CA. Correcting vitamin D insufficiency improves insulin sensitivity in obese adolescents: a randomized controlled trial. Am J Clin Nutr. 2013;97(4):774–781. doi: 10.3945/ajcn.112.050013

10. Никитина И.Л., Тодиева А.М., Каронова Т.Л., Буданова М.В. Ожирение у детей и подростков: особенности фенотипа, ассоциации с компонентами метаболического синдрома. Вопросы детской диетологии, 2012;10(5):23–30. [Nikitina IL, Todieva AM, Karonova TL, Budanova MV. Obesity in children and adolescents: phenotype and assotiation with metabolic syndrome. Voprosy Detskoi Dietologii = Questions of Pediatric Dietology. 2012;10(5):23–30. In Russian].

11. Grineva EN, Karonova TL, Nikitina IL, Micheeva E, Belyaeva O. Vitamin D deficiency is a risk factor for obesity and diabetes type 2 in women at late reproductive age. Aging. 2013;5 (7):575–581.

12. Никитина И.Л, Тодиева А.М., Каронова Т.Л., Гринёва Е.Н. Взаимосвязь уровня витамина D, содержания адипоцитокинов и метаболических нарушений у детей с ожирением. Трансляционная медицина. 2013;3(20):37–46. [Nikitina IL, Todieva AM, Karonova TL, Grineva EN. The relationship between level of vitamin D and metabolic syndrome in obese children. Translyatsionnaya Medicina = Translational Medicine. 2013;3 (20):37–46. In Russian].

13. Михно В.А., Никитина И.Л. Дисфункция эндотелия как фактор риска сахарного диабета и сердечно-сосудистой патологии. Забайкальский медицинский вестник. 009;1:53–64. [Mikhno VA, Nikitina IL. Endotelial disfunction as a risk factor of diabetes mellitus and cardiovascular pathology. Zabaikalskii Med. Vestnik = Medical Bulleten of Zabaykal Region, 2009;1:53–64. In Russian].

14. Никитина И.Л. Старт пубертата — известное и новое. Артериальная гипертензия. 2013;19(3):227–236. [Nikitina IL. The timing of puberty: well-known and new. Arterial’naya Gipertenziya = Arterial Hypertension, 2013;19(3): 227–236. In Russian].

15. Holic MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Robert P. Heaney RP et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrin Metab. 2011;96(7):1911–30.

16. August GP, Caprio S, Fennoy I, Freemark M, Kaufman FR, Lustig RH et al. Prevention and Treatment of pediatric obesity: an endocrine society clinical practice guidline. J Clin Endocrin Metab. 2008;93(12):4576–4599.

17. Cole TJ, Freeman JV, Preece MA. Body Mass Index reference curves for the UK. Archives of Disease in Childhood. 1995;73:17–24.

18. [Электронный ресурс]. Available from: http://www.who.int/growthref/who2007_bmi_for_age/en/index.html

19. Katzmarzyk PT, Srinivasan SR, Chen W, Malina RM, Bouchard C, Berenson GS. Body massindex, waist circumference, and clustering of cardiovascular disease risk factors in a biracial sample of children and adolescents. Pediatrics. 2004;114(2): 198–205.

20. Захарова И.Н., Мальцев С.В., Боровик Т.Э., Яцык Г.В., Малявская С.И., Вахлова И.В. и др. Результаты многоцентрового исследования «Родничок» по изучению недостаточности витамина D у детей раннего возраста в России. Педиатрия. 2015;94(1):62–67. [Zakharova IN, Maltsev SV, Borovik T,Yatsyk GV, Malyavskaya SI, Vakhlova IV et al. The results of multicentral study «Rodnichok» of vitamin D deficiency in infants of Russia. Pediatriia = Pediatrics. 2015;94(1):62–67. In Russian].

21. Esfahani M, Movahedian A, Baranchi M, Goodarzi MT. Adiponectin: an adipokine with protective features against metabolic syndrome. Iran J Basic Med Sci. 2015;18(5):430–442.

22. Roth CL, Elfers C, Kratz M, Hoofnage AN. Vitamin D deficiency in obese children and Its relationship to insulin resistance and adipokines. J Obes. 2011;2011:495101. doi: 10.1155/2011/495101

23. Zeng R, Xu CH, Xu YN, Wang YL, Wang M. Association of leptin levels with pathogenetic risk of coronary heart disease and stroke: a meta-analysis. Arq Bras Endocrinol Metabol. 2014;58 (8):817–823.