Abstract
BackgroundMicronutrient deficiencies are identified among obese individuals. Vitamin D deficiency (VDD) is prevalent in obese children, and is hypothesized to cause insulin resistance and metabolic abnormalities. This study aimed to determine the effect of vitamin D supplementation on obesity and related metabolic abnormalities among obese Sri Lankan children with VDD.MethodsA triple-blind randomized controlled trial was conducted among vitamin D deficient (< 20 ng/ml), obese children (n = 96), randomly allocated to three intervention arms - treatment arm receiving weekly vitamin D2 50,000 IU; supplementation arm receiving 2500 IU weekly and control arm, receiving placebo. Anthropometry, percentage fat mass (%FM) and blood pressure were assessed and fasting blood glucose, fasting insulin, lipid profile, aspartate transaminase (ALT), alanine transaminase (AST), vitamin D, parathyroid hormone (PTH) and hs-CRP and OGTT with 2-h random blood glucose and insulin was performed at baseline and after 24 weeks of treatment. Ethics Review Committee of Faculty of Medicine, University of Colombo approved the protocol.ResultsWaist circumference Z-score, %FM and serum calcium significantly improved across all three arms, ALT significantly improved in treatment and supplementation arms while, BMI Z-score, PTH and vitamin D significantly improved in the treatment arm. Biceps (p = 0.035) and subscapular (0.048) skin fold thickness, vitamin D (p = 0.004) and ALT (p = 0.012) significantly improved in the treatment arm.ConclusionsA strict dietary and physical activity regimen could improve some of the anthropometric, body composition and metabolic profiles, but high dose vitamin D, enhances those improvements. Therefore high dose vitamin D seems to potentiate management outcomes of obese children with vitamin D deficiency.Trial registrationThe study was registered at the Sri Lanka Clinical Trials Registry (SLCTR/2015/017) on 12th September 2015 at https://slctr.lk/trials/slctr-2015-017.
Highlights
Micronutrient deficiencies are identified among obese individuals
In a randomized controlled trial conducted by Belenchia et al among obese adolescents with mean vitamin D concentration of 19.5 ng/ml, a statistically significant effect was shown on fasting insulin and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) with treatment of vitamin D3 4000 IU/d
Age and gender distribution was similar in the three arms and there were no significant differences in mean systolic and diastolic blood pressure, anthropometry, body composition, serum vitamin D levels or other metabolic parameters between the three arms at baseline
Summary
Micronutrient deficiencies are identified among obese individuals. Vitamin D deficiency (VDD) is prevalent in obese children, and is hypothesized to cause insulin resistance and metabolic abnormalities. This study aimed to determine the effect of vitamin D supplementation on obesity and related metabolic abnormalities among obese Sri Lankan children with VDD. Contrary to the popular belief that obese individuals are adequately nourished, micronutrient deficiencies have been identified to be prevalent among obese across all age groups worldwide. As much as identifying the magnitude of the problem of vitamin D deficiency (VDD) among obese children, it is important to identify the part it plays in insulin resistance among them. Obese individuals were noted to have VDD associated with other micronutrients in several studies, the exact mechanism has not been revealed. Possible hypothesis for the lower 25-hydroxy vitamin D (25(OH)D) levels in obese children, includes decreased sun exposure due to sedentary lifestyle, poor quality diet and increased clearance of 25(OH)D due to being stored in adipose tissue [4]
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