Obezite ile D vitamini, C-reaktif protein, hemogram parametreleri ve kan grupları arasındaki ilişki

Amaç: Obezite günümüzde giderek artan en önemli sağlık sorunlarından biridir. Bu çalışmada, obez hastaların vitamin D düzeyleri, C-reaktif protein (CRP), hemogram parametreleri ve kan grupları ile beden kitle indeksi arasındaki ilişkiyi incelemek amaçlanmıştır.Materyal ve metod: Çalışmaya iç hastalıkları polikliniğine kilo vermek için başvuran ve diyet yapmak isteyen 161 kişi alındı. Hastalar beden kitle indeksine göre iki gruba ayrıldı. Demografik ve laboratuvar verileri hasta kayıtlarından elde edildi.Bulgular: Çalışmaya alınan 161 olgunun yaş ortalaması 31±8, kadın olgu sayısı 150 (%93) ve erkek olgu sayısı 11 (%7) idi. Obez olan bireyler obez olmayanlarla karşılaştırıldığında yaş, bel çevresi, yağ, yağ kitlesi, yağsız vücut kitlesi, total vücut suyu, bazal metabolizma hızı artmış iken yüksek dansiteli lipoprotein düzeyleri anlamlı derecede düşüktü. Obez bireylerde obez olmayanlara göre açlık kan şekeri, HbA1c, insülin direnci ve C-reaktif protein, sistolik ve diyastolik tansiyon değerleri arasında anlamlı fark vardı. Obezite ile cinsiyet arasında ilişki yoktu (Pearson Chi square test 0.455, p=0.500). Obez olan ve olmayan gruplar arasında D vitamin düzeyleri bakımından anlamlı fark yoktu (Mann-Whitney U test 2881, p=0.653). Ancak gruplar D vitamini yeterli ve yetersiz diye kategorize edildiğinde D vitamini ile obezite arasında istatiksel olarak anlamlı ilişki vardı (Pearson Chi square test 5.575, p=0.0189). Obezite ile hemoglobin, nötrofil, lenfosit, nötrofil/lenfosit oranı ve platelet lenfosit oranı bakımından anlamlı fark yoktu. Obezite ile kan grupları ve Rh bakımından anlamlı ilişki yoktu. Sonuç: D vitamini yetersizliği ile obezite arasında anlamlı ilişki vardı. D vitamini yetersizliği artmış insülin direnci ile birlikte idi. Bu durum D vitamini yetersizliğinin kendisi veya obezite gelişim sürecinde D vitamin metabolizmasındaki farklılıklarla açıklanabilir. Ayrıca CRP’nin artması obez bireylerde enflamasyonu göstermede yararlı bir marker olabilir.

Anahtar Kelimeler:

Obezite, D vitamini, hemogram, C-reaktif protein

Association of obesity with vitamin D, C-reactive protein, blood group and hemogram parameters

Objective: Obesity is one of the most important and growing health problems of today. We aimed to search for possible association between obesity and vitamin D as well as inflammatory and hemogram parameters. Material and method: In this study 161 patients presented to internal medicine outpatient clinic with an intention to enter a weight loss program for obesity has been included. Patients were divided into obese and non obese groups. Demographic and laboratory data were recorded.Results: Mean age was 31±8 and 93% of patients were women. Age, waist circumference, fat%, fat mass, free fat mass, total body water and basal metabolic rate were significantly higher while high density lipoprotein was significantly lower in obese patients. Similarly, fasting blood sugar, insulin resistance, C-reactive protein (CRP) and blood pressure were significantly higher in the obese group. Obesity and gender were not associated (Pearson Chi square test 0.455, p=0.500). Vitamin D levels did not differ significantly between groups (Mann-Whitney U test 2881, p=0.653). But there was significant association between vitamin D and obesity when vitamin D status was categorized (Pearson Chi square test 5.575, p=0.0189). There was no significant difference in hemoglobin, neutrophil, neutrophil/ lymphocyte ratio and platelet lymphocyte ratio between obese and non obes groups. Obesity was not associated with blood groups and Rh status. Conclusion: Obesity and vitamin deficiency were associated. This might be explained by vitamin D deficiency per se, or changes in vitamin D metabolism in obese persons. Also increased CRP in obese it might show a general inflammatory status in this group of patients.

Keywords:

Obesity vitamin D, c-reactive protein, hemogram, blood group,

PDF

___

1. Rajakumar K, Greenspan SL, Thomas SB, Holick MF. SOLAR ultraviolet radiation and vitamin D: a historical perspective. Am J Public Health 2007;97:1746-54.
2. http://www.who.int/topics/obesity/en/Erişim Tarihi: 12.12.2016.
3. Kershaw EE, Flıer JS. Adipose tissue as an endocrine organ. J Clin Endocrinol Metab, 2004;89(6):2548–2556.
4. Wright ORL, Hickman IJ. The effect of 25hydroxyvitamin D on ınsulin sensitivity in obesity: is it mediated via adiponectin? Can J Physiol PharmacoL 2013;91:496-501.
5. Alvarez JA, Ashraf A. Role of Vitamin D in insulin secretion and insulin sensitivity for glucose homeostasis. Int J Endocrinol 2010;351-385.
6. Rosen CJ, Adams JS, Bikle DD, et al. The Nonskeletal effects of Vitamin D: an Endocrine Society Scientific Statement. Endocrine Reviews 2012;33:456-492.
7. Shoenfeld N, Amital H, Shoenfeld Y.Theeffect of melanismand vitamin D synthesis on theincidence of autoimmunedisease.NatClinPractRheumatol. 2009;5(2):99-105.
8. Pearce SHS, Cheetham TD. Diagnosis and management of vitamin D deficiency. BMJ 2010;340:5664.
9. Fidan F, Alkan BM, Tosun A. Çağın Pandemisi: D vitamini eksikliği ve yetersizliği. Türk Osteoporoz Dergisi 2014;20:71-74.
10. Uçar F, Taşlıpınar MY, Soydaş AÖ, Özcan N. Ankara etlik ihtisas eğitim ve araştırma hastanesine başvuran hastalarda 25-OH Vitamin D düzeyleri. Eur J Basic Med Sci 2012;2(1):12-15. 33.
11. Çimen MBY, Çimen ÖB. Obezite ve D vitamini. Mersin Üniv Saglık Bilim Derg 2016;9(2).
12. Deepu D, Hardigan P, Bray N, Penzell D, Savu C. The incidence of vitamin D deficiency in theThe incidence of vitamin D deficiency in the obese: a retrospective chart review. J Comm Hosp Int Med Pers 2015,5:26069.
13. World Health Organization. Prevention and management of the global epidemic of obesity. Report of the WHO Consultation on Obesity. Geneva: WHO; 1998 (Technical Report Series, No. 894).
14. Han TS, Lean MEJ. Obezite Antropetrik Gostergeleri ve Yağ Depolarının Bolgesel Dağılımı. Bjorntorp P (ed). International Text Book of Obesity. And Danışmanlık, Eğitim, Yayıncılık ve Organizasyon Ltd. Şti., Istanbul,2002; 60–65.
15. Mai XM, Chen Y, Camargo CA Jr, Langhammer A. Cross-sectional and prospective cohort study of serum 25hydroxyvitamin D level and obesity in adults: the HUNT study. Am J Epidemiol 2012;15;175(10):1029-1036.
16. Vimaleswaran KS, Berry DJ. Causal relationship between obesity and vitamin D Status: Bi-directional mendelian randomization analysis of multipleStatus: Bi-directional mendelian randomization analysis of multiple kohorts. Plos Med 2013, 10(2), 1-11.
17. McGill AT, Stewart JM, Lithander FE, Strik CM, Poppitt SD. Relationships of low serum vitamin D3 with anthropometry and markers of the metabolic syndrome and diabetes in overweight and obesity. Nutr J 2008;7:4.
18. Aypak C, Yıkılkan H, Dicle M, Önder Ö, Görpelioğlu S. Erişkin obez hastalarda D vitamini düzeyinin vücut kitle indeksi ile ilişkisi. Haseki Tıp Bülteni 2013; 954: 9598. DOI: 10.4274/Haseki.954
19. Borissova AM, Tankova T, Kirilov G, Dakovska L, Kovacheva R. the effect of vitamin D3 on insulin secretion and peripheral insulin sensitivity in type 2 diabetic patients. Int J Clin Pract 2003;57(4):258-261.
20. Chiu KC, Chu A, Go VL, Saad MF. Hypovitaminosis D is associated with insulin resistance and cell dysfunction 56. Chiu KC, Chu A, Go VL, Saad MF. Hypovitaminosis D is associated with insulin resistance and cell dysfunction. Am J Clin Nutr 2004;79:820-825.
21. Need AG, O’Loughlin PD, Horowitz M, Nordin BE. Relationship between fasting serum glucose, age, body mass index and serum 25 hydroxyvitamin D in postmenopausal women. Clin Endocrinol (Oxf) 2005;62:738-41.
22. McKinney K, Breitkopf CR, Berenson AB. Association of race, body fat and season with vitamin D status among young women: a cross-sectional study. Clin Endocrinol (Oxf) 2008;69:535-41.
23. Konradsen S, Ag H, Lindberg F, Hexeberg S, Jorde R. Serum 1,25-dihydroxy vitamin D is inversely associated with body mass index. Eur J Nutr 2008;47:87-91.
24. Martins D, Wolf M, Pan D. Prevalence of cardiovascular factors ad the serum levels of 25 hydroxyvitamin D in the United States: data from the third National Health and Nutrition Examination Surveys. Arch Intern Med 2007;167:1159-1165.
25. Bahadır A, Baltacı D, Y Türker, ve ark. Is the neutrophil tolymphocyte ratio indicative of inflammator state in patients with obesity and metabolic syndrome? Anatol J Cardiol 2015:15(10):816-822. Doi:10.5152/akd.2014.5787
26. Atmaca H.U, Akbaş F, Ökten İ.Ö, ve ark. Nötrofil lenfosit oranı obezlerde inflamatuar bir belirteç olarak kullanılabilir mi? İstanbul Med J:2014 15(4).
27. Kazuyo MİTO. MD.PHD,Masamichi OKUBO. MD.PHD,Miki HANAFUJA.Elevated While Blood Cell Count in Subjects With Impaiered Glucose Tolerance.Diabetes Care 27:491496,2004
28. Brörntorp P. International Texbook of Obesity Türkçe, 1. Baskı, And Yayıncılık, İstanbul, 2002.
29. Kopelman PG. Hormones and obesity. Bailliere’s Clinical Endocrinology and metabolism 1994;8(3):549-560.
30. Tulika Chandra , Ashish Gupta M . Association and Distribution of Hypertension, Obesity and ABO Blood groups in Blood Donors . Iranian Journal of Pediatric Hematology Oncology Vol: 2. No:4