|Year : 2019 | Volume
| Issue : 4 | Page : 329-330
The case of fat-soluble vitamin in obese
Puja Dudeja1, Prafull Mohan2
1 Department of Community Medicine, AFMC, Pune, Maharashtra, India
2 Department of Pharmacology, AFMC, Pune, Maharashtra, India
|Date of Web Publication||8-Jul-2019|
Department of Community Medicine, AFMC, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dudeja P, Mohan P. The case of fat-soluble vitamin in obese. Med J DY Patil Vidyapeeth 2019;12:329-30
Vitamin D (VD) deficiency has been one of the most underdiagnosed and common nutritional deficiencies in the world. Low VD status is important issue in global health care because it has been found to be associated with a wide range of illnesses and chronic conditions, such as osteoporosis, cancer, metabolic syndrome, and cardiovascular diseases. However, this association, as brought forth by, is primarily through observational studies and cannot, yet, be labeled as causation as the same does not pass muster in interventional studies and/or their meta-analyses. Moreover, these disease states have not been found to be improving with VD supplementation. It appears that the low VD levels are more of a watershed event that pushes the predisposed, irreversibly, into a particular disease state, an event which is not reversed by a later VD supplementation. In India, the prevalence of VD deficiency is as high as 70% and the prevalence of obesity is also rising and both are of public health concern.
The main sources of intake of VD are through sunlight and dietary intake. However, there are multiple factors which have an impact on actual serum VD levels such as hormonal status, adipose tissue, social and/or religious norms of covering the whole body, and use of sunscreen on exposed parts. Production of 25-hydroxyvitamin D is as such not regulated, and the serum concentration reflects both cutaneous synthesis and absorption from diet. Low VD levels have been found to be associated with obesity and indeed increased body fat stores; however, the exact mechanism of the same is not clear.
Review of the literature suggests that low level of this fat-soluble vitamin in people with high adipocytes is due to lack of physical activity/altered behavior. Another proposed hypothesis is that VD might be getting sequestered in fat stores in obese individuals leading to low serum levels. Alternatively, lower dietary intake, reduced synthesis capacity, reduced intestinal absorption, and altered metabolism have been proposed. Nevertheless, this association has implications in clinical practice. Obesity has been documented as one of the causal factors for the development of VD deficiency but not vice versa. These findings imply that population-level interventions aimed at reducing obesity will automatically lead to a reduction in the prevalence of VD deficiency. Moreover, there is a role of monitoring and treating VD deficiency through supplementation in obese.
Various supplementation guidelines with respect to VD vary with age, physiological status such as adolescents, pregnancy, postmenopausal, or disease condition such as osteoporosis and neurodevelopmental disorders; however, none of them have considered varying dosages in obese individuals. The clinical relevance of this inverse relation between obesity and serum VD levels may imply that while prescribing VD supplements to obese individuals, the required dosage may be more than the nonobese individuals. However, a cross-sectional study (unpublished) by the authors in a tightly matched cohort has not revealed any difference in VD levels between obese and nonobese males, wherein other variables, namely, diet and sunlight exposure remained same. While the effect of VD supplementation in obese and nonobese is yet to be ascertained in Phase II of this study, another study Shah et al. revealed that supplementation with VD at 150,000 IU every 3 months failed to increase serum 25(OH) D or alter inflammatory markers and lipids in overweight and obese youth. While it may be premature to suggest differential dosage of VD in obese and nonobese individuals, it is quite emphatic that index of suspicion with respect to VD deficiency should definitely be more in case of obese individuals.
The definitive health impact of low VD levels is still not well defined, and hence, the likely benefit of VD supplementation remains nebulous. However, the supplementation is unlikely to lead to hypervitaminosis in our population wherein the prevalence of low VD levels is more than 70%, which, although, is no ground for universal or indiscriminate supplementation. The answer to this Holy Grail shall be provided by VITAL trial which was designed to test whether supplemental vitamin D and omega-3 fatty acids affect risk of cancer and cardiovascular disease, along with ancillary studies for examining diabetes, atrial fibrillation, cognition, autoimmune disorders, lung diseases, depression, and other outcomes the results of which are still awaited.
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