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COMMENTARY
Year : 2019  |  Volume : 12  |  Issue : 4  |  Page : 329-330  

The case of fat-soluble vitamin in obese


1 Department of Community Medicine, AFMC, Pune, Maharashtra, India
2 Department of Pharmacology, AFMC, Pune, Maharashtra, India

Date of Web Publication8-Jul-2019

Correspondence Address:
Puja Dudeja
Department of Community Medicine, AFMC, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_246_18

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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

How to cite this URL:
Dudeja P, Mohan P. The case of fat-soluble vitamin in obese. Med J DY Patil Vidyapeeth [serial online] 2019 [cited 2019 Jul 24];12:329-30. Available from: http://www.mjdrdypv.org/text.asp?2019/12/4/329/262235



Vitamin D (VD) deficiency has been one of the most underdiagnosed and common nutritional deficiencies in the world.[1] 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.[2] 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.[3]

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.[4] 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.[5]

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.[6] 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.[7] 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.[8] 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.[9] 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.



 
  References Top

1.
Holick MF. Vitamin D: Extraskeletal health. Rheum Dis Clin North Am 2012;38:141-60.  Back to cited text no. 1
    
2.
Pannu PK, Calton EK, Soares MJ. Calcium and Vitamin D in obesity and related chronic disease. Adv Food Nutr Res 2016;77:57-100.  Back to cited text no. 2
    
3.
Gupta R, Gupta A. Vitamin D deficiency in India: Prevalence, causalities and interventions. Nutrients 2014;6:729-75.  Back to cited text no. 3
    
4.
Harinarayan CV, Ramalakshmi T, Prasad UV, Sudhakar D, Srinivasarao PV, Sarma KV, et al. High prevalence of low dietary calcium, high phytate consumption, and Vitamin D deficiency in healthy South Indians. Am J Clin Nutr 2007;85:1062-7.  Back to cited text no. 4
    
5.
Cunha KA, Magalhães EI, Loureiro LM, Sant'Ana LF, Ribeiro AQ, Novaes JF, et al. Calcium intake, serum Vitamin D and obesity in children: Is there an association? Rev Paul Pediatr 2015;33:222-9.  Back to cited text no. 5
    
6.
Mehmood ZH, Papandreou D. An updated mini review of Vitamin D and obesity: Adipogenesis and inflammation state. Open Access Maced J Med Sci 2016;4:526-32.  Back to cited text no. 6
    
7.
Vimaleswaran KS, Berry DJ, Lu C, Tikkanen E, Pilz S, Hiraki LT, et al. Causal relationship between obesity and Vitamin D status: Bi-directional mendelian randomization analysis of multiple cohorts. PLoS Med 2013;10:e1001383.  Back to cited text no. 7
    
8.
Pludowski P, Holick MF, Grant WB, Konstantynowicz J, Mascarenhas MR, Haq A, et al. Vitamin D supplementation guidelines. J Steroid Biochem Mol Biol 2018;175:125-35.  Back to cited text no. 8
    
9.
Shah S, Wilson DM, Bachrach LK. Large doses of Vitamin D fail to increase 25-hydroxy Vitamin D levels or to alter cardiovascular risk factors in obese adolescents: A pilot study. J Adolesc Health 2015;57:19-23.  Back to cited text no. 9
    




 

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