Vitamin D and risk of developing type 2 diabetes in the SUN project: a prospective cohort study

A. Valer-Martinez1,2, C. Sayon-Orea3,4,5,1, J. A. Martinez6,7, F. J. Basterra-Gortari3,1,8, M. A. Martinez-Gonzalez9,4,1,3, M. Bes-Rastrollo3,4,1
1Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
2Department of Family Medicine, Aragon Health Service (SALUD), Zaragoza, Spain
3IdiSNa, Navarra Institute for Health Research, Universidad de Navarra, Pamplona, Spain
4CiberOBN, Instituto de Salud Carlos III, Madrid, Spain
5Navarra Public Health Institute, Pamplona, Spain
6Department of Nutrition, Food Science and Physiology, Centre for Nutrition Research, University of Navarra, Pamplona, Spain
7Institute IMDEA Food, Madrid, Spain
8Department of Endocrinology and Nutrition, Hospital Universitario de Navarra, Universidad Pública de Navarra, Pamplona, Spain
9Harvard T.H. Chan School of Public Health, Boston, USA

Tóm tắt

Vitamin D deficiency has been associated with multiple chronic diseases, including metabolic disorders such as insulin resistance and type 2 diabetes (T2D). The aim of the study was to analyze the association between validated predicted serum vitamin D status and the risk of developing T2D in a large prospective cohort based on a Mediterranean population. The SUN project is a prospective and dynamic Spanish cohort that gathers university graduates who have answered lifestyle questionnaires, including a validated Food Frequency Questionnaire. The association between predicted serum vitamin D and the risk of T2D was assessed through Cox regression models according to quartiles (Q) of predicted vitamin D at baseline. The models were adjusted for potential confounders and sensitivity analyses were performed to ensure the robustness of our findings. Our study included a total of 18,594 participants and after a total follow-up of 238,078 person-years (median follow-up of 13.5 years), 209 individuals were diagnosed with incident T2D. We found a significant inverse association between predicted levels of serum vitamin D and the risk of developing T2D, after adjusting for potential confounders and performing different sensitivity analyses (hazard ratio Q4 vs. Q1: 0.48, 95% CI 0.26–0.88; p for trend = 0.032). The outcomes suggest that higher levels of vitamin D at baseline may be associated with a reduced risk of developing T2D.

Từ khóa


Tài liệu tham khảo

Stumvoll M, Goldstein BJ, van Haeften T (2005) Type 2 diabetes: principles of pathogenesis and therapy. Lancet 365:1333–1346 Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB et al (2022) IDF diabetes atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract 183:109–119 Cashman KD, Dowling KG, Škrabáková Z, Gonzalez-Gross M, Valtueña J, De Henauw S et al (2016) Vitamin D deficiency in Europe: pandemic? Am J Clin Nutr 103(4):1033–1044 Schleicher RL, Sternberg MR, Looker AC, Yetley EA, Lacher DA, Sempos CT et al (2016) National estimates of serum total 25-hydroxyvitamin D and metabolite concentrations measured by liquid chromatography-tandem mass spectrometry in the US population during 2007–2010. J Nutr 146(5):1051–1061 Amrein K, Scherkl M, Hoffmann M, Neuwersch-Sommeregger S, Köstenberger M, Tmava Berisha A et al (2020) Vitamin D deficiency 2.0: an update on the current status worldwide. Eur J Clin Nutr 74:1498–1513 Holick MF (2017) The vitamin D deficiency pandemic: approaches for diagnosis, treatment and prevention. Rev Endocr Metab Disord 18(2):153–165 Institute of Medicine (US) (2011) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium. In: Ross AC, Taylor CL, Yaktine AL, et al. (eds.) Dietary Reference Intakes for Calcium and Vitamin D. Washington (DC), National Academies Press (US). https://doi.org/10.17226/13050https://www.ncbi.nlm.nih.gov/books/NBK56070/ Roseland JM, Phillips KM, Patterson KY, Pehrsson PR, Taylor CL (2018) Vitamin D in Foods: An Evolution of Knowledge. Vitamin D Health, Disease and Therapeutics, vol 2, 4th edn. Elsevier, Amsterdam The Netherlands, pp 41–78 Charoenngam N, Holick MF (2020) Immunologic effects of vitamin d on human health and disease. Nutrients 12(7):1–28 Giovinazzo S, Alibrandi A, Campennì A et al (2017) Correlation of cardio-metabolic parameters with vitamin D status in healthy premenopausal women. J Endocrinol Invest 40:1337–1343 Pittas AG, Jorde R, Kawahara T, Dawson-Hughes B (2020) Vitamin D supplementation for prevention of type 2 diabetes mellitus: to D or Not to D? J Clin Endocrinol Metab 105(12):3721–3733 Afzal S, Bojesen SE, Nordestgaard BG (2013) Low 25-hydroxyvitamin D and risk of type 2 diabetes: a prospective cohort study and metaanalysis. Clin Chem 59(2):381–391 Song Y, Wang L, Pittas AG, Del Gobbo LC, Zhang C, Manson JE et al (2013) Blood 25-hydroxyvitamin D levels and incident type 2 diabetes: a meta-analysis of prospective studies. Diabetes Care 36(5):1422–1428 Rafiq S, Jeppesen PB (2021) Insulin resistance is inversely associated with the status of vitamin d in both diabetic and non-diabetic populations. Nutrients. https://doi.org/10.3390/nu13061742 Szymczak-Pajor I, Śliwińska A (2019) Analysis of association between vitamin D deficiency and insulin resistance. Nutrients 11(4):794 Muñoz-Garach A, García-Fontana B, Muñoz-Torres M (2019) Vitamin D status, calcium intake and risk of developing type 2 diabetes: an unresolved issue. Nutrients 11(3):1–17 Pittas AG, Dawson-Hughes B, Sheehan P, Ware JH, Knowler WC, Aroda VR et al (2019) Vitamin D Supplementation and prevention of Type 2 Diabetes. N Engl J Med 381(6):520–530 Kawahara T, Suzuki G, Mizuno S, Inazu T, Kasagi F, Kawahara C et al (2022) Effect of active vitamin D treatment on development of type 2 diabetes: DPVD randomised controlled trial in Japanese population. BMJ 377:e066222 Jorde R, Sollid ST, Svartberg J, Schirmer H, Joakimsen RM, Njølstad I et al (2016) Vitamin D 20 000 IU per week for five years does not prevent progression from prediabetes to diabetes. J Clin Endocrinol Metab 101(4):1647–1655 Li X, Liu Y, Zheng Y, Wang P, Zhang Y (2018) The effect of vitamin D supplementation on glycemic control in type 2 diabetes patients: a systematic review and meta-analysis. Nutrients 10(3):375 Saponaro F, Marcocci C, Zucchi R (2019) Vitamin D status and cardiovascular outcome. J Endocrinol Invest 42:1285–1290 Carlos S, De La Fuente-Arrillaga C, Bes-Rastrollo M, Razquin C, Rico-Campà A, Martínez-González MA et al (2018) Mediterranean diet and health outcomes in the SUN cohort. Nutrients 10(4):1–24 Willett W, Stampfer MJ (1986) Total energy intake: implications for epidemiologic analyses. Am J Epidemiol 24(1):17–27 Valer-Martinez A, Sayon-Orea C, Alfredo J, Hernandez M, De La Fuente-Arrillaga C, Rojas JP et al (2023) Forecasting levels of serum 25-hydroxyvitamin D based on dietary intake, lifestyle and personal determinants in a sample of Southern Europeans. Br J Nutr. https://doi.org/10.1017/S0007114523000946 Martin-Moreno JM, Boyle P, Gorgojo L, Maisonneuve P, Fernandez-Rodriguez JC, Salvini S et al (1993) Development and validation of a food frequency questionnaire in Spain. Int J Epidemiol 22(3):512–519 De La Fuente-Arrillaga C, Vazquez Ruiz Z, Bes-Rastrollo M, Sampson L, Martinez-González MA (2010) Reproducibility of an FFQ validated in Spain. Public Health Nutr 13(9):1364–1372 Fernández-Ballart JD, Lluís Piñol J, Zazpe I, Corella D, Carrasco P, Toledo E et al (2010) Relative validity of a semi-quantitative food-frequency questionnaire in an elderly mediterranean population of Spain. Br J Nutr 103(12):1808–1816 Martínez-González MA, López-Fontana C, Varo JJ, Sánchez-Villegas A, Martinez JA (2005) Validation of the Spanish version of the physical activity questionnaire used in the nurses’ health study and the health professionals’ follow-up study. Public Health Nutr 8(7):920–927 Martínez-González MA, De La Fuente-Arrillaga C, Nunez-Cordoba JM, Basterra-Gortari FJ, Beunza JJ, Vazquez Z et al (2008) Adherence to mediterranean diet and risk of developing diabetes: prospective cohort study. BMJ 336(7657):1348–1351 ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D et al (2023) Classification and diagnosis of diabetes: standards of care in diabetes—2023. Diabetes Care 46:S19–S40 Bes-Rastrollo M, Valdivieso-Pérez J, Sánchez-Villegas A, Alonso A, Martínez-González MA (2005) Validación del peso e índice de masa corporal auto-declarados de los participantes de una cohorte de graduados universitarios [validation of self-reported weight and body mass index of participants from a cohort of college graduates]. Rev Esp Obes 3:352–358 Trichopoulou A, Costacou T, Bamia C, Trichopoulos D (2003) Adherence to a mediterranean diet and survival in a Greek population. N Engl J Med 26:2599–2608 Zhang Y, Tan H, Tang J, Li J, Chong W, Hai Y et al (2020) Effects of vitamin D supplementation on prevention of type 2 diabetes in patients with prediabetes: a systematic review and meta-analysis. Diabetes Care 43(7):1650–1658 Ye Z, Sharp SJ, Burgess S, Scott RA, Imamura F, Langenberg C et al (2015) Association between circulating 25-hydroxyvitamin D and incident type 2 diabetes: a mendelian randomisation study. Lancet Diabetes Endocrinol 3(1):35–42 Ávila-Rubio V, García-Fontana B, Novo-Rodríguez C, Cantero-Hinojosa J, Reyes-García R, Muñoz-Torres M (2018) Higher levels of serum 25-hydroxyvitamin D are related to improved glucose homeostasis in women with postmenopausal osteoporosis. J Womens Health 27(8):1007–1015 Park SK, Garland CF, Gorham ED, BuDoff L, Barrett-Connor E (2018) Plasma 25-hydroxyvitamin D concentration and risk of type 2 diabetes and pre-diabetes: 12-year cohort study. PLoS ONE 13(4):1–17 Issa CM (2017) Vitamin D and type 2 diabetes mellitus. Adv Exp Med Biol 996:193–205 Vondra K, Hampl R (2021) Vitamin D and new insights into pathophysiology of type 2 diabetes. Horm Mol Biol Clin Investig 42(2):203–208 Mitri J, Pittas AG (2014) Vitamin D and diabetes. Endocrinol Metab Clin North Am 43(1):205–232 Maddaloni E, Cavallari I, Napoli N, Conte C (2018) Vitamin D and diabetes mellitus. Front Horm Res 50:161–176 Pittas AG, Kawahara T, Jorde R, Dawson-Hughes B, Vickery EM, Angellotti E et al (2023) Vitamin D and risk for type 2 diabetes in people with prediabetes. Ann Intern Med 176(3):355–364 Hsia DS, Nelson J, Vickery EM, Rasouli N, LeBlanc ES, Kim S et al (2023) Effect of vitamin D on regression to normal glucose regulation and individual glycemic measures: a secondary analysis among participants adherent to the trial protocol in the randomized clinical trial vitamin D and type 2 diabetes (D2d) study. Diabetes Res Clin Pract 202:110792 Niroomand M, Fotouhi A, Irannejad N, Hosseinpanah F (2019) Does high-dose vitamin D supplementation impact insulin resistance and risk of development of diabetes in patients with pre-diabetes? A double-blind randomized clinical trial. Diabetes Res Clin Pract 148(2):1–9 Sacerdote A, Dave P, Lokshin V, Bahtiyar G (2019) Type 2 Diabetes Mellitus, insulin resistance, and vitamin d. Curr Diab Rep. https://doi.org/10.1007/s11892-019-1201-y Ahmed LHM, Butler AE, Dargham SR, Latif A, Robay A, Chidiac OM et al (2020) Association of vitamin D2 and D3 with type 2 diabetes complications. BMC Endocr Disord 20(1):65 Palmer JR, Gerlovin H, Bethea TN, Bertrand KA, Holick MF, Ruiz-Narvaez EN et al (2016) Predicted 25-hydroxyvitamin D in relation to incidence of breast cancer in a large cohort of African American women. Breast Cancer Res 18(1):86 Fuchs MA, Yuan C, Sato K, Niedzwiecki D, Ye X, Saltz LB et al (2017) Predicted vitamin D status and colon cancer recurrence and mortality in CALGB 89803 (Alliance). Ann Oncol 28(6):1359–1367 Petersen SB, Strøm M, Maslova E, Granström C, Vestergaard P, Mølgaard C et al (2015) Predicted vitamin D status during pregnancy in relation to offspring forearm fractures in childhood: a study from the Danish National Birth Cohort. Br J Nutr 114(11):1900–1908 Jones KS, Redmond J, Fulford AJ, Jarjou L, Zhou B, Prentice A et al (2017) Diurnal rhythms of vitamin D binding protein and total and free vitamin D metabolites. J Steroid Biochem Mol Biol 172:130–135 Lombardi G, Vitale JA, Logoluso S, Logoluso G, Cocco N, Cocco G et al (2017) Circannual rhythm of plasmatic vitamin D levels and the association with markers of psychophysical stress in a cohort of Italian professional soccer players. Chronobiol Int 34(4):471–479 Rothman KJ, Gallacher JEJ, Hatch EE (2013) Why representativeness should be avoided. Int J Epidemiol 42(4):1012–1021