| ObjectiveDeficiency in Vitamin D is common that it doesn't only affect Skeletal and muscular system but also is related with glucose metabolism, lipid metabolism and cardiovascular disease. How to rationally supplement vitamin D is one of the clinical problems that everybody pays close attention to.This project aims to explore the problems below: 1. The assessment of the eff-icacy of different doses of vitamin D supplementation on different vitamin D deficiency; 2. The effects of stratification supplementation of vitamin D on glucose metabolism, lipid metabolism, muscle strength; 3. The possible mechanisms of stratification supplementation of vitamin D on lipid metabolism and athletic metabolism.MethodsThe elderly population in a community of Beijing city were investigated. The ages,sex, lifestyle and diseases were collected and the height, weight, heart rate, blood pressure,the level of vitamin D (25 hydroxyvitamin D, 25(OH)D) were measured. 156 cases of vitamin D deficiency were identified. The patients who were volunteered to participate in this experiment were randomly divided into the experimental group and the control group.The control group was given health education, the experimental group received health education + vitamin D3 oral treatment, dose were as follows: vitamin D insufficiency(20ng/ml < serum 25(OH)D<30ng/ml) were orally given 5000IU vitamin D3 per week; vitamin D deficiency (12ng/ml <serum 25(OH)D< 20ng/ml) were orally given 10000IU vitamin D3 per week; vitamin D severse deficiency (serum 25(OH)D<12ng/ml)were orally given 15000IU vitamin D3 per weekly. We evaluated the safety of stratification supplementation of vitamin D3 months after 9 months treatment (calcium concentration detection), comprehensive evaluated curative effect 9 months after treatment (Blood 25(OH) D levels, blood pressure (BP), glucose metabolism related indicators, lipid metabolism related indicators, blood uric acid and muscle strength were measured) and to investigate the mechanism of stratification supplementation of vitamin D (serum hormone levels and adiponectin, Dickkopf related protein 1 (DKK-1), preptin; sclerostin were measured).Results1 .Baseline: The height, weight, age, waist circumference, 25 (OH) D, sugar metabolism, lipid index, liver and kidney function and bone metabolism index between control group and vitamin D group baseline indexes had no significantdifference. Serum uric acidof the control group (312.47±68.80 mol/L) is slightly higher than that of vitamin D group (282.26±73.95 mol/L, p=0.039). Analysis the lifesytle of two groups showed control group and vitamin D group had no differences in drinking, smoking, drinking tea,coffee, the proportion of movement time and illumination time.2.Intervention effect: After nine months of stratified dose of vitamin D supplementation, the level of 25 (OH) D in the intervention group was significantly increased from 14.30 + 4.30ng/ml to 33.62 + 6.99ng/ml, while the control group did not change significantly, p<0.000. The adequacy of vitamin D in the intervention group was 36%and in the control group it was 4%.3.The changes of related metabolic indexes after intervention: (1) At the end of the study, the changes of body weight, BMI, waist circumference, hip circumference and neck circumference between the two groups were similar, and there was no statistical difference.(2) There was statistical difference between the intervention group and the control group in terms of HDL-C, LDL-C. Further study with grouping by sex found that after vitamin D intervention male HDL-C increased (from 1.33 to 1.56 + 0.28mmol/L + 0.33mmol/L,p<0.05), LDL-C decreased (down from 3.31 + 0.76mmol/L to 2.86 + 0.9mmol/L, p<0.05);while female HDL-C increased (from 1.69 + 0.45mmol/L to 1.94 + 0.52mmol/L, p=0.029),but LDL-C decreased (from 2.80 + 0.85mmol/L to 2.24 + 0.68mmol/L, p=0.035); TC decreased (down from 4.92 + 0.94mmol/L to 4.43 + 0.88mmol/L, p=0.04). (3) After vitamin D intervention, fasting blood glucose decreased (from 5.46 + 1.96mmol/L to 5.28+ 0.84 mmol/L, p=0.03), and the control group changed little. (4) The strength of upper and lower limbs was improved after vitamin D supplementation, but the grip strength does not change obviously. (5) Vitamin D supplementation lowered the heart rate of men.4.Possible mechanism of vitamin D improving metabolic related indexes. In order to investigate the possible mechanisms of vitamin D affecting glucose metabolism, lipid metabolism, and muscle strength, we carried out the detection of related hormones and mediators. (1) At the end of the study, the levels of gonadal hormones in the two groups showed that vitamin D supplementation could increase the level of testosterone in men(control group vs intervention group, 4.50±1.59nmol/L vs 4.92±2.98nmol/L, p=0.034) (2)The relevant indexes of bone metabolism: vitamin D supplementation increased the male bone calcium (control group vs intervention group, 16.122±5.07ng/ml vs 19 ± 7.13ng/ml,p=0.031) and beta -CTX level (control group vs intervention group,0.3 ± 0.1 ng/ml vs0.4 ±0.2ng/ml, p=0.034); reduce the parathyroid hormone level (control group the vs intervention group, 40.52±15.73 pmol/L 31.79±vs 9.41 pmol/L,p=0.005). (3) Vitamin D intervention group increased male adiponectin levels (from 4.1 ±2.4pg/mL to 5.5±2.4pg/mL,p=0.021) and women adiponectin level (from 6±2.7pg/mL to 8.3±3.1pg/mL, p=0.021),reduced DKK-1 levels in men (from 307.1±88.6pg/mL to 264.9 ±+ 77.8pg/mL, p=0.037),improve the male preptin level (from 27.3±21.0pg/mL to 37.5±24.1pg/mL, p=0.047) and female preptin levels (from 29.3±18.7pg/mL to 45.6±34.8pg/mL, p=0.047), while the control group had no significant change in the index.Conclusion1 .Stratification supplementation of vitamin D (vitamin D insufficiency (20ng/ml<25(OH) D<30ng/ml) treated with oral vitamin D3 preparation 5000IU/w; vitamin D deficiency (12ng/ml<25 (OH) D<20ng/ml) treated with oral vitamin D3 preparation of 10000IU/w; vitamin D severse deficiency (25 (OH) D < 12ng/ml) treated with vitamin D3 preparation of 15000IU/w) can effectively improve the content of 25(OH)D, and increase the proportion of vitamin D standards;2.Vitamin D supplementation can lower fasting glucose levels and improv lipid mass spectrometry: increase levels of HDL-C in men and women,decrease levels of LDL-C in men and women, and decrease levels of TC in women.3.Vitamin D supplementation can improve muscle strength in middle-aged and elderly people with vitamin D deficiency.4.Vitamin D supplements have gender differences in hormone regulation, can increase the secretion of testosterone in males and osteocalcin; reduce the production of PTH;increase in adiponectin levels of men and women; reduce the male body DKK-1 level;improve the levels of men and women in preptin. |
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