Obez ve aşırı kilolu hastalarda vitamin d seviyesinin vücut kitle indeksi, beslenme, fiziksel aktivite ve güneşlenme ile ilişkisinin retrospektif olarak incelenmesi
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Dosyalar
Tarih
2014
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Vitamin D eksikliğinin kemik sağlığı üzerine etkisine ilaveten birçok iskelet dışı immün sistem bozukları, kardiyovasküler hastalıklar, diyabetes mellitus, bazı kanserlerin oluşumunu hızlandırdığı bilinmektedir. Son araştırmalarda ise obez kişilerde vitamin D seviyesinin obez olmayan bireylere göre anlamlı olarak düşük olduğu bildirilmiştir. Bu düşüklük obez hastalarda vitamin D'nin adipoz doku içinde hapsolması ve insülin direnci ile ilişkilendirilmektedir. Çalışmamızda ağustos 2013-temmuz 2014 tarihleri arasında aile hekimliği ve check-up polikliniğine ilk kez başvuran toplam 2150 hasta kayıtları retrospektif olarak taranmıştır. Araştırma kriterlerine uygun olarak vitamin D istenilen 682 hasta aşırı kilolu, obez, morbid obez olarak 3 gruba ayrılmıştır. serum vitamin D seviyesi'nin gruplar arasında, antropometrik ölçümler, metabolik parametreler, kan basıncı, fiziksel aktivite, beslenme ve güneşlenme ile ilişkisinin araştırılması amaçlanmıştır. Çalışmamızın sonuçlarına göre olguların yaş ortalaması 39,55±12,1 olup; vücut kitle indeksi 35,6±6 olarak bulunmuştur. Serum vitamin D seviyesi tüm olgularda ortalama 9,1±5,62 ng /mL olarak saptanmıştır. Olguların sadece %1,1'inde vitamin D seviyesi yeterli düzeyde olduğu bununla birlikte %68,5'inde ciddi vitamin D eksikliği saptanmıştır. Vücut vitamin D seviyesi ve depolarını etkileyen güneşlenme, besinsel faktörlerin (yumurta, balık, kırmızı et ve mantar) tüketimi ile fiziksel aktivite durumları analiz edilmiştir. Olguların %58 inde yeterli güneşlenme mevcut iken geriye %42'sinde yeterli güneşlenme olmadığı; sadece %5,9'unda haftalık olarak yeterli balık tüketildiği; %65,5' sinde yeterli miktarda yumurta tüketildiği ve sadece %18,9'inde yeterli kırmızı et tüketimi saptanmıştır. Olguların %82,7'sinde karaciğer tüketimi olmadığı ve yalnız %3,3'ünde yeterli mantar tüketimi izlenmiştir. Olguların %26,9'unda regüler egzersiz saptanmıştır. Beslenme, güneşlenme, fiziksel aktivite arasında anlamlı farklılık bulunamamıştır. Olgularda VKI ve insülin direnci ile vitamin D arasında negatif anlamlı korelasyon gözlenmiştir (p<0,001).Obez olmayan grup 1 olgularında en yüksek vitamin D seviyesi sonbahar mevsiminde (12,2±8,3 ng/mL) iken en düşük vitamin D seviyesi ilkbahar döneminde (9,2±5,7 ng/mL) izlenmiştir. Grup 2 (VKI=30-40)'deki olgularda en yüksek vitamin D seviyesi yaz döneminde (10,9±7,2 ng/mL) olup en düşük seviyesi ilkbahar mevsiminde (8,4±5,6 ng/mL) izlenmiştir. Grup 3 (VKI>40)'teki en yüksek vitamin D seviyesi yaz döneminde (9,2±5,6 ng/mL) iken en düşük seviyeler ilkbahar mevsiminde (6,9±3,2 ng/mL ) gözlemlenmiştir. Çalışmamızda da üzerinde durduğumuz nedenlerle D vitamininden zengin gıdalarla yeterli düzeyde beslenilemediği ve güneş ışınlarından yeterince faydalanılamadığı bilinmektedir. Bu durumda D vitamininden zenginleştirilmiş yiyecekler veya D vitamini destek tedavisinin önemi ortaya çıkmaktadır.
In addition to the effect on bone health, vitamin D deficiency is well-known to accelerate many extraskeletal immune disorders, cardiovascular diseases, diabetes mellitus and the formation of certain cancers. In recent studies in obese people vitamin D levels have reported significantly lower than those of non-obese individuals. This impairment is associated with being trapped of vitamin D in the adipose tissue in obese patients and insulin resistance. In our study, a total of 2150 patient records whose admitted for the first time to family medicine and check-up clinic between August 2013- July 2014 were browsed retrospectively. According to research criteria, vitamin D requested 682 patients were divided into 3 groups as overweight, obese and morbidly obese. The relationship between anthropometric measurements, metabolic parameters, blood pressure, physical activity, nutrition and sunbathing and serum vitamin D level is aimed to investigate among groups. Acording to the results of our study, the mean age of the patients 39.55±12.1 years-old and body mass index was found to be 35.6±6 kg/m2. Serum vitamin D level is determined as an avarage of 9.1±5.62 ng/mL in all cases. Only 1.1% of cases level of vitamin D was found adequate, however 68.5% with severe vitamin D deficiency. Vitamin D levels and sun, consumption of dietary factors( egg, fish, meat and mushroom), physical activity status-that all affects vitamin D storage- were analyzed. In 58% of cases have enough sunbath while the rest 42% do not have enough sunbath. In only 5.9% weekly fish consumption is enough. 65.5% consume egg in sufficient quantities and only 18.9% red meat consumption is found enough. In 82.7% of cases there were no liver consumption and in only 3.3% adequate mushroom consumption was seen. Regular exercise was found in 26.9% of cases. There was no significant difference between nutrition, sunbathing and physical activity. In cases negative correlation was observed between vitamin D with BMI and insulin resistance (p<0.001). In nonobese group 1 patients, the highest vitamin D level was observed in autumn (12.2±8.3 ng/mL) while lowest vitamin D level was in spring semester(9.2±5.7 ng/mL). Cases in group 2 (BMI=30-40) were observed with highest vitamin D level in summer(10.9±7.2 ng/mL) and the lowest level in spring(8.4±5.6ng/mL).With the reasons we stand on in our study inadequate feeding with vitamin D-rich food and being benefitted unsufficiently from sun is known. In this situation importance of vitamin D enriched food or vitamin D supplementation is emerged.
In addition to the effect on bone health, vitamin D deficiency is well-known to accelerate many extraskeletal immune disorders, cardiovascular diseases, diabetes mellitus and the formation of certain cancers. In recent studies in obese people vitamin D levels have reported significantly lower than those of non-obese individuals. This impairment is associated with being trapped of vitamin D in the adipose tissue in obese patients and insulin resistance. In our study, a total of 2150 patient records whose admitted for the first time to family medicine and check-up clinic between August 2013- July 2014 were browsed retrospectively. According to research criteria, vitamin D requested 682 patients were divided into 3 groups as overweight, obese and morbidly obese. The relationship between anthropometric measurements, metabolic parameters, blood pressure, physical activity, nutrition and sunbathing and serum vitamin D level is aimed to investigate among groups. Acording to the results of our study, the mean age of the patients 39.55±12.1 years-old and body mass index was found to be 35.6±6 kg/m2. Serum vitamin D level is determined as an avarage of 9.1±5.62 ng/mL in all cases. Only 1.1% of cases level of vitamin D was found adequate, however 68.5% with severe vitamin D deficiency. Vitamin D levels and sun, consumption of dietary factors( egg, fish, meat and mushroom), physical activity status-that all affects vitamin D storage- were analyzed. In 58% of cases have enough sunbath while the rest 42% do not have enough sunbath. In only 5.9% weekly fish consumption is enough. 65.5% consume egg in sufficient quantities and only 18.9% red meat consumption is found enough. In 82.7% of cases there were no liver consumption and in only 3.3% adequate mushroom consumption was seen. Regular exercise was found in 26.9% of cases. There was no significant difference between nutrition, sunbathing and physical activity. In cases negative correlation was observed between vitamin D with BMI and insulin resistance (p<0.001). In nonobese group 1 patients, the highest vitamin D level was observed in autumn (12.2±8.3 ng/mL) while lowest vitamin D level was in spring semester(9.2±5.7 ng/mL). Cases in group 2 (BMI=30-40) were observed with highest vitamin D level in summer(10.9±7.2 ng/mL) and the lowest level in spring(8.4±5.6ng/mL).With the reasons we stand on in our study inadequate feeding with vitamin D-rich food and being benefitted unsufficiently from sun is known. In this situation importance of vitamin D enriched food or vitamin D supplementation is emerged.
Açıklama
YÖK Tez No: 501310
Anahtar Kelimeler
Aile Hekimliği, Family Medicine, Halk Sağlığı, Public Health
