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      Serum 25-Hydroxy Vitamin D and Insulin Resistance, Metabolic Syndrome, and Glucose Intolerance Among Arab Americans

      , PHARMD, MS, CDE 1 , , PHARMD 1 , , PHD 2 , , MD, MPH 3

      Diabetes Care

      American Diabetes Association

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          To describe 25-hydroxy vitamin D (25-OH-D) levels and examine associations between 25-OH-D levels and insulin resistance (IR), metabolic syndrome (MS), and glucose intolerance in Arab Americans.


          Serum 25-OH-D levels were measured in a representative, cross-sectional sample of 542 Arab Americans with IR (46%), MS (33%), and glucose intolerance (42%).


          Vitamin D insufficiency (5 to <20 ng/ml) was present in 75% and hypovitaminosis D (20 to <40 ng/ml) in 24% of participants. In men, 25-OH-D levels were lower in those with glucose intolerance than normoglycemia ( P = 0.01). No such difference was found in women. In men, 25-OH-D was negatively correlated with homeostasis model assessment of insulin resistance ( r = −0.19; P = 0.0043), triglycerides ( r = −0.18; P = 0.0069), fasting plasma glucose ( r = −0.15; P = 0.027), and A1C ( r = −0.14; P = 0.038). In women, 25-OH-D was positively correlated with HDL ( r = 0.19; P = 0.0008).


          Vitamin D insufficiency and hypovitaminosis D are extremely common among Arab Americans, and they are associated with IR, components of the MS, and glucose intolerance in men.

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          Most cited references 8

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          The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis.

          Altered vitamin D and calcium homeostasis may play a role in the development of type 2 diabetes mellitus (type 2 DM). EVIDENCE ACQUISITION AND ANALYSES: MEDLINE review was conducted through January 2007 for observational studies and clinical trials in adults with outcomes related to glucose homeostasis. When data were available to combine, meta-analyses were performed, and summary odds ratios (OR) are presented. Observational studies show a relatively consistent association between low vitamin D status, calcium or dairy intake, and prevalent type 2 DM or metabolic syndrome [OR (95% confidence interval): type 2 DM prevalence, 0.36 (0.16-0.80) among nonblacks for highest vs. lowest 25-hydroxyvitamin D; metabolic syndrome prevalence, 0.71 (0.57-0.89) for highest vs. lowest dairy intake]. There are also inverse associations with incident type 2 DM or metabolic syndrome [OR (95% confidence interval): type 2 DM incidence, 0.82 (0.72-0.93) for highest vs. lowest combined vitamin D and calcium intake; 0.86 (0.79-0.93) for highest vs. lowest dairy intake]. Evidence from trials with vitamin D and/or calcium supplementation suggests that combined vitamin D and calcium supplementation may have a role in the prevention of type 2 DM only in populations at high risk (i.e. glucose intolerance). The available evidence is limited because most observational studies are cross-sectional and did not adjust for important confounders, whereas intervention studies were short in duration, included few subjects, used a variety of formulations of vitamin D and calcium, or did post hoc analyses. Vitamin D and calcium insufficiency may negatively influence glycemia, whereas combined supplementation with both nutrients may be beneficial in optimizing glucose metabolism.
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            Concentrations of serum vitamin D and the metabolic syndrome among U.S. adults.

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              Lack of acculturation is a risk factor for diabetes in arab immigrants in the US.

              To examine the relationship between dysglycemia (impaired fasting glucose, impaired glucose tolerance, and diabetes) and acculturation, physical activity, and perceived stress in Arab immigrants in the U.S. In a cross-sectional population-based study, we examined 520 Arab Americans, aged 20-75 years, who were born in the Middle East and immigrated to southeastern Michigan. Dysglycemia was assessed by history and with a 2-h 75-g oral glucose tolerance test. Acculturation, physical activity, and perceived stress were measured with standardized questionnaires. Associations were found between dysglycemia in men and older age at immigration, unemployment, speaking Arabic with friends, being less active in Arabic organizations, more frequent consumption of Arabic food, and less integration into American society. Dysglycemia in women was associated with being raised in rural areas of the Middle East, older age at immigration, longer length of stay in the U.S., not being employed outside the home, less than high school education, not attending Arabic or American schools, and not being able to read Arabic. Among men, older age at immigration, shorter length of stay in the U.S., less activity in Arab organizations, and eating Arabic food were associated with dysglycemia independent of age and BMI. Among women, acculturation was very low and was confounded with age and BMI as powerful risk factors for dysglycemia. No association was found between physical activity, perceived stress, and the risk of dysglycemia in either sex. Lack of acculturation is an important risk factor for dysglycemia in immigrant Arab Americans. Intervention programs aimed at diabetes prevention should consider the acculturation process.

                Author and article information

                Diabetes Care
                Diabetes Care
                Diabetes Care
                American Diabetes Association
                June 2010
                3 March 2010
                : 33
                : 6
                : 1373-1375
                1Department of Pharmacy Practice, Wayne State University, Detroit, Michigan;
                2Department of Biostatistics, University of Michigan, Ann Arbor, Michigan;
                3Departments of Internal Medicine and Epidemiology, A. Alfred Taubman Health Care Center, University of Michigan, Ann Arbor, Michigan.
                Author notes
                Corresponding author: William H. Herman, wherman@ 123456umich.edu .
                © 2010 by the American Diabetes Association.

                Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

                Funded by: National Institutes of Health
                Award ID: UL1RR024986
                Original Research
                Cardiovascular and Metabolic Risk

                Endocrinology & Diabetes


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