INTRODUCTION:

Vitamin D has long been considered a hormone primarily useful in the regulation ofphosphocalcic metabolism and bone mineralization. Over the past ten years, the progression of fundamental and clinical knowledge on the multi-tissue influence of this steroid has been staggering^1,2.

Vitamin D increases calcium absorption through the brush borderof the intestinal mucosa on the basolateral side of the celland regulatesskeletal homeostasis^3,4. It is obtained by exposure to the sun, from foodstuffs (mainly fish liver oils, oily fish and eggs), fortified foods (such as milk, yogurt, margarine), and supplements^5,6. It is available as a medicine and a nutrient. It is present in two forms: vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol).

Obesity is currently a public health problem due to its worryingly increasing prevalence over the past ten years^7,8. Changes in diet and reduced physical activity lead to an imbalance in the energy balance^9-11. There are also psychosocial and biological factors, such as alterations in adipose tissue and its interactions with other tissues involved in the regulation of energy homeostasis and the development of co-morbidities^12,13.

Obesity now affects almost the entire planet, including many emerging countries. According to the World Health Organization (WHO), 35% of adults worldwide are obese or overweight. Associated complications, especially diabetes and cardiovascular disease, kill at least 2.8 million people each year^14,15.

In clinical practice, the diagnosis of obesity is based on an easily usable index: the body mass index (BMI), which corresponds to the weight (in kg) divided by the square of the height (in meters). Obesity is then defined by a BMI greater than 30kg/m^{2 16-18}.

Obesity has been long associated with low vitamin D status^19-21. Many epidemiological studies, including National Health and Nutrition Examination Survey (NHANES) and Framingham^22-24, have shown increasing prevalence of hypovitaminosis D with increasing BMI.

The objective was to determine the phosphocalcic profile, the lipid balance and the dosage of vitamin D in an obese and overweight population;

MATERIALS AND METHODS:

Patients:

This is a descriptive cross-sectional study. It took place at the LES Mimosas Kenitra Medical Analysis Laboratory for 12 months. The population concerned includes subjects Men and women aged between 20 and 70 years who have BMI (Weight/height2)> 25.

- Inclusion criteria:

· Obese or overweight patients (BMI> 25), showing no

· associated pathology. Non-inclusion criteria:

· Subjects> 70 years old.

· Patients taking vitamins, calcium and phosphorus.

· Cancer patients.

All patients benefited from:

▪ A questionnaire detailing:

Sociodemographic characteristics: Age, Sex, Civil status Professional activity; Mode of transport.

Physical activity: Sport, Sedentary lifestyle.

Quality of life: Tobacco, Alcohol consumption.

The questionnaire tells us about the duration of sun exposure, the location, and the use of protective sun creams.

Measuring weight and height to calculate your BMI:

▪ The BMI (or Quételet index or BMI) is a simple index of weight for height commonly used for the classification of underweight, overweight and obesity in adults. It is calculated by dividing the weight in kilograms by the square of the height in meters (kg / m2) (WHO. 2003), and classifying the patients into 4 categories:

Weight (kg)

BMI = --------------------

Height²(m²)

Overweight: 25 ≤ BMI <30

Grade 1 obesity (Moderate obesity): 30 ≤ BMI <35 Severe obesity: 35 ≤ BMI <40

Morbid obesity: over 40

▪ Assessment of the phosphocalcic balance by measuring the plasma concentration of calcium, phosphorus, parathyroid hormone and vitamin D, as well as total cholesterol, HDL, LDL.

Regarding the determination of Total Cholesterol, HDL, LDL, Calcium, Phosphorus:

These parameters were assayed in the COBAS e 411 Analyzer automated system (automated system for immunological analyzes). The instrument uses electrochemiluminescence (ECL) technology to provide a wide variety of assays.

Regarding the VITD, PTH dosage:

Using the MINI VIDAS automaton for the VIT D, PTH assay.

Statistical analyzes:

Statistical analyses were carried out with SPSS (version 21.0). The normal distribution of variables was assessed with a Kolmogorov-Smirnov test. If normality was not present, logarithmic transformations were made before further analysis. Serum calcium, cholesterol, phosphorusand 25OHD were tested with both ANOVAand ANCOVA to show the effect of confounding factors. Covariates were also noted in eachanalysis. The post-hoc analyses were performed with Tukey's Honestly Significant Different (HSD) test and Dunnett's test. All data are reported as means±standard deviations; p<0.05 was considered significant.

RESULTS:

1. Epidemiologic characteristics:

During the study, 350 residents of Kenitra, aged 30-70 years, were studied. Their mean age was 41.4 (median 14) years. Calcium and phosphate concentrations were normally distributed. However, levels of 25-OHD and PTH were not normally distributed (figure1).

Figure 1: Prevalence of vitamin D statut in the studied population.

2. Prevalence of vitamin D:

Figure 3 shows the prevalence of vitamin D insufficiency (25-OHD 20-30 ng/mL), deficiency (25-OHD <20 ng/mL) and normal among males and females and according to the BMI. Therefore, the prevalence of vitamin D deficiencyamong males and females was 45% and 52.4% respectively [p=0.04, odds ratio (OR)=0.7, χ2=3.9]. The prevalence of vitamin D deficiency was compared in the age-groups of 20-39, 40-59, and 60-80 years. It was higher among the younger age-group (p=0.001).

Figure 2: Prevalence of vitamin D statut according to gendre (a) and BMI (b).

3. Distribution of biochemical balance disorders according to BMI ranges:

The figure 3 show that 69% of patients with severe obesity present with hypercholesterolemia while 62% of overweight patients have normal cholesterol values.

Figure 3: Prevalence of some parameters according to BMI ranges.

DISCUSSION:

Vitamin D is implicated in several cellular physiologic functions. A few studies have examined the effect of vitamin D supplementation on cardiovascular risk factors in subjects^25-30.

The present study concerned overweight and obese patients, in these patients we proceeded to the evaluation of the phosphocalcic balance by measuring the plasma concentration of calcium, phosphorus, parathyroid hormone and vitamin D, as well as total cholesterol, HDL, LDL.

The sampled population consists of 350 patients representing proportions of 85% women and 15% men. The average age is 46.47.82% of obese patients were female and 18% were male.78% of overweight patients were female and 22% of overweight patients were male.

The predominance of women is an epidemiological constant found in most of the studies carried out^9,31.

Regarding vitamin D, our results clearly show a deficiency invitamin D in obese patients. This is in agreement with various studies carried out^32-34. Normal Concentrations: (25 (OH) D 75-250 nmol/l (30-100ng /ml) were found only in overweight subjects (12%).

The mean Cholesterol value was 2.42 in women, and 1.93 in men.

The mean HDL value was 0.50 in women and 0.51 in men. These results are consistent with those of Guasch, A. 2012 performed on obese patients³⁵. The mean LDL value was 1.59 in women, and 0.55 in men.

Concerning the phosphocalcic balance, our study did not reveal any discernible abnormalitiesin serum calcium andpatient phosphoremia. The mean value of Calcium was 91.76 in women, and 91.57 in men. The mean value of Phosphorus was 1.13mmol/L in women and 1.10 mmol/L in men.

The levels of calcium and phosphorus found were within the standards while other studies have shown hypercalcemia and hyperphosphatemia^36,37.

The PTH assay revealed normal levels in obese and overweight people, on the other hand hyperparathyroidism is noted in patients with morbid obesity of 86% and 61% in patients with severe obesity. Our findings are consistent with several other studies on vitamin D status and parathyroid activity assessment ^38,39.

In the female population 63% of women have a vitamin D deficiency [defined by a 25 (OH) D level of less than 25nmol/l (10ng/ml)], on the other hand 17% of men in the male population have a vitamin D deficiency, which is comparable with other studies^40,41.

Vitamin D deficiency was initially considered to be a causal factor favoring the development of obesity^42,43 and that vitamin D supplementation could be beneficial in weight regulation³¹. In addition, a new study⁴⁴, using genetic variants of obesity and the synthesis andmetabolism of vitamin D in a bidirectional Mendelian analysis, has shown that it is indeed the increase in the mass index. body (BMI) which induces the vitamin drop, and not the other way around. This is because Vitamin D is stored in fatty tissue (a fat-soluble vitamin), and the study authors indicate that the increased storage capacity in obese people may prevent Vitamin D from circulating properly in the blood.The data cited were taken from 21 cohorts already formed and comprising 42,000 patients^45,46.

CONCLUSION:

Regardless of the field considered, it is clear that the serum concentration of vitamin D constitutes a powerful biomarker of the state of health of an individual. Low 25 (OH) D concentrations are associated with many pathologies.

In our analysis, we saw that vitamin D deficiency had a possible relationship with obesity that could be explained by several hypotheses: insufficient sun exposure, lack of exercise, lower vitamin intake, retention of blood vitamin D in adipose tissue ... However, the higher the body weight, the more vitamin D needs increase.

The work of this thesis evaluated the phosphocalcic balance as well as the concentration of vitamin D. The results are very significant for vitamin D, clearly demonstrating a vitamin D deficiency in obese patients.

Vitamin D deficiency is often not recognized clinically, although laboratory measurements are easy to perform, but dosing is still expensive.

CONFLICT OF INTEREST:

I confirm that I have no conflicts of interest regarding this investigation.

ACKNOWLEDGMENTS:

I would like to thank Dr Ouhssine, DrBoudhane and Dr Chakit for their kind support during this study and all other laboratory team.

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Received on 04.11.2022 Modified on 12.12.2022

Research J. Pharm. and Tech 2023; 16(7):3405-3409.

DOI: 10.52711/0974-360X.2023.00563