INTRODUCTION:

Fat-soluble nutrient Vitamin D plays a crucial role in the body's capability to absorb and retain calcium and phosphorus, vital for bone health. Insufficient levels of vitamin D can result from limited sunlight exposure, dietary deficiencies, or conditions like nephrotic syndrome. Skin exposure to sunlight produces Vitamin D, our diet provides additional intake. In the liver, vitamin D undergoes hydroxylation to form 25-hydroxyvitamin D (25(OH)D), the main circulating form in the blood flow. 25(OH)D is further transported to kedneys and hydroxylated to create 1,25-dihydroxyvitamin D (1,25(OH)2D), a biologically active form^1-3

Vitamin D shows its physiological effects via its binding to receptors found in all cells. Within issues, the vitamin D receptor becomes concentrated in cell nuclei, where it controls the transcription of around 3% of the entire human genome.⁴

Apart from its skeletal effect, vitamin D has proved its importance in periodontal disease, autoimmune, dry eye disease, pain management, acute traumatic brain injury and toxoplasmosis.^5-11 The prevalence of Type 2 diabetes mellitus in the Indian population has also been connected to Vitamin D deficiency.¹² Previous research has indicated that between 30% to 50% of adults are deficient in vitamin D. Among children, 32% of the general children and 74% obese children have been reported to have inadequate levels of vitamin D.^{13 -15}.

Insufficient levels of vitamin D may lead to dyslipidemia and different lipid irregularities. Specifically, an increase in triglycerides (TG), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL), coupled with a decrease in high-density lipoprotein cholesterol (HDL), have been pinpointed as significant risk factors for cardiovascular illness and atherosclerosis in adults.^16-20 While observation based studies have connected vitamin D deficiency to cardiovascular problems and dyslipidemia, the effectiveness of vitamin D supplementation to manage cardiovascular illness is still a topic of debate.^21-23

Various research groups have reported that persons with sufficient serum vitamin D tend to have a more appropriate lipid profile contrast to those who are having vitamin D deficiency. A longitudinal study spanning nearly fifteen years shown an converse relationship of serum triglyceride levels and serum 25(OH)D levels. Additionally, many studies have indicated that people deficient in vitamin D often exhibit higher values of HDL cholesterol, although these findings have shown some variability.²⁵

it is crucial to understand connection between potential protective role of serum 25(OH)D in sustaining a normal lipid level and the effects of vitamin D deficiency on lipid profile,. Therefore, the aim of study is to explore the association of serum vitamin D levels with lipid profiles in healthy individuals from North Gujarat, India.

MATERIAL AND METHODS:

We conducted a retrospective study involving adult population going through routine health check-up from North Gujarat, India. The study conducted between January 2021 to March 2022 involving the review of the records of healthy both male and female adults aging over 20 years,.

The final analysis included laboratory reports of 1109 subjects who had undergone a comprehensive medical health check-up including testosterone, lipid profile, serum 25(OH)D HbA₁C, Iron, Haemoglobin levels, thyroid profile and PSA (Prostate Specific Antigen).

Blood samples for 25(OH)D and lipid profile were collected following an overnight fast, according to the laboratory results. Competitive chemiluminescent immunoassay was used to quantify 25(OH)D levels. Serum 25(OH)D concentration below 20ng ml⁻¹ were previously characterized as deficiency, but according to current clinical standards, levels from 20 to 30 ng ml⁻¹ are measured as vitamin D insufficiency.^[26] "Deficiency" was defined in our study as a blood 25(OH)D level below 30ng ml⁻¹.

A photometry assay was used to evaluate the serum lipid parameters, which includes triglycerides, total cholesterol, HDL, LDL, and VLDL. A simple subtraction of HDL cholesterol from the overall cholesterol yielded non-HDL cholesterol. Reference ranges were considered as per NCEP ATP III guidelines²⁷ (Table 1).The lipid profile was considered abnormal if any one or more than one parameters (triglycerides, total cholesterol, HDL, LDL and VLDL found abnormal. Any lipid parameter having value more than normal range is considered as abnormal except for HDL where observed value less than the normal lower limit is considered as abnormal.

Table 1: Reference ranges for lipid parameters

Cholesterol	Normal value (mg/dL)
Total Cholesterol	< 200
HDL (high-density lipoprotein)	40-60
LDL (low-density lipoprotein)	< 100
VLDL (Very low-density lipoprotein)	5 – 40
Triglycerides	< 150
Non-HDL (Non high-density lipoprotein)	<160

The Sarvajanik Institutional Ethics Committee approved the study protocol (DCGI reg. No.: ECR/295/Indt/ GJ/2018). Microsoft Excel, which includes both continuous and categorical variables, was used for data collection. Characterization the continuous variables were performed by employing mean and standard deviation. Categorical variables frequency and percentage are shown in pie charts and bar graphs, while percentages are shown in other visual representations. A statistical association between serum vitamin D and lipid parameters was determined using a Chi square test, with a critical value adjusted at P < 0.05. SPSS version 20 was utilized to carry out statistical analysis.²⁸

RESULTS AND DISCUSSION:

Major circulating form of vitamin D is 25(OH)D has longer half-life. It is considered as the most sensitive indication of blood vitamin D status and the greatest marker of complete vitamin D picture. The subjects aged >20 years, including 584 male and 525 female were included in this study. Their mean age and mean serum 25(OH)D concentration were found to be 46.97±13.39 years and 22.48±10.80ng ml⁻¹ respectively (Table 2).

Table 2: Mean age and mean 25(OH)D concentration among included population (N=1109)

Variables	Frequency
Lowest age (Year)	21
Highest age (Year)	94
Mean age ± Std. Deviation	46.97 ± 13.39
Minimum 25(OH)D (ng/ml)	6
Maximum 25(OH)D (ng/ml)	97
Mean 25(OH)D ± Std. Deviation	22.48 ± 10.80

Multiple international investigations have reported widespread vitamin D insufficiency. Almost 37% of the world's population had serum 25(OH)D values less than 20ng/ml.^29–31 The report from north India and China also have shown severe vitamin D deficiency.³²Table 3 shows that there has been a global report of a significant vitamin D deficit. Vitamin D insufficiency followed a nearly identical pattern in the male and female subjects (Table 4).

Table 3: Age wise distribution of vitamin D deficiency

Age group	25(OH)D status
Age group	Deficient (<30 ng/ml)	Sufficient (30-100 ng/ml)	Total
21 to 40	333	49	382
41 to 60	431	91	522
>60	177	28	205
Total	941	168	1109

Table 4: Gender wise distribution of vitamin D deficiency

25(OH)D status	Gender		Total
25(OH)D status	F	M	Total
Deficient (<30 ng/ml)	440	501	941
Sufficient (30-100 ng/ml)	85	83	168
Total	525	584	1109

Table 5: Associations of 25(OH)D with different lipid parameters (N=1109)

Parameter	Lipid Profile	25 (OH) D Deficient	25 (OH) D Sufficient	Total	p value
Total Cholesterol	Normal	712	121	833	.315
Total Cholesterol	Abnormal	229	47	276	.315
HDL Cholesterol	Normal	791	135	926	.234
HDL Cholesterol	Abnormal	150	33	183	.234
LDL Cholesterol	Normal	496	74	570	.039
LDL Cholesterol	Abnormal	445	94	539	.039
VLDL Cholesterol	Normal	863	143	1006	.007
VLDL Cholesterol	Abnormal	78	25	103	.007
Non-HDL Cholesterol	Normal	772	131	903	.212
Non-HDL Cholesterol	Abnormal	169	37	206	.212
Triglycerides	Normal	749	135	884	.821
Triglycerides	Abnormal	192	33	225	.821
Overall lipid profile	Normal	427	59	486	.014
Overall lipid profile	Abnormal	514	109	623	.014

In present study we evaluated data of complete lipid profile of 1109 Indian subjects. We considered lipid profile as abnormal if any one of the constituent parameters (Total Cholesterol, HDL, LDL, VLDL, Non-HDL Cholesterol and Triglycerides) recorded abnormal (Table 5).

Here we report very high prevalence of abnormal lipid profile. Total 56% subject were found with at least one abnormal lipid parameter. The highest level of abnormality was observed with LDL type cholesterol (Table -5).

In our findings Vitamin D deficient individuals have found to have considerably higher levels of bad cholesterol (LDL) and VLDL as compared to patients with normal vitamin D. Increased total cholesterol, LDL cholesterol, VLDL cholesterol, triglyceride levels, and low HDL-C have been found to be significantly associated in an Indian study of a similar kind.²⁴A higher level of vitamin D has not been associated with elevated total cholesterol or triglyceride levels.

Researchers in India discovered that persons in the information technology (IT) industry who lacked vitamin D had much elevated values of bad cholesterol (LDL) and much lower levels of total cholesterol (TC), very low- VLDL and (HDL).³³

A study from Gujarat, India revealed that on 12 months of supplementation, TG and VLDL levels are significantly lowered in the vitamin D supplemented group compared to the non-supplemented group.³⁴Serum 25(OH) D and HDL were positively correlated, whereas serum vitamin D3 was shown to correlate negatively with serum cholesterol, triglyceride, LDL, and VLDL, according to a study from North Bengal.³⁵International research confirmed the favorable correlation between serum vitamin D levels and HDL and the negative correlation with total cholesterol, triglycerides, and LDL.^36,
37

So far, we haven't discovered any link of 25 (OH)D with triglyceridesand HDL cholesterol. Nagative correlation between 25(OH)D levels and TG or HDL in healthy individuals has been found in a small number of investigations, which is consistent with our findings.^38–39The inability to ascertain the participants' levels of physical activity, exposure to sunlight, eating habits, nutritional intake, and overall lifestyle behaviours is a potential drawback of our study.

CONCLUSION:

Serum vitamin D levels have a significant impact on people's lipid profiles generally. A 25 (OH)D shortage mostly impacts LDL cholesterol. The primary drawback of our study is that we couldn't find out how active the participants were, how much sun they got, what they ate, how much nutrition they consumed, or their overall lifestyle habits. For establishing correlation between lipid level and vitamin D status, large-scale, longitudinal research involving multiple centres should be conducted. To further understand the heterogenicity shown in the published studies, additional research is necessary.

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Received on 21.02.2023 Modified on 05.12.2023

Research J. Pharm. and Tech 2024; 17(9):4253-4256.

DOI: 10.52711/0974-360X.2024.00657