Impact of activated vitamin D on insulin resistance in nondiabetic chronic kidney disease patients.
Impact of activated vitamin D on insulin resistance in nondiabetic chronic kidney disease patients.
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DOI：
10.1111/j.1365-2265.2011.04229.x
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发表时间：
2012-07
影响因子：
3.2
通讯作者：
Danziger J
中科院分区：
文献类型：
--
作者：
Friedman DJ;Bhatt N;Hayman NS;Nichols BJ;Herman M;Nikolaev N;Danziger J
虽然维生素D缺乏与胰岛素抵抗增加有关，但因果关系尚未建立。维生素D缺乏和肥胖之间的密切关系混淆了对这种关系的解释。目前评估慢性肾病（CKD）患者内源性25-羟基维生素D（25（OH）D）浓度的临床方法，以及独立给予活化维生素D（AD），为阐明维生素D、肥胖和胰岛素抵抗之间的因果关系提供了独特的机会。我们评估了120例非糖尿病CKD患者的25（OH）D和体重指数（BMI）与空腹胰岛素浓度的关系。此外，我们还描述了AD治疗如何改变这些关系。在整个队列中，空腹胰岛素浓度与25（OH）D（r=-0.22，P=0.02）和BMI（r=-0.36，P<.0001）呈负相关。AD的管理改变了这些关系。在接受AD治疗的个体中，25（OH）D与空腹胰岛素之间没有关联，平均空腹胰岛素浓度显著低于未接受AD治疗的个体（40.5 ± 22.0 vs 54.1 ± 30.9 pmol/L，P=0.01）。在多变量分析中，AD治疗和BMI是空腹胰岛素的独立预测因子。此外，接受AD治疗的肥胖患者的胰岛素浓度与非肥胖患者相似（46.1 ± 24.9 vs 40.2 ± 21.5 pmol/L），而未经治疗的肥胖患者的空腹胰岛素浓度明显较高（74.4 ± 33.4 pmol/L，P=0.003）。25（OH）D缺乏与CKD患者的胰岛素抵抗相关。用药理学剂量的AD替代与较低的空腹胰岛素浓度相关，特别是在肥胖患者中。
Although vitamin D deficiency has been associated with increased insulin resistance, a causal link has not been established. Interpreting the relationship has been confounded by a close correlation between vitamin D deficiency and obesity. The current clinical approach of assessing endogenous 25-hydroxyvitamin D (25(OH)D) concentrations in patients with Chronic Kidney Disease(CKD), and independently administering activated vitamin D(AD), allows a unique opportunity to clarify cause and effect in the relationship of vitamin D, obesity, and insulin resistance. We assessed how 25(OH)D and body mass index(BMI) related to fasting insulin concentrations in 120 nondiabetic CKD patients. In addition, we described how treatment with AD modified these relationships. In the full cohort, fasting insulin concentrations varied inversely with both 25(OH)D (r=−0.22, P=0.02) and BMI (r=−0.36, P<.0001). The administration of AD altered these relationships. In individuals treated with AD, there was no association between 25(OH)D and fasting insulin, and the mean fasting insulin concentrations were significantly lower than in those not receiving AD (40.5 ± 22.0 vs 54.1 ± 30.9 pmol/L, P=0.01). In a multivariate analysis, both AD treatment and BMI were independent predictors of fasting insulin. Furthermore, obese patients treated with AD had insulin concentrations similar to nonobese patients (46.1 ± 24.9 vs 40.2 ± 21.5 pmol/L), whereas untreated obese patients had markedly higher fasting insulin concentrations (74.4 ± 33.4 pmol/L, P=0.003). 25(OH)D deficiency is associated with insulin resistance in CKD. Replacement with pharmacologic doses of AD is associated with lower fasting insulin concentrations, especially in obese patients.
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影响因子：
7.7
作者：
Forouhi NG;Luan J;Cooper A;Boucher BJ;Wareham NJ
通讯作者：
Wareham NJ
DOI：
10.1111/j.1365-2362.2008.01977.x
发表时间：
2008-08-01
影响因子：
5.5
作者：
Talmor, Y.;Bernheim, J.;Rashid, G.
通讯作者：
Rashid, G.
影响因子：
16.2
作者：
Ford, ES;Ajani, UA;Liu, S
通讯作者：
Liu, S
影响因子：
19.6
作者：
Wolf, M.;Shah, A.;Thadhani, R.
通讯作者：
Thadhani, R.
低血清维生素D3与超重和肥胖症中代谢综合征和糖尿病的标志物的关系。
影响因子：
5.4
作者：
McGill, Anne-Thea;Stewart, Joanna M.;Lithander, Fiona E.;Strik, Caroline M.;Poppitt, Sally D.
通讯作者：
Poppitt, Sally D.