Effect of Vitamin D Supplementation on Inflammatory Markers in Non-Obese Lebanese Patients with Type 2 Diabetes: A Randomized Controlled Trial
Abstract
:1. Introduction
2. Subjects and Methods
2.1. Participants
2.2. Research Design and Supplementation Protocol
2.3. Laboratory Assessment
2.3.1. Primary Outcomes
2.3.2. Secondary Outcomes
2.4. Anthropometry Assessment
2.5. Statistical Analysis
3. Results
3.1. Anthropometric Characteristics of the Study’s Subjects
3.2. Study Outcomes
3.2.1. Predictors of Inflammatory Marker Changes at Six Months
3.2.2. Post Hoc Analyses
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Abbreviations
References
- Bland, R.; Markovic, D.; Hill, C.E.; Hughes, S. Expression of 25-hydroxyvitamin D3-1 alpha-hydroxylase in pancreatic islets. J. Steroid Biochem. Mol. Biol. 2004, 121, 89–90. [Google Scholar] [CrossRef]
- Khalife, H.; Khalife, H.; Omyri, H.; Khalife, H.; Abdel-Sater, F. Vitamin D deficiency among the healthy population in Lebanon. World J. Pharm. Pharm. Sci. 2017, 6647, 69–80. [Google Scholar]
- El-Rassi, R.; Baliki, G.; Fulheihan, G.E.H. Vitanim D Status in Middle East and Africa; American University of Beirut Medical Center, Department of Internal Medicine and International Osteoporosis Foundation: Beirut, Lebanon, 2009. [Google Scholar]
- International Diabetes Federation: IDF Diabetes Atlas. 2019. Available online: https://www.diabetesatlas.org/upload/resources/2019/IDFAtlas9th_Edition_2019.pdf (accessed on 5 January 2020).
- Sepehri, Z.; Kiani, Z.; Afshari, M.; Kohan, F.; Dalvand, A.; Ghavami, S. Inflammasomes and type 2 diabetes: An updated systemic review. Immunol. Lett. 2017, 24, 97–103. [Google Scholar] [CrossRef]
- International Diabetes Federation. Diabetes Atlas 2015, 7th ed.; International Diabetes Federation: Brussels, Belgium, 2015. [Google Scholar]
- Bou-Orm, I.; Adib, S. Prevalence and clinical characteristics of diabetes mellitus in Lebanon: A national survey. East Mediterr. Health J. 2020, 26, 182–188. [Google Scholar] [CrossRef] [PubMed]
- Zhao, L.M.; Tian, X.Q.; Ge, J.P.; Xu, Y.C. Vitamin D intake and type 2 diabetes risk: A meta-analysis of prospective cohort studies. Afr. Health Sci. 2013, 13, 1130–1138. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Blum, M.; Dolnikowski, G.; Seyoum, E.; Harris, S.S.; Booth, S.L.; Peterson, J.; Dawson-Hughes, B. Vitamin D3 in fat tissue. Endocrine 2008, 33, 90–94. [Google Scholar] [CrossRef] [PubMed]
- Alberti, K.G.M.M.; Eckel, R.H.; Grundy, S.M.; Zimmet, P.Z.; Cleeman, J.I.; Donato, K.A.; Fruchart, J.-C.; James, P.T.; Loria, C.M.; Smith, S.C.; et al. Harmonizing the metabolic syndrome: A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association for the Study of Obesity. Circulation 2009, 120, 1640–1645. [Google Scholar] [CrossRef] [Green Version]
- Garcia, C.; Feve, B.; Ferre, P.; Halimi, S.; Baizri, H.; Bordier, L.; Guiu, G.; Dupuy, O.; Bauduceau, B.; Mayaudon, H. Diabetes and inflammation: Fundamental aspects and clinical implications. Diabetes Metab. 2010, 36, 327–338. [Google Scholar] [CrossRef]
- McGill, T.; Stewart, J.M.; Lithander, F.; Strik, C.M.; Poppitt, S.D. Relationship of low serum vitamin D3 with anthropometry and markers of the metabolic syndrome and diabetes in overweight and obesity. Nutr. J. 2008, 7, 4. [Google Scholar] [CrossRef] [Green Version]
- Velloso, L.A.; Eizirik, D.L.; Cnop, M. Type 2 diabetes mellitus-an autoimmune disease? Nat. Rev. Endocrinol. 2013, 9, 750–755. [Google Scholar] [CrossRef] [PubMed]
- Donath, M.Y.; Shoelson, S.E. Type 2 diabetes as an inflammatory disease. Nat. Rev. Immunol. 2011, 11, 98–107. [Google Scholar] [CrossRef]
- Laird, E.; McNulty, H.; Ward, M.; Hoey, L.; McSorley, E.; Wallace, J.M.W.; Caeson, E.; Molly, A.M.; Healy, M.; Cunningham, C.; et al. Vitamin D deficiency is associated with inflammation in older Irish adults. J. Clin. Endocrinol. Metab. 2014, 99, 1807–1815. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Akash, M.S.; Rehman, K.; Chen, S. Role of inflammatory mechanisms in pathogenesis of type 2 diabetes mellitus. J. Cell. Biochem. 2013, 114, 525–531. [Google Scholar] [CrossRef] [PubMed]
- Dutta, D.; Mondal, S.A.; Choudhuri, S.; Maisnam, I.; Reza, A.H.H.; Bhattacharya, B.; Chowdhury, S.; Mukhopadhyay, S. Vitamin-D supplementation in prediabetes reduced progression to type 2 diabetes and was associated with decreased insulin resistance and systemic inflammation: An open label randomized prospective study from Eastern India. Diabetes Res. Clin. Pract. 2014, 103, e18–e23. [Google Scholar] [CrossRef]
- Wu, C.; Qiu, S.; Zhu, X.; Li, L. Vitamin D supplementation and glycemic control in type 2 diabetes patients: A systematic review and meta-analysis. Metabolism 2017, 73, 67–76. [Google Scholar] [CrossRef]
- Lee, C.J.; Iyer, G.; Liu, Y.; Kalyani, R.R.; Ligon, C.B.; Varma, S.; Mathioudakis, N. The effect of vitamin D supplementation on glucose metabolism in type 2 diabetes mellitus: A systematic review and meta-analysis of intervention studies. J. Diabetes Complicat. 2017, 31, 1115–1126. [Google Scholar] [CrossRef] [PubMed]
- Nimitphong, H.; Chanprasertyothin, S.; Jongjaroenprasert, W.; Ongphiphadhanakul, B. The association between vitamin D status and circulating adiponectin independent of adiposity in subjects with abnormal glucose tolerance. Endocrine 2009, 36, 205–210. [Google Scholar] [CrossRef] [PubMed]
- Alvarez, J.A.; Ashraf, A. Role of vitamin D in insulin secretion and insulin sensitivity for glucose homeostasis. Int. J. Endocrinol. 2010, 2010, 351–385. [Google Scholar] [CrossRef] [Green Version]
- Husemoen, L.L.N.; Skaaby, T.; Thuesen, B.H.; Jørgensen, T.; Fenger, R.V.; Linneberg, A. Serum (25(OH) D) and incident type 2 diabetes: A cohort study. Eur. J. Clin. Nutr. 2012, 66, 1309–1314. [Google Scholar] [CrossRef] [Green Version]
- Forouhi, N.G.; Ye, Z.; Rickard, A.P.; Khaw, K.T.; Luben, R.; Langenberg, C.; Wareham, N.J. Circulating 25-hydroxyvitamin D concentration and the risk of type 2 diabetes: Results from the European Prospective Investigation into Cancer (EPIC)-Norfolk cohort and updates meta-analysis of prospective studies. Diabetologia 2012, 55, 2173–2182. [Google Scholar] [CrossRef]
- Peterson, C.A.; Heffernan, M.E. Serum tumor necrosis factor-alpha concentrations are negatively correlated with serum (25(OH) D) concentrations in healthy women. J. Inflamm. 2008, 24, 10. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- De Vita, F.; Lauretani, F.; Bauer, J.; Bautmans, I.; Shardell, M.; Cherubini, A.; Bondi, G.; Zuliani, G.; Bandineli, S.; Dall’Aglio, E.; et al. Relationship between vitamin D and inflammatory markers in older individuals. Age 2014, 36, 9694. [Google Scholar] [CrossRef] [Green Version]
- Lim, S.; Kim, M.J.; Choi, S.H.; Shin, C.S.; Park, K.S.; Jang, H.C.; Billings, L.K.; Meigs, J.B. Association of vitamin D deficiency with incidence of type 2 diabetes in high-risk Asian subjects. Am. J. Clin. Nutr. 2013, 97, 524–530. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Vieth, R.; Bischoff-Ferrari, H.; Boucher, B.J. The urgent need to recommend an intake of vitamin D that is effective. Am. J. Clin. Nutr. 2007, 85, 649–650. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Bischoff-Ferrari, H.A.; Giovannucci, E.; Willett, W.C.; Dietrich, T.; Dawson-Hughes, B. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am. J. Clin. Nutr. 2006, 84, 18–28. [Google Scholar] [CrossRef] [PubMed]
- Giustina, A.; Adler, R.A.; Binkley, N.; Bollerslev, J.; Bouillon, R.; Dawson-Hughes, B.; Ebeling, P.R.; Feldman, D.; Formenti, A.M.; Marcocci, C. Consensus statement from 2nd International Conference on Controversies in Vitamin D. Rev. Endocr. Metab. Disord. 2020, 21, 89–116. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Pittas, A.G.; Dawson-Hughes, B.; Sheehan, P.R.; Rosen, C.J.; Ware, J.H.; Knowler, W.C.; D2d Research Group. Rationale and Design of the Vitamin D and Type 2 Diabetes (D2d) Study: A Diabetes Prevention Trial. Diabetes Care 2014, 37, 3227–3234. [Google Scholar] [CrossRef] [Green Version]
- Byrn, M.A.; Adams, W.; Penckofer, S.; Emanuele, M.A. Vitamin D Supplementation and Cognition in People with Type 2 Diabetes: A Randomized Control Trial. J. Diabetes Res. 2019, 2019, 5696391. [Google Scholar] [CrossRef]
- Hagvik, J. Glucose Measurement: Time for a Gold Standard. J. Diabetes Sci. Technol. 2007, 1, 169–172. [Google Scholar] [CrossRef] [Green Version]
- Ambade, V.M.; Sharma, Y.V.; Somani, B.L. Methods for estimation of blood glucose a comparative evaluation. Med. J. Armed. Forces India 1998, 54, 131–133. [Google Scholar] [CrossRef] [Green Version]
- Ahmadieh, H.; Itani, H.; Itani, S.; Sidani, K.; Kassem, M.; Farhat, K.; Jbeily, M.; Itani, A. Diabetes and depression in Lebanon and association with glycemic control: A cross-sectional study. Dovepress 2018, 11, 717–728. [Google Scholar] [CrossRef] [Green Version]
- El Hajj, C.; Chardigny, J.M.; Boirie, Y.; Yammine, K.; Helou, M.; Walrand, S. Effect of vitamin D treatment on glucose homeostasis and metabolism in Lebanese older adults: A randomized controlled trial. J. Nutr. Health Aging 2018, 22, 1128–1132. [Google Scholar] [CrossRef] [PubMed]
- Tang, Z.; Fang, Z.; Huang, W.; Liu, Z.; Chen, Y.; Li, Z.; Zhu, T.; Wang, Q.; Simpson, S.; Lin, R.; et al. Non-Obese Diabetes and Its Associated Factors in an Underdeveloped Area of South China, Guangxi. Int. J. Environ. Res. Public Health 2016, 13, 976. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- National Centers for Disease Control and Prevention. National Diabetes Statistics Report. 2014. Available online: http://www.cdc.gov/diabetes/data/statistics/statistics-report.html (accessed on 6 March 2020).
- Hedlund, L.; Brekke, H.K.; Brembeck, P.; Augustin, H. A Short Questionnaire for Assessment of Dietary Vitamin D Intake. Eur. J. Nutr. Food Saf. 2014, 4, 150–156. [Google Scholar] [CrossRef]
- Nikooyeh, B.; Neyestani, T.R.; Tayebinejad, N.; Alavi-Majd, H.; Shariatzadeh, N.; Kalayi, A.; Zahedirad, M.; Heravifard, S.; Salekzamani, S. Daily intake of vitamin D- or calcium vitamin D-fortified Persian yogurt drink (doogh) attenuates diabetes-induced oxidative stress: Evidence for antioxidative properties of vitamin D. J. Hum. Nutr. Diet 2014, 27 (Suppl. 2), 276–283. [Google Scholar] [CrossRef] [PubMed]
- Ghavamzadeh, S.; Mobasseri, M.; Mahdavi, R. The Effect of Vitamin D Supplementation on Adiposity, Blood Glycated Hemoglobin, Serum Leptin and Tumor Necrosis Factor-α in Type 2 Diabetic Patients. Int. J. Prev. Med. 2014, 5, 1091–1098. [Google Scholar]
- Inanir, A.; Ozoran, K.; Tutkak, H.; Mermerci, B. The effects of calcitriol therapy on serum interleukin-1, interleukin-6 and tumour necrosis factor-alpha concentrations in post-menopausal patients with osteoporosis. J. Int. Med. Res. 2004, 32, 570–582. [Google Scholar] [CrossRef]
- Farrokhian, A.; Raygan, F.; Bahmani, F.; Talari, H.R.; Esfandiari, R.; Esmaillzadeh, A.; Asemi, Z. Long-Term Vitamin D Supplementation Affects Metabolic Status in Vitamin D–Deficient Type 2 Diabetic Patients with Coronary Artery Disease. J. Nutr. 2017, 147, 384–389. [Google Scholar] [CrossRef] [Green Version]
- Yu, Y.; Tian, L.; Xiao, Y.; Huang, G.; Zhang, M. Effect of Vitamin D Supplementation on Some Inflammatory Biomarkers in Type 2 Diabetes Mellitus Subjects: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Ann. Nutr. Metab. 2018, 73, 62–73. [Google Scholar] [CrossRef]
- Ngo, D.T.; Sverdlov, A.L.; McNeil, J.J.; Horowitz, J.D. Does vitamin D modulate asymmetric dimethylarginine and C-reactive protein concentrations? Am. J. Med. 2010, 123, 335–341. [Google Scholar] [CrossRef]
- Colin, E.M.; Asmawidjaja, P.S.; van Hamburg, J.P.; Mus, A.M.; van Driel, M.; Hazes, J.M.; van Leeuwen, J.P.; Lubberts, E. 1, 25-Dihydroxyvitamin D3 modulates Th17 polarization and interleukin-22 expression by memory T cells from patients with early rheumatoid arthritis. Arth. Rheum. 2010, 62, 132–142. [Google Scholar] [CrossRef] [PubMed]
- Khoo, A.L.; Chai, L.Y.; Koenen, H.J.; Sweep, F.C.; Joosten, I.; Netea, M.G.; van der Ven, A.J. Regulation of cytokine responses by seasonality of vitamin D status in healthy individuals. Clin. Exp. Immunol. 2011, 164, 72–79. [Google Scholar] [CrossRef] [PubMed]
- Müller, K.; Diamant, M.; Bendtzen, K. Inhibition of production and function of interleukin-6 by 1, 25-dihydroxyvitamin D3. Immunol. Lett. 1991, 28, 115–120. [Google Scholar] [CrossRef]
- Campbell, I.L.; Kay, T.W.; Oxbrow, L.; Harrison, L.C. Essential role for interferon-gamma and interleukin-6 in autoimmune insulin-dependent diabetes in NOD/Wehi mice. J. Clin. Investig. 1991, 87, 739–742. [Google Scholar] [CrossRef] [PubMed]
- Stepanova, A.P.; Karonova, T.L.; Galagoudza, M.; Vasileva, E.Y.; Jude, E.B. The Effect of Vitamin D Supplementation on the Cytokines Levels in Patients with Type 2 Diabetes Mellitus and Diabetic Neuropathy. Diabetes 2019, 68. [Google Scholar] [CrossRef]
- Querfeld, U.; Hoffmann, M.; Klaus, G.; Eifinger, F.; Ackerschott, M.; Michalk, D.; Kern, P.A. Antagonistic effects of vitamin D and parathyroid hormone on lipoprotein lipase in cultured adipocytes. J. Am. Soc. Nephrol. 1999, 10, 2158–2164. [Google Scholar]
- Hewison, M. An update on vitamin D and human immunity. Clin. Endocrinol. 2012, 76, 315–325. [Google Scholar] [CrossRef]
- Chagas, C.E.; Borges, M.C.; Martini, L.A.; Rogero, M.M. Focus on vitamin D, inflammation and type 2 diabetes. Nutrients 2012, 4, 52–67. [Google Scholar] [CrossRef] [Green Version]
- Zittermann, A.; Frisch, S.; Berthold, H.K.; Gotting, C.; Kuhn, J.; Kleesiek, K.; Stehle, P.; Koertke, H.; Koerfer, R. Vitamin D supplementation enhances the beneficial effects of weight loss on cardiovascular disease risk markers. Am. J. Clin. Nutr. 2009, 89, 1321–1327. [Google Scholar] [CrossRef]
- Kubiak, J.; Thorsby, P.M.; Kamycheva, E.; Jorde, R. Vitamin D supplementation does not improve CVD risk factors in vitamin D-insufficient subjects. Endocr. Connect. 2018, 7, 840–849. [Google Scholar] [CrossRef] [Green Version]
- Seibert, E.; Lehmann, U.; Riedel, A.; Ulrich, C.; Hirche, F.; Brandsch, C.; Stangl, G.I. Vitamin D3 supplementation does not modify cardiovascular risk profile of adults with inadequate vitamin D status. Eur. J. Nutr. 2017, 56, 621–634. [Google Scholar] [CrossRef] [PubMed]
Vitamin D Group (n = 45) | Placebo Group (n = 43) | Between Group Difference | |||||||
---|---|---|---|---|---|---|---|---|---|
Variable | Baseline | After Supplementation | Mean Change (95% CI) | * p Value | Before | After Supplementation | Mean Change (95% CI) | * p Value | †p Value |
Sample size | 45 | - | - | - | 43 | - | - | - | - |
Gender (M/F) | 23M/22F | - | - | - | 22M/21F | - | - | - | - |
Age (years) | 66.9 ± 4.1 | - | - | - | 65.7 ± 4.5 | - | - | - | 0.2 |
Diabetes Duration (years) | 8.7 | - | - | - | 8.5 | - | - | - | - |
TNF-α (pg/mL) | 3.05 ± 1.02 | 2.61 ± 1.04 | −0.44 | 0.0001 | 2.97 ± 0.98 | 3.01 ± 0.83 | 0.04 | 0.68 | <0.0001 |
hs-CRP (ng/mL) | 5.25 ± 2.47 | 2.84 ± 2.14 | −2.41 | 0.0001 | 5.3 ± 2.31 | 5.19 ± 2.23 | −0.12 | 0.34 | <0.0001 |
IL-6 (pg/mL) | 3.86 ± 1.7 | 3.15 ± 1.8 | −0.71 | 0.27 | 4.11 ± 1.8 | 4.21 ± 1.6 | −0.1 | 0.31 | 0.94 |
Vitamin D Group (n = 45) | Placebo Group (n = 43) | Between Group Difference | |||||||
---|---|---|---|---|---|---|---|---|---|
Variable | Baseline | After Supplementation | Mean Change (95% CI) | * p Value | Baseline | After Supplementation | Mean Change (95% CI) | * p Value | †p Value |
25(OH)D (ng/mL) | 14.8 ± 4.5 | 34.9 ± 4.7 | 20.1 | <0.0001 | 15.02 ± 4.2 | 14.5 ± 3.9 | −0.52 | 0.96 | <0.0001 |
BMI (kg/m2) | 22.6 ± 1.72 | 21.2 ± 1.1 | −1.4 | <0.0001 | 23.2 ± 5.71 | 24.1 ± 4.89 | 0.9 | 0.08 | <0.0001 |
Waist circumference (cm) | 91.5 ± 5.88 | 88.3 ± 5.63 | −3.2 | 0.0001 | 92.2 ± 5.62 | 93.9 ± 5.14 | 0.4 | 0.21 | 0.0001 |
Body fat (%) | 29.3 ± 6.40 | 27.9 ± 6.50 | −1.4 | 0.0001 | 30.41 ± 5.33 | 30.92 ± 4.36 | 0.51 | 0.13 | 0.05 |
Systolic BP (mmHg) | 141 ± 2.8 | 140 ± 2.2 | 0.9 | 0.58 | 144 ± 2.5 | 143 ± 2.3 | −1 | 0.18 | 0.34 |
Diastolic BP (mmHg) | 84 ± 2.1 | 86 ± 2.2 | 1.7 | 0.31 | 86 ± 1.9 | 85 ± 1.7 | −0.9 | 0.24 | 0.21 |
TG (mg/dL) | 242.8 ± 9.9 | 211.2 ± 8.8 | −31.2 | 0.0001 | 244.2 ± 8.78 | 240.2 ± 8.18 | −3.9 | 0.46 | 0.02 |
TC (mg/dL) | 180.2 ± 0.99 | 179.4 ± 1.2 | −0.6 | 0.21 | 182.62 ± 1.1 | 182.1 ± 1.2 | −0.02 | 0.12 | 0.38 |
HDL-c (mg/dL) | 32.31 ± 1.26 | 35.4 ± 1.12 | 3.02 | 0.0001 | 31.81 ± 1.15 | 31.42 ± 1.08 | −0.49 | 0.11 | 0.022 |
LDL-c (mg/dL) | 145.5 ± 4.27 | 140.9 ± 1.2 | −4.4 | 0.041 | 146.3 ± 5.01 | 145.9 ± 5.2 | −0.8 | 0.32 | 0.18 |
FBG (mg/dL) | 184.6 ± 0.8 | 184.5 ± 0.9 | −0.1 | 0.11 | 185.14 ± 0.8 | 185.09 ± 0.7 | 0.05 | 0.95 | 0.84 |
HbA1c (%) | 6.59 ± 0.64 | 6.53 ± 0.63 | −0.06 | 0.38 | 6.82 ± 1.27 | 6.64 ± 1.31 | −0.18 | 0.31 | 0.31 |
HOMA-IR | 2.85 ± 2.55 | 2.51 ± 2.46 | −0.34 | 0.27 | 2.66 ± 1.91 | 2.41 ± 1.92 | −0.25 | 0.96 | 0.26 |
PTH (ng/L) | 37.5 ± 3.8 | 30.7 ± 3.7 | −6.7 | <0.0001 | 36.25 ± 8.04 | 36.1 ± 7.56 | −0.15 | 0.17 | <0.0001 |
Mean Change | Vitamin D Deficient (n = 16) Insufficient (n = 29) | Placebo Deficient (n = 15) Insufficient (n = 28) | p-Value | |
---|---|---|---|---|
TNF-α | Deficient | −0.48 ± 1.01 | 0.03 ± 0.78 | <0.001 |
Insufficient | −0.38 ±1.02 | 0.05 ± 0.8 | <0.001 | |
hs-CRP | Deficient | −2.83 ± 2.16 | −0.12 ± 2.21 | <0.001 |
Insufficient | −2.13 ± 2.51 | −0.11 ± 2.30 | <0.001 | |
IL-6 | Deficient | −0.73 ± 1.8 | −0.18 ± 1.6 | 0.92 |
Insufficient | −0.66 ± 1.7 | −0.09 ± 1.7 | 0.96 | |
25(OH)D | Deficient | 20.8 ± 3.6 | −0.01 ± 3.6 | <0.001 |
Insufficient | 17.6 ± 3.2 | −0.03 ± 3.8 | <0.001 |
© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
El Hajj, C.; Walrand, S.; Helou, M.; Yammine, K. Effect of Vitamin D Supplementation on Inflammatory Markers in Non-Obese Lebanese Patients with Type 2 Diabetes: A Randomized Controlled Trial. Nutrients 2020, 12, 2033. https://doi.org/10.3390/nu12072033
El Hajj C, Walrand S, Helou M, Yammine K. Effect of Vitamin D Supplementation on Inflammatory Markers in Non-Obese Lebanese Patients with Type 2 Diabetes: A Randomized Controlled Trial. Nutrients. 2020; 12(7):2033. https://doi.org/10.3390/nu12072033
Chicago/Turabian StyleEl Hajj, Cynthia, Stéphane Walrand, Mariana Helou, and Kaissar Yammine. 2020. "Effect of Vitamin D Supplementation on Inflammatory Markers in Non-Obese Lebanese Patients with Type 2 Diabetes: A Randomized Controlled Trial" Nutrients 12, no. 7: 2033. https://doi.org/10.3390/nu12072033