Correlation between Levels of Vitamins D3 and E in Type 2 Diabetes Mellitus: A Case-Control Study in Serdang, Selangor, Malaysia
Abstract
:1. Introduction
2. Materials and Methods
2.1. Materials
2.2. Study Design and Subject Recruitment
2.3. Sample Size Calculation
2.4. Socio-Demographic Parameters
2.5. Anthropometric Assessment
2.6. Direct Enzymatic HbA1c Assay
2.7. C-Peptide Enzyme-Linked Immunosorbent Assay Kit
2.8. Vitamin D3 Analysis Using High-Performance Liquid Chromatography (HPLC)
2.8.1. Extraction of Vitamin D3 from Blood Plasma
2.8.2. Analysis of the Level of Plasma Vitamin D3
2.9. Analysis of Plasma Total Vitamin E and Its Isomers
2.10. Statistical Analysis
3. Results
3.1. Descriptive Characteristics
3.2. The Association of Levels of Plasma Vitamin D3, Calcium and Vitamin E in Connection with Glycaemic Status and Lipid Profiles
- i.
- Smoking status (current smoker and ex-smoker)
- ii.
- Physical activity (good)
- iii.
- Educational level (secondary and tertiary)
- iv.
- Marital status (single)
- v.
- Family history (of diabetes)
- vi.
- HDL (male and female)
- vii.
- LDL (>2.6 mmol/L)
- viii.
- TC (>5.2 mmol/L)
- ix.
- FBG (>6.61 mmol/L)
- x.
- HbA1c (>6.5%)
- xi.
- C-peptide (>3.31 ng/mL)
- xii.
- Calcium (<8.6 mg/dL and no deficiency of calcium)
- i.
- Smoking status (current smoker and ex-smoker)
- ii.
- Physical activity (good)
- iii.
- Educational level (lower secondary, secondary and tertiary)
- iv.
- Marital status (single)
- v.
- Family history (of diabetes)
- vi.
- HDL (male and female)
- vii.
- LDL (>2.6 mmol/L)
- viii.
- TC (>5.2 mmol/L)
- ix.
- FBG (>6.61 mmol/L)
- x.
- HbA1c (>6.5%)
- xi.
- C-peptide (>3.31 ng/mL)
4. Discussions
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | Group | p-Value < 0.05 | Vitamin D3 (ng/mL) | Total Vitamin E (μg/mL) | |
---|---|---|---|---|---|
Non-DM, n = 50 (%) | DM, n = 50 (%) | ||||
Gender | |||||
Male | 28 (56) | 26 (51) | - | 11.94 ± 25.96 | 2.17 ± 4.54 |
Female | 22 (44) | 24 (48) | - | 15.41 ± 31.29 | 1.32 ± 2.30 |
p-value | 0.55 | 0.25 | |||
Age (years) | |||||
≤35 | 11 (22) | 3 (6) | - | 4.90 ± 5.36 | 3.63 ± 3.75 |
>35–50 | 21 (42) | 16 (32) | - | 10.58 ± 19.20 | 5.03 ± 4.31 |
>50–65 | 18 (36) | 27 (54) | - | 19.51 ± 37.84 | 4.42 ± 3.54 |
>65 | - | 4 (8) | - | 3.57 ± 6.18 | 1.35 ± 0.38 |
p-value | 0.68 | 0.10 | |||
Ethnicity | |||||
Malay | 45 (90) | 33 (66) | - | 12.47 ± 26.27 | 4.59 ± 3.64 |
Chinese | 1 (2) | 9 (18) | - | 8.46 ± 11.07 | 2.67 ± 4.09 |
Indian | 4 (8) | 8 (16) | - | 24.70 ± 46.73 | 4.93 ± 4.92 |
p-value | 0.80 | 0.10 | |||
Marital status | |||||
Married | 45 (90) | 46 (92) | - | - | - |
Divorced | 4 (8) | 2 (4) | - | - | - |
Single | 1 (2) | 2 (4) | - | - | - |
Education level | |||||
Lower | - | - | - | - | - |
Secondary | 5 (10) | 7 (13) | - | - | - |
Tertiary | 45 (90) | 43 (86) | - | - | - |
Height (cm) | |||||
Mean ± SD | 163.8 ± 7.91 | 164.4 ± 8.67 | - | - | - |
Waist circumference (cm) | |||||
Mean ± SD | 95.12 ± 13.54 | 103.4 ± 16.17 | <0.05 | - | - |
Body weight (kg) | |||||
Mean ± SD | 73.68 ± 15.81 | 78.50 ± 15.14 | 0.36 | - | - |
Body mass index (BMI) (kg/m2) | |||||
Normal (18.5–24.9) | 13 (26) | 8 (16) | 0.09 | - | - |
Overweight (≥25) | 23 (46) | 20 (40) | - | - | |
Obesity (≥30) | 14 (28) | 22 (44) | - | - | |
Mean ± SD | 27.31 ± 4.63 | 28.69 ± 4.80 | - | - | |
Vitamin D3 (ng/mL) | 11.73 ± 20.49 | 15.35 ± 34.76 | 0.25 | - | - |
Total vitamin E (µg/mL) | 3.97 ± 3.33 | 4.9 ± 4.3 | 0.09 | - | - |
Medical History | Non-DM n = 50 (%) | DM n = 50 (%) |
---|---|---|
Family history of diabetes | ||
Yes | 23 (46) | 31 (62) |
No | 27 (54) | 19 (38) |
Subjects with other comorbid diseases | ||
Cardiovascular disease (CVD) | - | 6 (12) |
Gastrointestinal disease (GI) | 4 (8) | 8(16) |
Hyperlipidaemia | 4 (8) | 17 (34) |
Renal disease (RD) | - | 7 (14) |
Arthritis | 3 (6) | 14 (28) |
Epilepsy | - | 1 (2) |
Missing | 39 (78) | 7 (14) |
Lifestyle Behaviour | Group | Chi Square Test | ||
---|---|---|---|---|
Non-DM n = 50 (%) | DM n = 50 (%) | Value | p-Value | |
Smoking habits | ||||
Current smokers | 7 (14) | 5 (10) | 0.59 | 0.75 |
Ex-smokers | 4 (8) | 3 (6) | ||
Never smoked | 39 (78) | 42 (84) | ||
Physical activity | ||||
Good (3–5 times per week) | 27 (54) | 27 (54) | 1.89 | 0.60 |
Fair (<3 times per week) | 13 (26) | 17 (34) | ||
Poor (never exercise) | 10 (20) | 6 (12) |
Variables | Non-DM Mean ± SD, n = 50 (%) | DM Mean ± SD, n = 50 (%) | Test Value | p-Value |
---|---|---|---|---|
Vitamin D3 status | ||||
Deficiency (<20 ng/mL) | 3.43 ± 2.65, (82%) | 4.437 ± 2.86, (84%) | Z = −1.345 | ns |
Optimal (20–80 ng/mL) | 33.79 ± 20.41, (16%) | 37.88 ± 21.08, (10%) | Z = −0.732 | ns |
Toxicity (>80 ng/mL) | 113.5 ± 25.19, (2%) | 141.7 ± 26.58, (6%) | Z = −1.342 | ns |
Vitamin D3 deficiency (<20 ng/mL): Glycaemic status | ||||
HbA1c (%) | 6.67 ± 1.97 | 9.45 ± 2.51 | Z = 5.00 | <0.05 * |
FBG (mmol/L) | 5.57 ± 0.72 | 9.48 ± 3.19 | Z = −6.19 | <0.05 * |
C-Peptide (ng/mL) | 2.11 ± 0.35 | 2.23 ± 0.29 | Z = −1.40 | ns |
Vitamin D3 deficiency (< 20 ng/mL): Lipid profiles | ||||
TG (mmol/L) | 1.12 ± 0.57 | 1.05 ± 0.43 | Z = −0.11 | ns |
TC (mmol/L) | 4.18 ± 1.40 | 3.22 ± 1.42 | Z = −3.14 | <0.05 * |
LDL-C (mmol/L) | 2.14 ± 0.58 | 1.47 ± 0.81 | Z = −4.58 | <0.05 * |
HDL-C (mmol/L) | 1.08 ± 0.60 | 0.66 ± 0.48 | Z = −3.05 | <0.05 * |
Calcium status | ||||
Low (<8.6 mg/dL) | 5.3 ± 2.7, (56%) | 5.8 ± 1.49, (50%) | Z = −0.23 | ns |
Normal (8.6–10.3 mg/dL) | 9.4 ± 1.4, (10%) | 9.6 ± 2.99, (9%) | Z = −0.60 | ns |
High (>10.3 mg/dL) | 12.2 ± 2.95, (34%) | 14.6 ± 2.15, (44%) | Z = −3.22 | <0.05 * |
Low calcium (< 8.6 mg/dL): Glycaemic status | ||||
HbA1c (%) | 7.07 ± 1.59 | 9.24 ± 2.49 | Z = −3.62 | <0.05 * |
FBG (mmol/L) | 5.37 ± 0.53 | 8.94 ± 3.31 | Z = −4.87 | <0.05 * |
C-Peptide (ng/mL) | 2.02 ± 0.31 | 2.19 ± 0.24 | Z = −2.01 | <0.05 * |
Low calcium (< 8.6 mg/dL): Lipid profiles | ||||
TG (mmol/L) | 1.22 ± 0.57 | 1.24 ± 0.48 | Z = −0.25 | ns |
TC (mmol/L) | 4.41 ± 0.85 | 3.81 ± 1.26 | Z = −1.83 | ns |
LDL-C (mmol/L) | 2.38 ± 0.58 | 1.76 ± 0.79 | Z = −3.27 | <0.05 * |
HDL-C (mmol/L) | 1.42 ± 0.60 | 1.00 ± 0.69 | Z = −2.00 | <0.05 * |
New Variables | SPSS Coding | Participants | N (%) |
---|---|---|---|
No deficiency | 0 | 8 | 8 |
Deficiency of vitamin D3 (< 20 ng/mL) | 1 | 92 | 92 |
Covariates | S.E | Wald | Sig. | OR | 95% CI for OR | |
---|---|---|---|---|---|---|
Lower | Upper | |||||
Age | 0.04 | 0.49 | 0.48 | 0.98 | 0.91 | 1.05 |
Waist (cm) | 0.03 | 0.05 | 0.82 | 0.99 | 0.95 | 1.04 |
BMI (kg/m2) | 0.09 | 0.09 | 0.76 | 1.03 | 0.87 | 1.21 |
Smoking status | 0.46 | 0.79 | ||||
Current smoker | 0.86 | 0.40 | 0.53 | 0.58 | 0.11 | 3.13 |
Ex-smoker | 1.40 | 0.03 | 0.86 | 1.28 | 0.08 | 19.94 |
Physical activity (good) | 0.96 | 0.08 | 0.78 | 0.76 | 0.12 | 4.97 |
Education level | 1.41 | 0.65 | 0.42 | 3.13 | 0.20 | 49.59 |
Marital status (single) | 1.02 | 0.72 | 0.40 | 0.42 | 0.06 | 3.09 |
Family history | 0.70 | 0.01 | 0.92 | 1.07 | 0.27 | 4.21 |
HDL (male) | 0.84 | 1.08 | 0.30 | 2.38 | 0.46 | 12.28 |
HDL (female) | 0.98 | 0.29 | 0.59 | 0.59 | 0.09 | 4.03 |
LDL (>2.6 mmol/L) | 0.89 | 0.83 | 0.36 | 2.25 | 0.40 | 12.78 |
TC (>5.2 mmol/L) | 1.02 | 0.03 | 0.87 | 0.84 | 0.11 | 6.20 |
FBG (>6.61 mmol/L) | 0.80 | 0.02 | 0.90 | 1.11 | 0.23 | 5.27 |
HbA1c (>6.5%) | 0.76 | 1.57 | 0.21 | 0.39 | 0.09 | 1.71 |
C-peptide (>3.1 ng/mL) | 1.13 | 1.08 | 0.30 | 0.31 | 0.03 | 2.83 |
Calcium (mg/dL) | 0.74 | 1.81 | 0.18 | 2.69 | 0.64 | 11.38 |
Constant | 4.50 | 1.22 | 0.27 | 144.02 |
Isomers of Vitamin E (µg/Ml) | Mean ± SD | Test Value | p-Value | |
---|---|---|---|---|
Non-DM, n = 50 | DM, n = 50 | |||
α-Tocopherol | 2.18 ± 1.98 | 2.11 ± 1.54 | t = 0.19 | 0.17 |
α-Tocotrienol | 0.94 ± 0.18 | 1.39 ± 0.55 | t = −1.61 | 0.22 |
β-Tocotrienol | 0.01 ± 0.02 | 0.01 ± 0.03 | Z = −0.63 | 0.53 |
γ-Tocotrienol | 0.65 ± 0.23 | 1.13 ± 0.20 | t = −2.13 | <0.05 * |
δ-Tocotrienol | 0.12 ± 0.06 | 0.18 ± 0.05 | t = −1.31 | 0.16 |
Total vitamin E | 3.97 ± 3.33 | 4.90 ± 4.30 | t = −1.21 | 0.09 |
Variables | Total vitamin E | |||||||
---|---|---|---|---|---|---|---|---|
<4.9 µg/mL, n = 56 | Test Value | p-Value | >4.9 µg/mL, n = 44 | Test Value | p-Value | |||
Non-DM, n = 29 | DM, n = 27 | Non-DM, n = 21 | DM, n = 23 | |||||
Glycaemic status | ||||||||
FBG (mmol/L) | 5.75 ± 0.80 | 9.16 ± 2.92 | t = −6.05 | <0.05 * | 5.33 ± 0.51 | 9.36 ± 3.56 | t = −5.36 | <0.05 * |
HbA1c (%) | 6.80 ± 2.23 | 8.58 ± 2.53 | t = −2.79 | <0.05 * | 6.71 ± 1.70 | 10.19 ± 2.49 | t = −5.36 | <0.05 * |
C-peptide (ng/mL) | 2.14 ± 0.31 | 2.21 ± 0.28 | t = −0.89 | 0.38 | 2.05 ± 0.38 | 2.26 ± 0.29 | t = −2.05 | <0.05 * |
Lipid profile status | ||||||||
LDL-C (mmol/L) | 2.12 ± 0.53 | 1.38 ± 0.72 | t = 4.40 | <0.05 * | 2.38 ± 0.65 | 1.57 ± 0.83 | t = 3.57 | <0.05 * |
HDL-C (mmol/L) | 1.04 ± 0.67 | 0.80 ± 0.52 | t = 1.51 | 0.14 | 1.27 ± 0.58 | 0.77 ± 0.65 | t = 2.68 | <0.05 * |
TC (mmol/L) | 4.13 ± 1.30 | 3.12 ± 1.36 | t = 2.83 | <0.05 * | 4.59 ± 1.38 | 3.38 ± 1.37 | t = 2.91 | <0.05 * |
TG (mmol/L) | 1.17 ± 0.62 | 1.09 ± 0.53 | t = 0.48 | 0.63 | 1.16 ± 0.54 | 1.07 ± 0.37 | t = 0.66 | 0.51 |
Other profile status | ||||||||
Vitamin D3 (ng/mL) | 12.32 ± 21.44 | 15.94 ± 29.58 | t = −0.53 | 0.60 | 10.09 ± 15.27 | 8.44 ± 14.60 | t = 0.37 | 0.72 |
Calcium (mg/dL) | 8.33 ± 3.84 | 9.04 ± 4.78 | t = −0.61 | 0.54 | 7.79 ± 3.67 | 10.18 ± 4.32 | t = −1.97 | 0.06 |
New Variables | SPSS Coding | Participants | n (%) |
---|---|---|---|
<4.9 µg/mL | 0 | 56 | 56 |
>4.9 µg/mL | 1 | 44 | 44 |
Covariates | S.E | Wald | Sig. | OR | 95% CI for OR | |
---|---|---|---|---|---|---|
Lower | Upper | |||||
Age | 0.03 | 0.04 | 0.85 | 0.10 | 0.95 | 1.05 |
Waist Circumference (cm) | 0.02 | 5.87 | 0.02* | 1.06 | 1.01 | 1.10 |
BMI | 0.06 | 0.32 | 0.58 | 0.96 | 0.85 | 1.09 |
Smoking status | 2.64 | 0.27 | 0.57 | 0.11 | 2.92 | |
Current smoker | 0.84 | 0.46 | 0.50 | 0.57 | 0.11 | 2.92 |
Ex-smoker | 1.18 | 2.35 | 0.13 | 0.16 | 0.02 | 1.66 |
Physical activity (good) | 0.76 | 0.29 | 0.59 | 0.66 | 0.15 | 2.95 |
Marital status | 0.66 | 0.72 | ||||
Single | 1.76 | 0.23 | 0.63 | 0.43 | 0.01 | 13.44 |
Married | 1.33 | 0.64 | 0.43 | 0.35 | 0.03 | 4.69 |
Family history | 0.53 | 0.86 | 0.35 | 1.63 | 0.58 | 4.58 |
HDL | 2.014 | 0.365 | ||||
HDL (male: <0.9 mmol/L) | 0.57 | 1.42 | 0.23 | 1.97 | 0.65 | 5.98 |
HDL (female: <1.15 mmol/L) | 0.78 | 1.52 | 0.22 | 2.62 | 0.57 | 12.05 |
LDL (>2.6 mmol/L) | 0.71 | 0.12 | 0.73 | 0.78 | 0.19 | 3.13 |
TC (≥5.2 mmol/L) | 0.81 | 0.12 | 0.73 | 0.75 | 0.15 | 3.69 |
FBG (>6.61 mmol/L) | 0.60 | 3.74 | 0.05* | 3.21 | 0.98 | 10.47 |
HbA1c (>6.5%) | 0.58 | 2.23 | 0.14 | 0.42 | 0.14 | 1.31 |
C-peptide (>3.1 ng/mL) | 1.40 | 2.23 | 0.14 | 0.12 | 0.01 | 1.93 |
Constant | 3.04 | 1.30 | 0.25 | 0.03 |
Variables | Non-DM | DM | ||||||
---|---|---|---|---|---|---|---|---|
Vitamin D3 | Calcium | α-tocopherol | Total Vitamin E | Vitamin D3 | Calcium | α-tocopherol | Total Vitamin E | |
Ethnicity | 0.24 | 0.08 | −0.14 | −0.17 | 0.09 | 0.10 | −0.04 | −0.13 |
Age | 0.04 | 0.12 | 0.24 | 0.30 * | 0.06 | 0.05 | −0.19 | 0.06 |
Gender | 0.11 | 0.11 | −0.1 | −0.11 | 0.09 | 0.10 | −0.04 | −0.13 |
Family history of diabetes | 0.03 | 0.16 | −0.17 | −0.07 | 0.03 | 0.40 ** | 0.03 | −0.05 |
Smoking status | 0 | 0 | −0.06 | −0.04 | −0.03 | 0.37 ** | 0.24 | 0.41 ** |
Physical activity | 0.23 | 0.02 | 0.19 | 0.17 | −0.02 | 0.09 | 0.12 | −0.11 |
Waist circumference (cm) | 0.08 | −0.09 | 0.40 ** | 0.27 | −0.12 | 0.39 ** | 0.03 | −0.07 |
BMI (kg.m−2) | 0.03 | −0.18 | 0.19 | 0.19 | 0.11 | −0.03 | −0.11 | −0.25 |
HbA1c (%) | −0.03 | −0.24 | 0.05 | 0.22 | −0.05 | 0.07 | 0.38 ** | 0.46 ** |
FBG (mmol/L) | −0.25 | 0.22 | −0.21 | −0.22 | −0.02 | 0.11 | −0.01 | 0.07 |
C-Peptide (ng/mL) | −0.11 | 0.35 * | −0.2 | −0.14 | 0.05 | 0.02 | 0.14 | 0.08 |
HDL-C (mmol/L) | 0.15 | −0.34 * | 0.23 | 0.16 | 0.30 * | −0.36 * | −0.05 | −0.14 |
LDL-C (mmol/L) | 0.19 | −0.23 | 0.21 | 0.24 | 0.12 | −0.32 * | 0.03 | 0.04 |
TG (mmol/L) | 0.03 | −0.08 | 0.09 | 0.16 | 0.09 | −0.37 ** | 0.14 | 0.27 |
TC (mmol/L) | 0.14 | −0.09 | 0.07 | 0.19 | 0.03 | −0.39 ** | 0.04 | 0.02 |
Vitamin D3 (ng/mL) | 1 | −0.08 | 0.07 | −0.09 | 1 | −0.12 | 0.03 | 0.06 |
Calcium (mg/dL) | −0.08 | 1 | −0.08 | −0.14 | −0.12 | 1 | 0.10 | 0.1 |
α-tocopherol (μg/mL) | 0.07 | −0.08 | 1 | 0.72 ** | 0.03 | 0.1 | 1 | 0.69 ** |
Total vitamin E (μg/mL) | 0.08 | −0.34 * | 0.72 ** | 1 | −0.05 | 0.27 | 0.69 ** | 1 |
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Razip, N.N.M.; Gopalsamy, B.; Abdul Mutalib, M.S.; Chang, S.K.; Abdullah, M.M.J.A.; Azlan, A.; Rejali, Z.; Khaza’ai, H. Correlation between Levels of Vitamins D3 and E in Type 2 Diabetes Mellitus: A Case-Control Study in Serdang, Selangor, Malaysia. Nutrients 2021, 13, 2288. https://doi.org/10.3390/nu13072288
Razip NNM, Gopalsamy B, Abdul Mutalib MS, Chang SK, Abdullah MMJA, Azlan A, Rejali Z, Khaza’ai H. Correlation between Levels of Vitamins D3 and E in Type 2 Diabetes Mellitus: A Case-Control Study in Serdang, Selangor, Malaysia. Nutrients. 2021; 13(7):2288. https://doi.org/10.3390/nu13072288
Chicago/Turabian StyleRazip, Nurliyana Najwa Md, Banulata Gopalsamy, Mohd Sokhini Abdul Mutalib, Sui Kiat Chang, Muhammad Mikhail Joseph Anthony Abdullah, Azrina Azlan, Zulida Rejali, and Huzwah Khaza’ai. 2021. "Correlation between Levels of Vitamins D3 and E in Type 2 Diabetes Mellitus: A Case-Control Study in Serdang, Selangor, Malaysia" Nutrients 13, no. 7: 2288. https://doi.org/10.3390/nu13072288