Povezanost nivoa vitamina D i pojave sarkopenije i osteopenije kod žena sa metaboličkim sindromom u postmenopauzi

Abstract

Niska koncentracija serumskog 25-hidroksivitamina D (25OHvitD) je povezana sa gubitkom koštane gustine i rizikom od pada kod žena u postmenopauzi. Ispitati koncetraciju 25OHvitD kod žena u postmenopauzi i njegov uticaj na telesni sastav, koštanu gustinu, mišićnu snagu, metabolički sindrom. METOD: Ovo je bila opservaciona, analitička studija, koja je uključila postmenopauzalne žene od 45 - 70 godina starosti. Uključene su žene koje su prvi put došle na merenje koštane gustine dvostruko-energetskom apsorpciometrijom X-zracima (DXA). Procenjivani su: obim struka (OS), indeks telesne maste (ITM), koštana gustina (BMD), glukoza, insulinska rezistencija (HOMA-IR), 25OHD, test mišićne snage (HGT), indeks telesne masti (FMI) i apendikularna mišićna masa (AMM) pomoću DXA aparata. REZULTATI: Prosečna starost žena je bila 57,16±5,71 godina. Početak menopauze kod ispitanica je bio sa 49,59±4,02 godina. Trajanje menopauze u proseku je bilo 7,51±4,99 godina. Prema dobijenom indeksu telesne mase (ITM) 28,03±4,65kg/m2, ispitivane postmenopauzalne žene bile su preterano uhranjene i imale su obim struka (OS) 91,56±10,85cm. Prosečna vrednost 25(OH)D iznosila je 39,43±16,73 nmol/L. Nije bilo ispitanica sa normalnim koncentracijama vitamina D. Insuficijenciju vitamina D imalo je 76,2 %. Pacijentkinje su imale osteopeniju. Prosečna mišićna snaga iznosila je 12,44±2,24kg i bila je statistički značajno niža u odnosu na normative za životnu dob(t = -21.65; p <0,001). Indeks skeletne mišićne mase (SMI) iznosio je 6,72±0,91kg/m2, tako da kod pacijentkinja nije potvrđena sarkopenija. Nađena je pozitivna korelacija između 25(OH)D i testa mišićne snage (R=0,227; p=0,022). Metabolički sindrom imalo je čak 69% ispitanica i potvrđena je korelacija 25OHD sa parametrima metaboličkog sindroma, obimom struka (R2=0,094; p=0,004), glikemijom našte (R2=-0,046; p=0,030), insulinskom rezistencijom (HOMA-IR) (R=-0,238; p=0,017) i indeksom telesne mase (R2=0,080; p=0,002). Procenat telesnih masti iznosio je 43,54±4,83% , statistički značajno više u odnosu na referente vrednosti za istu životnu dob (z=-2.575; p= 0.005). ZAKLJUČAK: Umereno gojazne posmenopauzalne žene imaju insuficijenciju vitamin D koja je povezana sa većim obimom struka, smajenom mišićnom snagom, većim procentom telesnih masti i parametrima metaboličkog sindroma.

Visceral fat is more harmful than subcutaneous fat. It was found that there is 45% more visceral fat in women with hypovitaminosis D, compared to women with normal vitamin D levels. Women with high amounts of visceral fat have an increased risk of metabolic syndrome (MetS), insulin resistance and low level of serum vitamin D. METHODS: This was observational, analytical study of postmenopausal women aged 45 - 70 years. The assessed parameters were: body mass index (BMI), waist circumference (WC), 25- hydroxyvitamin D (25OHD) status, glucose, serum insulin and HOMA-IR, bone mineral density (BMD), muscle strength (HGT), total fat mass (FM), fat mass index (FMI) and appendicular muscle mass (AMM) measured by DXA and. RESULTS: The average age of women was 57.16 ± 5.71 years. Start menopausal patients was 49.59 ± 4.02 with the years. Duration of menopause was 7.51 ± 4.99 years. According to the obtained body mass index (BMI) 28.03 ± 4,65kg/m2, postmenopausal woman was excess body weight with waist circumference (WC) 91.56 ± 10,85cm. The average value of 25(OH)D was 39.43 ± 16.73 nmol/L. There were no patients with normal concentrations of vitamin D insufficiency of vitamin D had 76.2%. Patients had osteopenia. The average muscle strength was 12.44 ± 2,24kg and was significant lower than the normative age (t = -21.65, p <0.001). The index of skeletal muscle mass (SMI) was 6.72 ± 0,91kg/m2 so that has not been confirmed sarcopenia. There was a positive correlation between 25 (OH) D and muscle strength (R = 0.227; p = 0.022). The metabolic syndrome had a 69% of patients and was confirmed 25OHD correlation with the parameters of the metabolic syndrome, waist circumference (R2 = 0.094; p = 0.004) and fasting glucose (R2 = -0.046, p = 0.030), insulin resistance (HOMA-IR) (R = -0.238, p = 0.017) and body mass index (R2 = 0.080; p = 0.002). Percentage body fat was 43.54 ± 4.83%, significant increase compared to the reference values for the same age (Z = -2.575; p = 0.005). CONCLUSIONS: Postmenopausal moderately obese women have vitamin D insufficiency associated with greater waist circumference, low muscle strength, increased body fat and parameters of the metabolic syndrome.