8/20/2019 1. IJGMP - Pediatric Obesity and Vitamin D Deficiency - Adilo.S.bahathiq - Saudi Arabia - OPaid http://slidepdf.com/reader/full/1-ijgmp-pediatric-obesity-and-vitamin-d-deficiency-adilosbahathiq- 1/12 PEDIATRIC OBESITY AND VITAMIN D DEFICIENCY: A CONCEPT AND UNDERSTANDING ADILO S. BAHATHIQ Vice-Dean, Public Health and Health Informatics, Associate Professor in Reproductive Endocrinology, Department of Physiology, ollege of !edicine, "!!-A#$"RA "niversity, !a%%ah, &audi Arabia ABSTRACT Pediatrics obesity is a ma'or community health issues globally no( days) *he commonness of Pediatrics obesity and vitamin D deficiency has increased over in several decades) It is caused by imbalance bet(een calories inta%e and calories utili+ed in body) ne or more factors cause obesity in children that is Physical, psychological, and social health problems are caused due to childhood obesity) Effective active strategies can be used to prevent and control obesity in children (hich is more effective) *he purpose of this paper is to address various factors influencing childhood obesity and vitamin D deficiency) It is also addressing the sources of Vitamin D, classification, Ris% factors, the role of vitamin D on adipose tissue, the genetic role in vitamin D and obesity, the role of inflammation on obesity and Vitamin D status in !iddle East, etc) KEYWORDS: hild besity, Pediatric besity, Vitamin D Deficiency INTRODUCTION SYNTHESIS OF VITAMIN D Vitamin D or sunshine vitamin, its main and ma'or source is obtained from the sun eposure and minor source is obtained from diet .dairy products, oil fish, meat and eggs/ 01-123) It consumed fe( steps to be synthesi+ed) In the s%in, "V-4 (avelengths in sunlight convert 5-dehydrocholesterol to cholecalciferol .vitamin D6/, (hich has the ability to enter the circulation) In the liver, vitamin D 6 by the 1 st hydroylation step it become 78.H/D) In the %idney, by the 7 nd hydroylation step it converted to 1,78.H/ 7D6 (hich is the bioactive form) #ater on, this final active form has the ability to bind to VDRs and act through it 01-123) VDRs are distributed throughout the body in the endocrine glands, endothelial cells, vascular smooth muscle cells, cardiomyocytes and hemolymphopoietic cells01,15,193) CLASSIFICATION :e can define vitamin D deficiency based on the follo(ing stratifications of 78.H/D serum concentration01,12,1;,7<,713= • Deficiency >8<)< nmol?# or >7<)< ng?m# • Insufficiency @ 8<)<5B); nmol?# or 7<)<7;); ng?m# • &ufficiency C58)< nmol?# or C6<)< ng?m# :e can define obesity based on the follo(ing stratificationsof 4!I= www.iase.!s e"i#$%iase.!s I&e$&ai#&a' (#!$&a' #) Ge&e$a' Me"i*i&e a&" P+a$,a*- I(GMP/ ISSNP/: 0123413335 ISSNE/: 012346778 V#'. 69 Iss!e 69 (!& 4 (!' 0729 2420 IASET
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8/20/2019 1. IJGMP - Pediatric Obesity and Vitamin D Deficiency - Adilo.S.bahathiq - Saudi Arabia - OPaid
PEDIATRIC OBESITY AND VITAMIN D DEFICIENCY: A CONCEPT AND
UNDERSTANDING
ADILO S. BAHATHIQ
Vice-Dean, Public Health and Health Informatics, Associate Professor in Reproductive Endocrinology,
Department of Physiology, ollege of !edicine, "!!-A#$"RA "niversity, !a%%ah, &audi Arabia
ABSTRACT
Pediatrics obesity is a ma'or community health issues globally no( days) *he commonness of Pediatrics obesity
and vitamin D deficiency has increased over in several decades) It is caused by imbalance bet(een calories inta%e and
calories utili+ed in body) ne or more factors cause obesity in children that is Physical, psychological, and social health problems are caused due to childhood obesity) Effective active strategies can be used to prevent and control obesity in
children (hich is more effective) *he purpose of this paper is to address various factors influencing childhood obesity and
vitamin D deficiency) It is also addressing the sources of Vitamin D, classification, Ris% factors, the role of vitamin D on
adipose tissue, the genetic role in vitamin D and obesity, the role of inflammation on obesity and Vitamin D status in
!iddle East, etc)
KEYWORDS: hild besity, Pediatric besity, Vitamin D Deficiency
INTRODUCTION SYNTHESIS OF VITAMIN D
Vitamin D or sunshine vitamin, its main and ma'or source is obtained from the sun eposure and minor source is
obtained from diet .dairy products, oil fish, meat and eggs/ 01-123)
It consumed fe( steps to be synthesi+ed) In the s%in, "V-4 (avelengths in sunlight convert 5-dehydrocholesterol
to cholecalciferol .vitamin D6/, (hich has the ability to enter the circulation) In the liver, vitamin D6 by the 1sthydroylation
step it become 78.H/D) In the %idney, by the 7nd hydroylation step it converted to 1,78.H/7D6 (hich is the bioactive
form) #ater on, this final active form has the ability to bind to VDRs and act through it 01-123) VDRs are distributed
throughout the body in the endocrine glands, endothelial cells, vascular smooth muscle cells, cardiomyocytes and
hemolymphopoietic cells01,15,193)
CLASSIFICATION
:e can define vitamin D deficiency based on the follo(ing stratifications of 78.H/D serum
concentration01,12,1;,7<,713=
• Deficiency >8<)< nmol?# or >7<)< ng?m#
• Insufficiency @ 8<)<5B); nmol?# or 7<)<7;); ng?m#
• &ufficiency C58)< nmol?# or C6<)< ng?m#
:e can define obesity based on the follo(ing stratificationsof 4!I=
Pe"ia$i* O;esi- a&" Via,i& D De)i*ie&*-: A C#&*e< a&" U&"e$sa&"i&= 1
• Increase circulating 1,78.H/7D6)
• Decrease in serum level of 78.H/D)
•
Decrease in HD#)
• Increase in triglycerides and #D#)
*he ris% factors that lin% the deficiency of vitamin D (ith child obese sub'ects= decreased sunlight eposure,
season .(inter/, limited outdoor activity, clothes that limit cutaneous vitamin D synthesis0B-853) !oreover, lo( vitamin D
levels in the mother during pregnancy play a role on her childs levels and lo(er birth (eight but higher fat mass at B to 2
years old child, race .non-(hite/, age of puberty, lo( mil% consumption, female gander0173 and some mutations in VDR 0
16-5B3)
A study done by *homas et al ) provided an increase in P*H levels and a decrease in 78.H/D levels in obese
sub'ects) &ince these changes normali+ed after (eight loss so, these changes considered as a conseFuences rather than a
ris% factors05-9<3)
L#w C#&*e&$ai#& #) Via,i& D i& O;ese S!;>e*s C#!'" ;e a Res!' #) De)e$e& Me*+a&is,s
• G* genotype variation could affect vitamin D levels and (eight gain by decreasing the insulin effect in brain
tissues, affecting appetite, food choice, and dietary inta%e from an early age09-253)
• Direct relationship bet(een circulating adiponectin and vitamin D levels) Inverse relationship bet(een the
circulating adiponectin and 4!I07-783) Gurthermore, patients (ith insulin resistance, type 7 diabetes and
cardiovascular disease have lo(er concentration of adiponectin07-783)
• *he relationship bet(een 4!I and serum level of 78.H/D is inverse, each unit increase in 4!Ibeing associated
(ith 1)18lo(er concentration of 78.H/D0B-8B3)
• 4ody fats acts as a reservoir for vitamin D .lipid soluble vitamin/, so increasing the content of body fats (ill
increase its seFuestration, leading to decrease its bioavailability0B-883)
• &ome studies has been sho(n that 78.H/D (as stored 66 in fat and 7< in muscle) 4ased on these studies(e
can loo% at the muscles as another reservoir for vitamin D0B-823)
• In obese sub'ects and due to hepatic steatosis, the liver may lo(er the rate of 78.H/Dsynthesis0B-893)
• High levels of leptin and I#2 .secreted by adipose tissue/ may inhabit 1,78.H/7D6 synthesis0B-8;3)
T+e R#'e #) Via,i& D #& A"i<#se Tiss!e
Recently, ne( studies classified the adipose tissues as one of the ma'or endocrine organs0B-2<3) Divided into t(o
types (hite and bro(n, each type has a different cell origin, structure and function01<3) *he bro(n one are present in
children only, it has an average life span of 1< years, so most of them disappears in adulthood01<3) At that time, they
replaced by the (hite one01<3) 4ro(n adipose tissues (or% as thermogenesis0B3, (hile the (hite adipose tissues serve
mainly as energy reserves, secrete hormones, mechanical protection and insulation to the body01<3)In response to high body (eight there (ill be an increase in both fat mass and lean body mass .subtracting body
bet(een PNs levels and fat mass) !oreover, vitamin D may play a role in modulating the inflammatory process in obese
sub'ects, 1,78.H/7D6and its analogs has been reported that it has a role in do(n regulating PNs synthesis by inhibiting
selectively the activity of O-706,87,863)
Via,i& D Sa!s i& Mi""'e Eas
Vitamin D deficiency and its comorbid conditions are a pandemic health problem, especially in the !iddle East,in
particular in &audi Arabia because of limited outdoor activities and the prevalence of (earing dar% s%in covering clothes
for cultural and religious reasons016-1B3) As a matter of fact, 6<-8< of children and adults in "AE, Australia, *ur%ey,
India and #ebanon have been found to have vitamin D deficiency016,58,523) Although, &audi Arabia is one of the sunniest
countries, vitamin D deficiency has long been reported as prevalent in &audi population018,55,593) A study done by
Arda(iet al ) reported an approimately 9< prevalence of vitamin D deficiency in 1157 &audi (omen from the (estern
region of &audi Arabia018-5;3)
D#si&= C#&si"e$ai#&s #) Via,i& D
Jo(adays, ne( studies proved that the optimum dose of vitamin D6 supplements is depend on body (eight 0
B,28,223, so (e suggest that obese sub'ects have to receive t(o to three times vitamin D more than non-obese to satisfy
their bodyQs vitamin D reFuirements0B-2B3)
Ho(ever, if the target of vitamin D supplementation in obese (as to affect one of comorbidities associated (ith
obesity, the dose (ill be various for each comorbid condition 0B3)
CONCLUSIONS
*he function of adipose tissues is not only as nutritive storage083) Recently, it classified as a ma'or endocrineorgan) Vitamin D is a fat soluble prohormone) It is easily stored and seFuestered in adipose tissue) Also, it can be stored in
muscles) *he deficiency of vitamin D is common in obese sub'ects) !any efforts have been made in the understanding of
vitamin D metabolism and functions) Interestingly, several studies provided the interrelationship bet(een vitamin D and
adipose tissue, it may both regulate and be regulated by vitaminD023) It is able to act via numerous genomic and non-
genomic mechanisms= including protein epression, inflammation, and cellular metabolism) *here is a clear relationship
bet(een G* rs;;6;2<; and being obese in childhood in 4ra+ilian Ama+on) !oreover, some evidence proved an
association bet(een genetic effects of G* and vitamin D levels) #i%e(ise, it has been proved a relationship bet(een
pediatric obesity, adiponectin and vitamin D levels) *he decrease in vitamin D levels (ill lead to decrease in circulating
adiponectin and as a result there (ill be an increase in the total body (eight) In fact, vitamin D deficiency and its comorbid
conditions are a pandemic health problem,particularly in &audi Arabia in the (estern region due to their food lifestyle,
limited outdoor activities and the prevalence of (earing dar% s%in covering clothes for cultural and religious reasons)
B<) 4elo VA, &ou+a-osta D, #ui+on !R, #anna !, arneiro P, et al) !atri metalloproteinase-; genetic
variations affect !!P-; levels in obese children) Int bes .#ond/) 7<17) 62=2;-58)
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