Vitamin D deficiency as a risk factor for cystic fibrosis-related diabetes in the Scandinavian Cystic Fibrosis Nutritional Study

• Published in: Diabetologia Vol. 54; no. 12; pp. 3007 - 3015
• Main Authors: Pincikova, T., Nilsson, K., Moen, I. E., Fluge, G., Hollsing, A., Knudsen, P. K., Lindblad, A., Mared, L., Pressler, T., Hjelte, L.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.12.2011; Springer; Springer Nature B.V
• Subjects: Adolescent; Biological and medical sciences; Child; Child, Preschool; Clinical Medicine; Cohort Studies; Consortia; Cross-Sectional Studies; Cystic fibrosis; Cystic Fibrosis - blood; Cystic Fibrosis - complications; Diabetes; Diabetes Mellitus - etiology; Diabetes. Impaired glucose tolerance; Diet Records; Endocrine pancreas. Apud cells (diseases); Endocrinology and Diabetes; Endocrinopathies; Endokrinologi och diabetes; Errors of metabolism; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Food; Food record; Glucose; Glucose Tolerance Test; Glycated Hemoglobin A - analysis; HbA(1c); Human Physiology; Humans; Insulin resistance; Internal Medicine; Klinisk medicin; Male; Medical and Health Sciences; Medical sciences; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Metabolic Diseases; Miscellaneous hereditary metabolic disorders; Pediatrics; Risk Factors; Scandinavian and Nordic Countries - epidemiology; Severity of Illness Index; Vitamin D; Vitamin D - administration & dosage; Vitamin D - blood; Vitamin D Deficiency - blood; Vitamin D Deficiency - complications; Vitamin deficiency; Young Adult; Denmark; Norway; Sweden; Cystic fibrosis; Food record; Diabetes; Vitamin D; HbA; Endocrinopathy; Respiratory disease; Diabetes mellitus; Nutrition disorder; Metabolic diseases; Genetic disease; Micronutrient; Risk factor; Digestive diseases; Nutritional status; Pancreatic disease
• ISSN: 0012-186X; 1432-0428; 1432-0428
• DOI: 10.1007/s00125-011-2287-1

Aims/hypothesis Many cystic fibrosis patients are vitamin D-insufficient. Cystic fibrosis-related diabetes is a major complication of cystic fibrosis. The literature suggests that vitamin D might possess certain glucose-lowering properties. We aimed to assess the relationship between vitamin D and cystic fibrosis-related glucose intolerance. Methods We enrolled 898 cystic fibrosis patients from Sweden, Norway and Denmark. Vitamin D intake was assessed using a seven-day food record. Serum 25-hydroxyvitamin D (s25OHD) and HbA 1c were measured, and an OGTT was carried out. Multiple linear and logistic regressions were used for HbA 1c and cystic fibrosis-related diabetes/OGTT result as outcome variables, respectively. Each model was controlled for country, and for known cystic fibrosis-related diabetes risk factors: age, sex, genotype, liver dysfunction, long-term corticosteroid treatment, and lung and pancreatic function. Results Degree of vitamin D insufficiency (OR 1.36; p  = 0.032) and s25OHD < 30 nmol/l (OR 1.79; p  = 0.042) were significant risk factors for cystic fibrosis-related diabetes. Accordingly, HbA 1c value was positively associated with s25OHD < 30 nmol/l and < 50 nmol/l, as well as with degree of vitamin D insufficiency (adjusted R 2  = 20.5% and p  < 0.05 in all). In subgroup analyses, s25OHD < 30 nmol/l determined the HbA 1c value in paediatric patients (adjusted R 2  = 20.2%; p  = 0.017), but not in adults. Conclusions/interpretation Vitamin D status is associated with HbA 1c and diabetes in cystic fibrosis, particularly in children. The study justifies prospective studies on the proposed role of vitamin D deficiency in the pathophysiology of diabetes mellitus.