الفهرس 
Vitamin DOnly 14 pages are availabe for public view
 |  | from | 233 |  |  |
| | | from | 233 | | |
Abstract
Vitamin D is a fat soluble vitamin which was known to be a regulator of calcium homeostasis. Recently, it is discovered to have pleiotropic functions beside calcium homeostasis as immunomodulator, cardiovascular protective effect and a role in insulin secretion and insulin sensitivity. Many studies suggested that vitamin deficiency is found to be related to many diseases as diabetes mellitus (type 1 and type 2), non alcoholic fatty liver diseases and many autoimmune diseases like rheumatoid arthritis and systemic lupus erythromatosis.
Diabetes mellitus is a metabolic disease due to insulin resistance or insulin deficiency or both. It’s considered a worldwide burden as one every eleven adults has diabetes. It has many complications that may affect people quality of life as retinopathy, neuropathy, nephropathy, cardiovascular and cerebrovascular complications.
Non alcoholic fatty liver disease is a broad spectrum term from fat accumulation at the liver to include cellular injury and inflammation up to fibrosis and cirrhosis. 86. 66% of type 2 diabetic patients are found to have non alcoholic fatty liver disease. It’s considered a great risk factor for non viral hepatocellular carcinoma.
Insulin resistance is considered a mutual pathology between both diabetes mellitus and Non alcoholic fatty liver disease. Vitamin D is acting against insulin resistance by many mechanisms such its anti-inflammatory effect, anti-oxidant and regulation of insulin receptor expression.
The aim of this study to evaluate total vitamin D level in type 2 diabetes mellitus (with diabetes duration more than 5 years) with non alcoholic fatty liver disease.
This study was conducted on 110 Egyptian participates between 25 – 55 years from the endocrine outpatient clinic at Ain Shams University hospital and El-Matarya teaching hospital from March 2017 to December 2017. They were divided into 4 groups as the following:
group 1: 30 patients with T2DM (more than 5 years) with NAFLD
group 2: 30 patients with T2DM (more than 5 years)
group 3: 30 patients with NAFLD
group 4: 20 healthy controls selected from outpatient as relative of patients or blood bank donors.
Exclusion criteria included:
1. Patients known having chronic liver disease or show evidence of it either clinically (lower limb edema, ascites and jaundice), laboratory (low albumin <3. 5 g/dl) or by abdominal ultrasound)
2. Patients known having chronic kidney disease or showed
elevated creatinine ( >1. 4 mg/dl)
3. Alcoholic patients
4. Any patient on drugs causing secondary steatosis as
corticosteroid, amiodarone. . . etc.
5. Any patient on any drug affects vitamin D metabolism or
absorption as antiepileptics, methotrexate, thiazides. . . etc.
They were conducted to the following after an informed written consent: Full medical history, full physical examination and the following laboratory tests: ALT, AST, GGT, albumin, creatinine, total cholesterol, LDL, triglycerides (TG), fasting plasma glucose (FPG), 2 hour post prandial blood sugar (2hpp), HbA1C and Vitamin D. Pelviabdominal ultrasonography was done to all our subjects plus fatty liver index (FLI) calculation.
In this present study, all groups show no difference as regard age, sex, weight, BMI and WC. All patient groups had high systolic and diastolic blood pressure, AST, ALT, total cholesterol, LDL, triglycerides and FLI in comparing to controls. Diabetic groups (1 and 2) had high FPG, 2hpp and HbA1c than non diabetic groups (3 and controls). NAFLD groups (1, 3) had higher total cholesterol, LDL, triglycerides and FLI than group 2 (T2DM only).
Total vitamin D level was lower in all patients groups (group 1(T2DM+NAFLD), group 2(T2DM) and group 3(NAFLD)) comparing to controls (15. 5±7. 46, 24. 4±8. 19 and 22. 86±9. 58 vs 55. 8±11. 98 ng/ml respectively). Diabetic patients with NAFLD had lower total vitamin D level than diabetic or NAFLD patients. No statistical difference between T2DM patients and NAFLD patients as regard vitamin D level. Females had lower total vitamin D level than males. Total vitamin D level has a negative correlation with age, weight, body mass index, waist circumference, systolic and diastolic blood pressure, total cholesterol, LDL, triglycerides, FPG, HbA1c, FLI and appearance of bright fatty liver by ultrasonography. .