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Roth, Christian

Journal of Pediatric Endocrinology and Metabolism

Editor-in-Chief: Kiess, Wieland

Ed. by Bereket, Abdullah / Cohen, Pinhas / Darendeliler, Feyza / Dattani, Mehul / Gustafsson, Jan / Luo, Feihong / Mericq, Veronica / Toppari, Jorma

Editorial Board Member: Battelino, Tadej / Buyukgebiz, Atilla / Cassorla, Fernando / Chrousos, George P. / Cutfield, Wayne / Fideleff, Hugo L. / Hershkovitz, Eli / Hiort, Olaf / LaFranchi, Stephen H. / Lanes M. D., Roberto / Mohn, Angelika / Root, Allen W. / Rosenfeld, Ron G. / Werther, George / Zadik, Zvi

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Hepatic dysfunction is associated with vitamin D deficiency and poor glycemic control in diabetes mellitus

1 / Zheni G. Stavre2 / Louise Maranda1 / Karen Cullen1 / Mary M. Lee1

1Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA

2Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA

Corresponding author: Benjamin U. Nwosu, MD, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA Phone: +1-508-334-7872, Fax: +1-508-856-4287

Citation Information: Journal of Pediatric Endocrinology and Metabolism. Volume 25, Issue 1-2, Pages 181–186, ISSN (Online) 2191-0251, ISSN (Print) 0334-018X, DOI: https://doi.org/10.1515/jpem-2011-0403, January 2012

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Background/Aims: The effect of the rising prevalence of nonalcoholic fatty liver disease on the 25-hydroxylation of pre-vitamin D in the liver, and consequent glycemic control in children with diabetes mellitus is not known. Our aim was to determine whether mild hepatic dysfunction was associated with impaired 25-hydroxylation of pre-vitamin D, and if this vitamin D deficiency was associated with impaired glycemic control in children and adolescents with type 1 diabetes (TIDM) and type 2 diabetes (T2DM).

Methods: We analyzed simultaneously measured HbA1c, ALT, AST, and 25OHD levels and clinical parameters in 121 children and adolescents with T1DM (n=81) and T2DM (n=40). The subjects, ages 11–21 years, all had diabetes of >6 months duration. Multivariate linear regression was used to analyze the associations, while comparisons between subgroups were made using two-tailed Student’s t-test.

Results: Vitamin D deficiency (25OHD <15 ng/mL (37.5 nmol/L) was more prevalent in T2DM patients (47.5%) compared to T1DM patients (18.5%). Subjects with T2DM had significantly elevated transaminases (AST 39.3±2.0 vs. 22.4±1.4, p<0.001; ALT 30.6±1.8 vs. 18.7±1.3, p<0.001) compared to T1DM patients, and demonstrated a significant inverse relationship between their HbA1c and 25OHD levels (β=–0.42, p=0.02), compared to T1DM subjects (β=–0.06, p=0.62).

Conclusions: The association of elevated ALT with vitamin D deficiency suggests that hepatic dysfunction could impair vitamin D metabolism and negatively impact glycemic control in youth with T2DM.

Keywords: glycemia; hepatic dysfunction; type 1 diabetes; type 2 diabetes; vitamin D deficiency

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