Effect of vitamin D replacement on indexes of insulin resistance in overweight elderly individuals: a randomized controlled trial

• Published in: The American journal of clinical nutrition 2016-08, Vol.104 (2), p.315-323
• Main Authors: El-Hajj Fuleihan, Ghada, Baddoura, Rafic, Habib, Robert H, Halaby, Georges, Arabi, Asma, Rahme, Maya, Singh, Ravinder J, Kassem, Moustapha, Mahfoud, Ziyad, Hoteit, Maha, Daher, Rose T, Kassir, Mohamed-Faisal
• Format: Article
• Language: English
• Subjects: Aged; Body Mass Index; Cholecalciferol - administration & dosage; Cholecalciferol - blood; Cholecalciferol - therapeutic use; Clinical trials; Comorbidity; Dietary Supplements; Double-Blind Method; Effects; Female; Humans; Insulin Resistance; Male; Obesity; Obesity - blood; Obesity - complications; Older people; Overweight; Vitamin D; Vitamin D - analogs & derivatives; Vitamin D - blood; Vitamin D Deficiency - blood; Vitamin D Deficiency - complications; Vitamin D Deficiency - drug therapy; Vitamins - administration & dosage; Vitamins - blood; Vitamins - therapeutic use
• ISSN: 0002-9165; 1938-3207
• DOI: 10.3945/ajcn.116.132589

It is unclear whether and at what dose vitamin D supplementation affects insulin resistance (IR). We sought to investigate whether vitamin D at doses higher than currently recommended decreases indexes of IR in an ambulatory population of overweight elderly subjects. This double-blind, randomized, controlled multicenter trial enrolled 257 elderly overweight individuals aged ≥65 y with baseline 25-hydroxyvitamin D [25(OH)D] concentrations between 10 and 30 ng/mL. All subjects received 1000 mg calcium citrate/d, with vitamin D administered weekly at an equivalent dose of 600 or 3750 IU/d. The homeostasis model assessment (HOMA) of IR index at 1 y was the primary outcome. We also assessed the McAuley index. In total, 222 subjects (55% women) with a mean ± SD age and body mass index (BMI; in kg/m(2)) of 71 ± 4 y and 30 ± 4, respectively, completed the study. Subjects' baseline characteristics, including IR indexes, were similar across groups: 69% had prediabetes, 54% had hypertension (47% were taking antihypertensive medications), and 60% had hyperlipidemia, nearly half of whom were receiving lipid-lowering drugs. At 1 y, mean ± SD serum 25(OH)D increased from 20 ± 7 to 26 ± 7 ng/mL in the low-dose arm (P < 0.0001) and from 21 ± 8 to 36 ± 10 ng/mL in the high-dose arm (P < 0.001). Median HOMA-IR indexes did not change compared with baseline concentrations and were similar in the high- [2.2 (IQR: 1.5, 2.9)] and low-dose [2.3 (IQR: 1.6, 3.3] treatment groups. Adjusted analyses showed that HOMA-IR was predicted by the baseline HOMA index and BMI but not by vitamin D dose, baseline serum 25(OH)D, or change in 25(OH)D. Vitamin D3 at 3750 IU/d did not improve HOMA-IR compared with the Institute of Medicine Recommended Dietary Allowance of 600 IU/d in elderly overweight individuals. This trial was registered at clinicaltrials.gov as NCT01315366.