Vitamin D3 supplementation and body composition in persons with obesity and type 2 diabetes in the UAE: A randomized controlled double-blinded clinical trial.

BACKGROUND & AIM: The co-existence of vitamin D deficiency with obesity and type 2 diabetes is highly prevalent in the United Arab Emirates. We do not have studies evaluating the vitamin D dose response and sufficiency, and if sufficient substitution dose during a longer period could decrease obesity or change fat distribution in obese type 2 diabetic vitamin D deficient Emiratis. METHODS: A randomized double-blind clinical trial was conducted for 6 months followed by another 6 months of un-blinded follow up with 87 obese, type 2 diabetic participants. Serum 25-hydroxy vitamin D (S-25(OH)D), anthropometric data, and life-style factors such as diet and sunlight exposure were measured. The study was executed in 3 phases in two arms vitamin D arm (n = 45) and placebo arm (n = 42); in Phase 1 the vitamin D arm received 6000 IU vitamin D3/day (3 months) followed by Phase 2 with 3000 IU vitamin D3/day. During follow up (phase 3) both the arms were un-blinded and supplemented with 2200 IU vitamin D3/day for another 6 months. RESULTS: At the baseline a significant (p < 0.01) positive association between body fat mass and body weight (r = 0.97) muscle mass (r = 0.47), water mass (r = 0.54), waist circumference (r = 0.82) and serum PTH (r = 0.28) was observed. On supplementation no significant changes in anthropometric dimensions was observed. S-25(OH) D peaked in phase 1 (77.2 ± 30.1 vs 28.5 ± 9.2, p = 0.003) followed by a decrease in phase 2 (62.3 ± 20.8, p = 0.006) paralleled by a decrease in parathyroid hormone in phase 2 (5.9 ± 2.4 vs 4.5 ± 1.8, p < 0.01) compared to baseline in vitamin D group. CONCLUSION: This study shows no significant influence of vitamin D supplementation on weight, fat mass or waist circumference in type 2 diabetic obese vitamin D deficient participants of Arab ethnicity after one year. Despite a relatively high daily dose of vitamin D3 we did not achieve target levels of S-25(OH)D above 75 nmol/L in this population. However, supplementation was safe, improved s- 25 (OH)D also reducing the incidence of eucalcemic parathyroid hormone elevation. CLINICAL TRIAL REGISTRY: ClinicalTrials.gov Identifier: NCT02101151.

Effect of Ramadan fasting on metabolic markers, body composition, and dietary intake in Emiratis of Ajman (UAE) with metabolic syndrome.

BACKGROUND/AIM: The aim of the study was to evaluate the effect of Ramadan fasting on metabolic markers, body composition and dietary intake in native Emiratis of Ajman, UAE with the metabolic syndrome (MS). DESIGN: 19 patients (14 Female, 5 Male) aged 37.1 ± 12.5 years, were encouraged healthy lifestyle changes during fasting and data was collected 1 week before and in the fourth week of Ramadan. RESULTS: No patients experienced complications or increased symptoms of hypoglycemia during Ramadan. Total energy consumption remained similar. Meal frequency decreased (3.2 ± 0.5 vs 2.1 ± 0.4 meals/day). Protein intake decreased 12% (P = 0.04) but fat intake increased 23% (P = 0.03). Body weight (103.9 ± 29.8 vs 102.1 ± 29.0 kg, P = 0.001) and waist circumference (123 ± 14 vs 119 ± 17 cm, P = 0.001) decreased. Forty percent of patients increased their physical activity due to increased praying hours. Fasting P-glucose (6.3 ± 1.7 vs 6.8 ± 2.0 mmol/L, P = 0.024) and B-HbA(1c) concentrations 6.3 ± 0.9 vs 6.5% ± 0.9%, P = 0.003) increased but P-insulin concentration, HOMA-IR index and lipid concentrations remained unchanged. CONCLUSION: The present study investigated the effect of Ramadan fasting on dietary intake, metabolic parameters and body composition showing that the energy consumption per day did not decrease, although the fat intake increased. However, the patients lost weight and reduced their waist circumference. Ramadan fasting has also elicited small but significant increases in Glucose and HbA(1c) after 4 weeks.

Reliability of the rapid bedside whole-blood quantitative cardiac troponin T assay in the diagnosis of myocardial injury in patients with acute coronary syndrome.

BACKGROUND: A rapid bedside whole-blood quantitative cTnT assay has recently been developed. We evaluated the reliability of this test for the diagnosis of myocardial injury in patients with acute coronary syndrome (ACS). MATERIAL/METHODS: Whole-blood cTnT levels were measured in 96 patients with ACS using the Roche Cardiac Reader(R) rapid bedside assay device, and the results were compared with serum cTnT levels in the same patients measured by the Roche Elecsys(R) Immunoanalyzer. There were 50 patients with clinical evidence of myocardial injury and 56 without. RESULTS: From the qualitative point of view (reporting negative or positive tests), the results of the rapid bedside tests were identical to those obtained by the serum immunoanalyzer. From quantitative the point of view, the rapid bedside tests could not measure exact values below 0.1 ng/ml (reported negative) or above 2.0 ng/ml (reported >2.0). The measurements made by the rapid bedside tests within the range of 0.1 to 2.0 ng/ml correlated well with those of the serum immunoanalyzer (Cardiac Reader(R) cTnT=0.61, Elecsys(R) cTnT+0.12; r=0.88), but their mean values were significantly lower (1.20I0.71 vs. 1.41I1.03, p=0.0007). CONCLUSIONS: The rapid bedside cTnT assay correlates well with immunoanalyzer measurements between the values of 0.1 and 2.0 ng/ml. However, they tend to give significantly lower values and fail to give exact values below 0.1 and above 2.0 ng/ml, which may affect their performance in monitoring and managing patients with ACS, and limit their use in predicting outcome.

Evaluation of 6 cardiac troponin assays in patients with acute coronary syndrome.

OBJECTIVE: An increasing body of evidence has demonstrated the value of strategies based on cardiac troponin (cTn) assays in the diagnosis, prognosis and monitoring of patients with acute coronary syndrome (ACS). We evaluated the performance and the practicability of 6 commercially available assays (5 cTnI and 1 cTnT) in patients with ACS. METHODS: This study was carried out between October 2001 and June 2002 at Armed Forces Hospital in collaboration with Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia. Blood samples from 96 patients, 40 with and 56 without clinical evidence of myocardial injury, were used for the evaluation. Cardiac TnI assays were performed using 5 different immunoanalyzers AxSYM (Abbott Laboratories), Stratus CS (Dade Behring), ACS:180 (Bayer), Centaur (Bayer) and Immulite (Diagnostic Products Corporation) while cTnT was measured on the Elecsys (Roche) immunoanalyzer. The sensitivity, specificity and positive and negative predictive values (PV) were calculated for all assays. General and special features related to installation, routine operation, quality control and other various special parameters of each immunoanalyzer were evaluated (using the score of 1-5 for each parameter) and compared with those of other analyzers. RESULTS: The highest reliability values were observed with Immulite, followed by AxSYM, then Stratus, then ACS:180, and Centaur, and lastly by Elecsys. The highest practicability values were observed with Elecsys, and Centaur, followed by AxSYM and the lowest values were observed with Stratus. CONCLUSION: Considering the combined performance and practicability score, the difference between the 10% coefficient variation cut off value and the 99th percentile value, and the difference in the relative reactivities to the various cTnI forms, the most favorable values were observed with AxSYM, followed by Immulite and Elecsys, then Centaur and Stratus, and lastly by ACS:180.