Vitamin D levels and depression in type 2 diabetes mellitus patients: a cross-sectional study
DOI:
https://doi.org/10.13181/mji.oa.237005Keywords:
depression, type 2 diabetes mellitus, vitamin D levelAbstract
BACKGROUND The prevalence of type 2 diabetes mellitus (T2DM) is increasing and commonly accompanied by comorbidities, such as depression. Vitamin D levels have been associated with T2DM and depression although the mechanism is uncertain. This study aimed to compare vitamin D levels between patients with T2DM with and without depression in the Indonesian community, where such research is rare.
METHODS This cross-sectional study was conducted at Cipto Mangunkusumo Hospital. The participants who met the inclusion criteria on an outpatient basis were screened for depression using the Beck Depression Inventory-II (BDI-II) questionnaire and then divided into 2 groups: patients with T2DM with (BDI-II ≥14) and without (BDI-II <14) depression. Both groups were examined for vitamin D levels using the ELISA method, and an analysis of the mean difference between both groups was performed.
RESULTS Of 60 patients, 23 (38%) experienced depression. The median vitamin D levels were 21.8 ng/ml (IQR 14.9–26.6) in the depression group and 26.5 ng/ml (IQR 23.96–34.08) in the non-depression group (p = 0.001). After performing multivariate analysis with confounding variables, the adjusted OR of variables (sex, sun exposure score, and body mass index) was 1.123 (95% CI: 1.003–1.259; p = 0.045).
CONCLUSIONS Vitamin D levels were significantly lower in patients with T2DM with depression. Future studies should be carried out to determine the benefits of vitamin D supplementation in patients with T2DM with depression and their pathophysiology.
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References
Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019;157:107843. https://doi.org/10.1016/j.diabres.2019.107843
Auliana A, Yunir E, Putranto R, Nugroho P. [The effect of depression on infection improvement diabetic foot ulcers]. J Penyakit Dalam Indones. 2015;2(4):212-6. Indonesian. https://doi.org/10.7454/jpdi.v2i4.88
B?descu SV, T?taru C, Kobylinska L, Georgescu EL, Zahiu DM, Z?grean L. The association between diabetes mellitus and depression. J Med Life. 2016;9(2):120-5.
Maimaitituerxun R, Chen W, Xiang J, Kaminga AC, Wu XY, Chen L, et al. Prevalence of comorbid depression and associated factors among hospitalized patients with type 2 diabetes mellitus in Hunan, China. BMC Psychiatry. 2023;23(1):158. https://doi.org/10.1186/s12888-023-04657-4
Khaledi M, Haghighatdoost F, Feizi A, Aminorroaya A. The prevalence of comorbid depression in patients with type 2 diabetes: an updated systematic review and meta-analysis on huge number of observational studies. Acta Diabetol. 2019;56(6):631-50. https://doi.org/10.1007/s00592-019-01295-9
Husain K, Sharma G, Rizvi A. Co-relation between vitamin D levels and Hamilton depression scores in patients with depression. J Med Sci Clin Res. 2017;5(7):25513-8. https://doi.org/10.18535/jmscr/v5i7.200
Hsaini A. Association between vitamin D, and depression among diabetes patients. Clin Nutr. 2018;37(Suppl 1):S283. https://doi.org/10.1016/j.clnu.2018.06.1990
Anglin RE, Samaan Z, Walter SD, McDonald SD. Vitamin D deficiency and depression in adults: systematic review and meta-analysis. Br J Psychiatry. 2013;202:100-7. https://doi.org/10.1192/bjp.bp.111.106666
Ju SY, Lee YJ, Jeong SN. Serum 25-hydroxyvitamin D levels and the risk of depression: a systematic review and meta-analysis. J Nutr Health Aging. 2013;17(5):447-55. https://doi.org/10.1007/s12603-012-0418-0
Milaneschi Y, Hoogendijk W, Lips P, Heijboer AC, Schoevers R, van Hemert AM, et al. The association between low vitamin D and depressive disorders. Mol Psychiatry. 2014;19(4):444-51. https://doi.org/10.1038/mp.2013.36
Al-Timimi DJ, Ali AF. Serum 25(OH) D in diabetes mellitus type 2: relation to glycaemic control. J Clin Diagn Res. 2013;7(12):2686-8. https://doi.org/10.7860/JCDR/2013/6712.3733
Husna K, Widajanti N, Sumarmi S, Firdaus H. [Correlation of sun exposure score and vitamin D intake with serum 25(OH)D levels in older women]. J Penyakit Dalam Indones. 2021;8(2):63-71. Indonesian. https://doi.org/10.7454/jpdi.v8i2.516
Ginting H, Näring G, van der Veld WM, Srisayekti W, Becker ES. Validating the Beck Depression Inventory-II in Indonesia's general population and coronary heart disease patients. Int J Clin Health Psychol. 2013;13(3):235-42. https://doi.org/10.1016/S1697-2600(13)70028-0
Jukic AM, Hoofnagle AN, Lutsey PL. Measurement of vitamin D for epidemiologic and clinical research: shining light on a complex decision. Am J Epidemiol. 2018;187(4):879-90. https://doi.org/10.1093/aje/kwx297
Westra S, Simsek S, Rutters F, Krul-Poel YM, Stehouwer CD, Dekker JM, et al. Low vitamin D levels are not a contributing factor to higher prevalence of depressive symptoms in people with type 2 diabetes mellitus: the Hoorn study. Diabet Med. 2017;34(4):577-81. https://doi.org/10.1111/dme.13265
Kamalzadeh L, Saghafi M, Mortazavi SS, Jolfaei AG. Vitamin D deficiency and depression in obese adults: a comparative observational study. BMC Psychiatry. 2021;21(1):599. https://doi.org/10.1186/s12888-021-03586-4
Stokes CS, Grünhage F, Baus C, Volmer DA, Wagenpfeil S, Riemenschneider M, et al. Vitamin D supplementation reduces depressive symptoms in patients with chronic liver disease. Clin Nutr. 2016;35(4):950-7. https://doi.org/10.1016/j.clnu.2015.07.004
Vaziri F, Nasiri S, Tavana Z, Dabbaghmanesh MH, Sharif F, Jafari P. A randomized controlled trial of vitamin D supplementation on perinatal depression: in Iranian pregnant mothers. BMC Pregnancy Childbirth. 2016;16:239. https://doi.org/10.1186/s12884-016-1024-7
Arathimos R, Ronaldson A, Howe LJ, Fabbri C, Hagenaars S, Hotopf M, et al. Vitamin D and the risk of treatment-resistant and atypical depression: a Mendelian randomization study. Transl Psychiatry, 2021;11(561). https://doi.org/10.1038/s41398-021-01674-3
Mozaffari-Khosravi H, Nabizade L, Yassini-Ardakani SM, Hadinedoushan H, Barzegar K. The effect of 2 different single injections of high dose of vitamin D on improving the depression in depressed patients with vitamin D deficiency: a randomized clinical trial. J Clin Psychopharmacol. 2013;33(3):378-85. https://doi.org/10.1097/JCP.0b013e31828f619a
Okereke OI, Reynolds CF 3rd, Mischoulon D, Chang G, Vyas CM, Cook NR, et al. Effect of long-term vitamin D3 supplementation vs placebo on risk of depression or clinically relevant depressive symptoms and on change in mood scores: a randomized clinical trial. JAMA. 2020;324(5):471-80. https://doi.org/10.1001/jama.2020.10224
Salk RH, Hyde JS, Abramson LY. Gender differences in depression in representative national samples: meta-analyses of diagnoses and symptoms. Psychol Bull. 2017;143(8):783-822. https://doi.org/10.1037/bul0000102
Eid RS, Gobinath AR, Galea LA. Sex differences in depression: insights from clinical and preclinical studies. Prog Neurobiol. 2019;176:86-102. https://doi.org/10.1016/j.pneurobio.2019.01.006
Zhao L, Han G, Zhao Y, Jin Y, Ge T, Yang W, et al. Gender differences in depression: evidence from genetics. Front Genet. 2020;11:562316. https://doi.org/10.3389/fgene.2020.562316
Al Qusaibi B, Mosli H, Kattan W, Fadel H, Alariefy A, Almalki B, et al. Depression among patients with type 2 diabetes mellitus at King Abdulaziz University Hospital (KAUH): a cross-sectional study. Cureus. 2022;14(6):e25990. https://doi.org/10.7759/cureus.25990
Wang Y, Yang H, Meng P, Han Y. Association between low serum 25-hydroxyvitamin D and depression in a large sample of Chinese patients with type 2 diabetes mellitus. J Affect Disord. 2017;224:56-60. https://doi.org/10.1016/j.jad.2016.10.040
Wacker M, Holick MF. Sunlight and vitamin D: a global perspective for health. Dermatoendocrinol. 2013;5(1):51-108. https://doi.org/10.4161/derm.24494
Nimitphong H, Holick MF. Vitamin D status and sun exposure in southeast Asia. Dermatoendocrinol. 2013;5(1):34-7. https://doi.org/10.4161/derm.24054
Komulainen K, Hakulinen C, Lipsanen J, Partonen T, Pulkki-Råback L, Kähönen M, et al. Long-term residential sunlight exposure associated with cognitive function among adults residing in Finland. Sci Rep. 2022;12(20818). https://doi.org/10.1038/s41598-022-25336-6
Cui Y, Gong Q, Huang C, Guo F, Li W, Wang Y, et al. The relationship between sunlight exposure duration and depressive symptoms: a cross-sectional study on elderly Chinese women. PLoS One. 2021;16(7):e0254856. https://doi.org/10.1371/journal.pone.0254856
Xu Y, Qi J, Yang Y, Wen X. The contribution of lifestyle factors to depressive symptoms: a cross-sectional study in Chinese college students. Psychiatry Res. 2016;245:243-9. https://doi.org/10.1016/j.psychres.2016.03.009
Veleva BI, van Bezooijen RL, Chel VG, Numans ME, Caljouw MA. Effect of ultraviolet light on mood, depressive disorders and well-being. Photodermatol Photoimmunol Photomed. 2018;34(5):288-97. https://doi.org/10.1111/phpp.12396
Køster B, Søndergaard J, Nielsen JB, Olsen A, Bentzen J. Reliability and consistency of a validated sun exposure questionnaire in a population-based Danish sample. Prev Med Rep. 2018;10:43-8. https://doi.org/10.1016/j.pmedr.2018.02.002
Islam MR, Sohan M, Daria S, Al Masud A, Ahmed MU, Roy A, et al. Evaluation of inflammatory cytokines in drug-naïve major depressive disorder: a systematic review and meta-analysis. Int J Immunopathol Pharmacol. 2023;37. https://doi.org/10.1177/03946320231198828
Berridge MJ. Vitamin D deficiency and diabetes. Biochem J. 2017;474(8):1321-32. https://doi.org/10.1042/BCJ20170042
Fallah M, Askari G, Asemi Z. Is vitamin D status associated with depression, anxiety and sleep quality in pregnancy: a systematic review. Adv Biomed Res. 2020;9:32. https://doi.org/10.4103/abr.abr_188_19
Di Gessa G, Biddulph JP, Zaninotto P, de Oliveira C. Changes in vitamin D levels and depressive symptoms in later life in England. Sci Rep. 2021;11(1):7724. https://doi.org/10.1038/s41598-021-87432-3
Saji Parel N, Krishna PV, Gupta A, Uthayaseelan K, Uthayaseelan K, Kadari M, et al. Depression and vitamin D: a peculiar relationship. Cureus. 2022;14(4):e24363. https://doi.org/10.7759/cureus.24363
Omidian M, Mahmoudi M, Abshirini M, Eshraghian MR, Javanbakht MH, Zarei M, et al. Effects of vitamin D supplementation on depressive symptoms in type 2 diabetes mellitus patients: randomized placebo-controlled double-blind clinical trial. Diabetes Metab Syndr. 2019;13(4):2375-80. https://doi.org/10.1016/j.dsx.2019.06.011
Penckofer S, Ridosh M, Adams W, Grzesiak M, Woo J, Byrn M, et al. Vitamin D supplementation for the treatment of depressive symptoms in women with type 2 diabetes: a randomized clinical trial. J Diabetes Res. 2022;2022:4090807. https://doi.org/10.1155/2022/4090807
Fazelian S, Amani R, Paknahad Z, Kheiri S, Khajehali L. Effect of vitamin D supplement on mood status and inflammation in vitamin D deficient type 2 diabetic women with anxiety: a randomized clinical trial. Int J Prev Med. 2019;10:17. https://doi.org/10.4103/ijpvm.IJPVM_174_18
Mirzavandi F, Babaie S, Rahimpour S, Razmpoosh E, Talenezhad N, Aghaei Zarch SM, et al. The effect of high dose of intramuscular vitamin D supplement injections on depression in patients with type 2 diabetes and vitamin D deficiency: a randomized controlled clinical trial. Obes Med. 2020;17:100192. https://doi.org/10.1016/j.obmed.2020.100192
Carlberg C, Raczyk M, Zawrotna N. Vitamin D: a master example of nutrigenomics. Redox Biol. 2023;62:102695. https://doi.org/10.1016/j.redox.2023.102695
Santana KV, Oliver SL, Mendes MM, Lanham-New S, Charlton KE, Ribeiro H. Association between vitamin D status and lifestyle factors in Brazilian women: implications of sun exposure levels, diet, and health. EClinicalMedicine. 2022;47:101400. https://doi.org/10.1016/j.eclinm.2022.101400
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