Vitamin D levels and depression in type 2 diabetes mellitus patients: a cross-sectional study

  • Rudi Putranto Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia https://orcid.org/0000-0002-7950-7706
  • Kresna Adhiatma Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Tri Juli Edi Tarigan Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Cleopas Martin Rumende Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Hamzah Shatri Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia https://orcid.org/0000-0003-1393-9669
  • Iris Rengganis Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Pringgodigdo Nugroho Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Ikhwan Rinaldi Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia https://orcid.org/0000-0002-6872-8802
DOI: https://doi.org/10.13181/mji.oa.237005
Keywords: depression, type 2 diabetes mellitus, vitamin D level
Abstract viewed: 152 times
PDF downloaded: 126 times
HTML downloaded: 30 times
EPUB downloaded: 31 times

Abstract

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.

References

  1. 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

  2. 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

  3. Bădescu SV, Tătaru C, Kobylinska L, Georgescu EL, Zahiu DM, Zăgrean L. The association between diabetes mellitus and depression. J Med Life. 2016;9(2):120-5.

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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

  20. 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

  21. 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

  22. 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

  23. 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

  24. 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

  25. 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

  26. 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

  27. 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

  28. 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

  29. 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

  30. 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

  31. 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

  32. 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

  33. 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

  34. 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

  35. Berridge MJ. Vitamin D deficiency and diabetes. Biochem J. 2017;474(8):1321-32. https://doi.org/10.1042/BCJ20170042

  36. 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

  37. 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

  38. 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

  39. 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

  40. 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

  41. 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

  42. 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

  43. 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

  44. 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

Published
2023-12-14
How to Cite
1.
Putranto R, Adhiatma K, Tarigan TJE, Rumende CM, Shatri H, Rengganis I, Nugroho P, Rinaldi I. Vitamin D levels and depression in type 2 diabetes mellitus patients: a cross-sectional study. Med J Indones [Internet]. 2023Dec.14 [cited 2024Apr.30];32(3):177-82. Available from: http://mji.ui.ac.id/journal/index.php/mji/article/view/7005
Issue
Vol. 32 No. 3 (2023): September
Section
Clinical Research

Copyright (c) 2023 Rudi Putranto, Kresna Adhiatma, Tri Juli Edi Tarigan, Cleopas Martin Rumende, Hamzah Shatri, Iris Rengganis, Pringgodigdo Nugroho, Ikhwan Rinaldi

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Authors who publish with Medical Journal of Indonesia agree to the following terms:

  1. Authors retain copyright and grant Medical Journal of Indonesia right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial License that allows others to remix, adapt, build upon the work non-commercially with an acknowledgment of the work’s authorship and initial publication in Medical Journal of Indonesia.
  2. Authors are permitted to copy and redistribute the journal's published version of the work non-commercially (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Medical Journal of Indonesia.

Most read articles by the same author(s)