ÖZ
Amaç
Selenyum (Se) ve D vitamini, metabolik sağlık ve insülin duyarlılığı ile ilişkili önemli mikro besin öğeleridir. Bu çalışmada, periyodik sağlık muayenesi için başvuran hastalarda Se eksikliği ile insülin direnci (IR) arasındaki ilişkinin araştırılması ve ayrıca D vitamini ile Se’nin IR üzerindeki olası sinerjik rolünün incelenmesi amaçlanmıştır.
Yöntemler
Bu kesitsel çalışma, Bezmialem Vakıf Üniversitesi Hastanesi Aile Hekimliği polikliniklerinde periyodik sağlık muayenesine başvuran 161 yetişkin hastada serum Se düzeyleri, D vitamini ve IR arasındaki ilişkiyi incelemiştir. Serum Se düzeyleri indüktif eşleşmiş plazma kütle spektrometrisi yöntemiyle, D vitamini düzeyleri ise sıvı kromatografi-kütle spektrometrisi yöntemiyle ölçülmüştür. İstatistiksel analizler SPSS® yazılımı (versiyon 22) kullanılarak yapılmıştır. İstatistiksel anlamlılık düzeyi p≤0.05 olarak kabul edilmiştir.
Bulgular
Hastaların ortalama yaşı 39.31±13.20 yıl idi. Çalışma popülasyonunun %72’si (n=116) kadındı. Ortalama vücut kitle indeksi 25.83±4.81 olarak bulundu. Hastaların ortalama Se düzeyi 71.66±11.56 µg/L idi. Katılımcıların %35’inde IR [IR'nin homeostatik model değerlendirmesi (HOMA-IR ≥2.5)] saptandı ve Se eksikliği olanlarda IR prevalansı anlamlı olarak daha yüksekti (<63 µg/L, p=0.016). Se eksikliği olan hastalarda D vitamini düzeyleri daha düşük (p=0.001) ve HOMA-IR değerleri daha yüksek bulundu (p=0.006).
Sonuç: Bulgular, Se ve D vitamini eksiklikleri ile bozulmuş insülin duyarlılığı ve değişmiş metabolik belirteçler arasında sinerjik bir ilişki olduğunu göstermektedir. Bu çalışma, insülin direnci ve metabolik sağlıkla ilişkili olarak Se ve D vitamininin potansiyel önemini vurgulamaktadır. Sonuçlarımız, bu mikro besin maddelerindeki eksikliklerin giderilmesinin insülin duyarlılığı ve metabolik sağlık açısından önemli olabileceğini göstermektedir.
Anahtar Kelimeler:
İnsülin direnci, selenyum, tip 2 diyabet, vitamin D
Kaynaklar
1
Rayman MP. Selenium and human health. Lancet. 2012;379:1256-68.
2
Rocourt CR, Cheng WH. Selenium supranutrition: are the potential benefits of chemoprevention outweighed by the promotion of diabetes and insulin resistance? Nutrients. 2013;5:1349-65.
3
Ouyang J, Cai Y, Song Y, Gao Z, Bai R, Wang A. Potential benefits of selenium supplementation in reducing insulin resistance in patients with cardiometabolic diseases: a systematic review and meta-analysis. Nutrients. 2022;14:4933.
4
Kim Y, Oh YK, Lee J, Kim E. Could nutrient supplements provide additional glycemic control in diabetes management? A systematic review and meta-analysis of randomized controlled trials of as an add-on nutritional supplementation therapy. Arch Pharm Res. 2022;45:185-204.
5
Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28:412-9.
6
Liang J, He Y, Huang C, Ji F, Zhou X, Yin Y. The regulation of selenoproteins in diabetes: a new way to treat diabetes. Curr Pharm Des. 2024;30:1541-7.
7
American Diabetes Association Professional Practice Committee. 2. classification and diagnosis of diabetes: standards of medical care in diabetes-2022. Diabetes Care. 2022;45(Suppl 1):S17-38.
8
Schwarz K, Foltz CM. Selenium as an integral part of factor 3 against dietary necrotic liver degeneration. 1951. Nutrition. 1999;15:255.
9
Wang XL, Yang TB, Wei J, Lei GH, Zeng C. Association between serum selenium level and type 2 diabetes mellitus: a non-linear dose-response meta-analysis of observational studies. Nutr J. 2016;15:48.
10
Shimada BK, Swanson S, Toh P, Seale LA. Metabolism of selenium, selenocysteine, and selenoproteins in ferroptosis in solid tumor cancers. Biomolecules. 2022;12:1581.
11
Men L, Yu S, Yao J, Li Y, Ren D, Du J. Selenoprotein S protects against adipocyte death through mediation of the IRE1α-sXBP1 pathway. Biochem Biophys Res Commun. 2018;503:2866-71.
12
Li F, Mao A, Fu X, She Y, Wei X. Correlation between SEPS1 gene polymorphism and type 2 diabetes mellitus: a preliminary study. J Clin Lab Anal. 2019;33:e22967.
13
Rayman MP, Stranges S. Epidemiology of selenium and type 2 diabetes: can we make sense of it? Free Radic Biol Med. 2013;65:1557-64.
14
Cheng L, Lv C, Xue L, Zhang C, Wang L, Wang X, et al. The prevention and improvement effects of vitamin D on type 2 diabetes mellitus: evidence from an umbrella review on meta-analyses of cohort studies and randomized controlled trials. Front Nutr. 2024;11:1462535.
15
Alharithy M, Alafif N. Association of selenium intake and selenium concentrations with risk of type 2 diabetes in adults: a narrative review. Metabolites. 2023;13:767.
16
Pludowski P, Grant WB, Karras SN, Zittermann A, Pilz S. Vitamin D supplementation: a review of the evidence arguing for a daily dose of 2000 international units (50 µg) of vitamin D for adults in the general population. Nutrients. 2024;16:391.
17
Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser. 1995;854:1-452.
18
Duffield-Lillico AJ, Reid ME, Turnbull BW, Combs GF Jr, Slate EH, Fischbach LA, et al. Baseline characteristics and the effect of selenium supplementation on cancer incidence in a randomized clinical trial: a summary report of the Nutritional Prevention of Cancer Trial. Cancer Epidemiol Biomarkers Prev. 2002;11:630-9.
19
Safaralizadeh R, Kardar GA, Pourpak Z, Moin M, Zare A, Teimourian S. Serum concentration of selenium in healthy individuals living in Tehran. Nutr J. 2005;4:32.
20
da Cunha S, Filho FM, Antelo DS, de Souza MM. Serum sample levels of selenium and copper in healthy volunteers living in Rio de Janeiro city. Sci Total Environ. 2003;301:51-4.
21
Karataş F, Halifeoğlu İ, Karatepe M, Konar V, Canatan H, Çolak R. Evaluation of changes in the level of serum selenium, MDA, and antioxidant vitamins (A, E, C) in diabetic patients. Firat Tip Derg. 2006;20:391-5.
22
Navarro-Alarcón M, López-G de la Serrana H, Pérez-Valero V, López-Martínez C. Serum and urine selenium concentrations as indicators of body status in patients with diabetes mellitus. Sci Total Environ. 1999;228:79-85.
23
Akbaraly TN, Arnaud J, Rayman MP, Hininger-Favier I, Roussel AM, Berr C, et al. Plasma selenium and risk of dysglycemia in an elderly French population: results from the prospective Epidemiology of Vascular Ageing Study. Nutr Metab (Lond). 2010;7:21.
24
Park K, Rimm EB, Siscovick DS, Spiegelman D, Manson JE, Morris JS, et al. Toenail selenium and incidence of type 2 diabetes in U.S. men and women. Diabetes Care. 2012;35:1544-51.
25
Salsman SJ, Hensley K, Floyd RA. Sensitivity of protein tyrosine phosphatase activity to the redox environment, cytochrome C, and microperoxidase. Antioxid Redox Signal. 2005;7:1078-88.
26
Ding H, Heng B, He W, Shi L, Lai C, Xiao L, et al. Chronic reactive oxygen species exposure inhibits glucose uptake and causes insulin resistance in C2C12 myotubes. Biochem Biophys Res Commun. 2016;478:798-803.
27
Mueller AS, Klomann SD, Wolf NM, Schneider S, Schmidt R, Spielmann J, et al. Redox regulation of protein tyrosine phosphatase 1B by manipulation of dietary selenium affects the triglyceride concentration in rat liver. J Nutr. 2008;138:2328-36.
28
Czernichow S, Couthouis A, Bertrais S, Vergnaud AC, Dauchet L, Galan P, et al. Antioxidant supplementation does not affect fasting plasma glucose in the Supplementation with Antioxidant Vitamins and Minerals (SU.VI.MAX) study in France: association with dietary intake and plasma concentrations. Am J Clin Nutr. 2006;84:395-9.
29
Bleys J, Navas-Acien A, Guallar E. Serum selenium and diabetes in U.S. adults. Diabetes Care. 2007;30:829-34.
30
Laclaustra M, Navas-Acien A, Stranges S, Ordovas JM, Guallar E. Serum selenium concentrations and diabetes in U.S. adults: National Health and Nutrition Examination Survey (NHANES) 2003-2004. Environ Health Perspect. 2009;117:1409-13.
31
Stranges S, Galletti F, Farinaro E, D’Elia L, Russo O, Iacone R, et al. Associations of selenium status with cardiometabolic risk factors: an 8-year follow-up analysis of the Olivetti Heart study. Atherosclerosis. 2011;217:274-8.
32
Gao S, Jin Y, Hall KS, Liang C, Unverzagt FW, Ji R, et al. Selenium level and cognitive function in rural elderly Chinese. Am J Epidemiol. 2007;165:955-65.
33
Zatterale F, Longo M, Naderi J, Raciti GA, Desiderio A, Miele C, et al. Chronic adipose tissue inflammation linking obesity to insulin resistance and type 2 diabetes. Front Physiol. 2020;10:1607.
34
Das P, Biswas S, Mukherjee S, Bandyopadhyay SK. Association of oxidative stress and obesity with insulin resistance in type 2 diabetes mellitus. Mymensingh Med J. 2016;25:148-52.
35
Steinbrenner H. Interference of selenium and selenoproteins with the insulin-regulated carbohydrate and lipid metabolism. Free Radic Biol Med. 2013;65:1538-47.
36
Misu H, Takamura T, Takayama H, Hayashi H, Matsuzawa-Nagata N, Kurita S, et al. A liver-derived secretory protein, selenoprotein P, causes insulin resistance. Cell Metab. 2010;12:483-95.
37
Coudray C, Roussel AM, Mainard F, Arnaud J, Favier A. Lipid peroxidation level and antioxidant micronutrient status in a pre-aging population; correlation with chronic disease prevalence in a French epidemiological study (Nantes, France). J Am Coll Nutr. 1997;16:584-91.
38
Dubey P, Thakur V, Chattopadhyay M. Role of minerals and trace elements in diabetes and insulin resistance. Nutrients. 2020;12:1864.
