title: The relationship between vitamin D status and cardiac autonomic neuropathy in patients with type 2 diabetes mellitus.
abstract: OBJECTIVE
  This study evaluates cardiac autonomic neuropathy and heart rate variability according to the vitamin D status in type 2 diabetes mellitus.
  
  
  METHODS
  A total of 163 patients were recruited. Cardiac autonomic neuropathy was assessed using five tests according to Ewing's protocol. The time and frequency domains of the heart rate variability were also evaluated. Patients were separated into three groups: vitamin D sufficient [25(OH)D ⩾ 20 ng/mL], vitamin D insufficient [10 ⩽ 25(OH)D < 20] and vitamin D deficiency [25(OH)D < 10] groups.
  
  
  RESULTS
  Both standard deviation of normal-to-normal RR intervals and square root of the average of the sum of the squares of the differences between adjacent NN intervals in the supine position were significantly lower in vitamin D deficient group. Low frequency/high frequency ratio in the upright position was significantly higher in the vitamin D deficient group. 25(OH)D levels are positively correlated with standard deviation of normal-to-normal RR intervals in the supine position. In multivariate logistic analysis, patients with vitamin D levels of 10 < 25(OH)D < 20 ng/mL showed borderline significantly lower cardiac autonomic neuropathy risk than those with 25(OH)D levels <10 ng/mL (odds ratio = 0.45 (0.23-1.01), p = 0.051).
  
  
  CONCLUSIONS
  Vitamin D deficiency was significantly correlated with heart rate variability parameters. However, there was only borderline significant association between vitamin D concentration and presence of cardiac autonomic neuropathy. Therefore, future studies are required to establish a relationship between vitamin D levels and cardiac autonomic neuropathy.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, Soonchunhyang University, Bucheon, South Korea Contributed equally to this article.
authors.forename: Chan-Hee
authors.initials: CH
authors.lastname: Jung
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, Cha University, Bundang, South Korea Contributed equally to this article.
authors.forename: Sang-Hee
authors.initials: SH
authors.lastname: Jung
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, Soonchunhyang University, Bucheon, South Korea.
authors.forename: Kyu-Jin
authors.initials: KJ
authors.lastname: Kim
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, Soonchunhyang University, Bucheon, South Korea.
authors.forename: Bo-Yeon
authors.initials: BY
authors.lastname: Kim
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, Soonchunhyang University, Bucheon, South Korea.
authors.forename: Chul-Hee
authors.initials: CH
authors.lastname: Kim
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, Soonchunhyang University, Bucheon, South Korea.
authors.forename: Sung-Koo
authors.initials: SK
authors.lastname: Kang
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, Soonchunhyang University, Bucheon, South Korea hanna@schmc.ac.kr.
authors.forename: Ji-Oh
authors.initials: JO
authors.lastname: Mok
mesh_terms: D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000378:metabolism* / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000378:metabolism* / Q000503:physiopathology; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D014807:Vitamin D / Q000378:metabolism*
chemical_list: D014807:Vitamin D
keywords: Cardiac autonomic neuropathy; heart rate variability; type 2 diabetes mellitus; vitamin D deficiency