Roles of Vitamin D and

Zinc In Type 1 Diabetes

Kaitlyn Warren
Ashton Huxtable
Deme Khamken
Lisa Swearingen
Sybil Pritchard
Autoimmune disorder characterized
by the destruction of pancreatic -
cells, which are responsible for
producing insulin.
Exact cause is unknown.
Genetic predisposition
Enterovirus
Environmental
TYPE 1 DIABETES
http://www.nature.com/ni/journal/v3/n4/fig_tab/ni0402-338_F1.html
SIGNS AND
SYMPTOMS
http://en.wikipedia.org/wiki/File:Main_symptoms_of_diabetes.png
Formerly known as insulin-
dependent or juvenile diabetes.
HISTORY/PREVALENCE
25.8 million children and adults in
the US have diabetes
8.3%
Only 5% have Type 1
http://www.diabetes.org/diabetes-basics/type-1/
CURRENT TREATMENTS
http://www.scientificamerican.com/blog/post/cancer-drug-cures-type-1-diabetes-i-2008-11-17/?id=cancer-drug-cures-type-1-diabetes-i-2008-11-17
http://www.bestsyndication.com/MAINpages/special-features/health/diabetes.htm
http://www.nytimes.com/health/guides/disease/type-1-diabetes/overview.html
Overall eating: specifically
carbs/sweets
15g=1 unit insulin
Individuals: everyone is different
Knowing your body
Some people are most
comfortable at different
levels (70-130ish)
Day to day changes:
Sleep: consistent
Stress: can increase, can be
emotion, nutritional, or
chemical stress
Hydration: hydrate constantly
Exercise: can be low or high
during workout, important to
check and regulate
Juice or quick sugar fix
good if low pre-workout
NUTRITION IMPLICATIONS
Zinc is a component of insulin
crystals.
Plays a role in reducing
oxidative stress.
ZnT-8 responsible for zinc
regulation
Anti-ZnT-8
ZINC IN T1D
http://pubs.rsc.org/en/content/articlehtml/2009/mt/b817203j
Deficiency may contribute to the
autoimmune process
Progression not necessarily affected
by continued deficiency.
Protection:
reduce helper T cells driving
autoimmune attack
protect -cells from cytokine-
induced death.
VITAMIN D AND T1D
http://www.vitamindwiki.com/Type+1+diabetes+is+increasing,
+vitamin+D+deficiency+may+be+one+of+the+reasons+%E2%80%
93+Aug+2013
American
Journal of
Epidemiology
Preclinical Serum 25-
Hydroxyvitamin D Levels and
Risk of Type 1 Diabetes in a
Cohort of US Military Personnel
Samples came from the Department of
Defense Serum Repository
40 million serum samples from 8
million personnel
Stored in freezers at -30C
US Naval Council of Personnel Boards
Database
Searched for US Marines diagnosed
with diabetes between 1997 and
2009
Identified 334 possible cases of Type
I Diabetes
Control: 2 matched to each case (except
for 7 cases)
Materials
Source: DoDSR Presentation
Serum25(OH)D levels were measured in
all of the samples and case-control
Main case group
Definite case group
Race and seasonal variations were
analyzed
Samples were analyzed using:
Linear regression models for long-
term average of vitamin D
Conditional logistic regression to
estimate the relative risk of T1D
Methods
Source: DiaSorin, Inc.
Results
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3626044/
Non-Hispanic Whites:
Average level: 93.2 nmol/L
Highest risk of T1D was among
individuals with the lowest 20% of 25
(OH)D levels
Non-Hispanic Blacks:
No significant associations
between 25(OH)D levels and T1D
Hispanics:
No significant associations
between 25(OH)D levels and T1D
Results
75-100nmol/L 100nmol/L
Main Case Group 40% lower risk 44% lower risk
Definite Case Group 54% lower risk 63% lower risk
Non-Hispanic Whites Data Table
Pediatric
Diabetes
Low zinc in drinking water is
associated with the risk of type 1
diabetes in children.
Families from Sweden were asked to send
in water samples from their tap
6 municipalities with high incidence
of T1D
7 municipalities with low incidence of
T1D
142 families that had a child with diabetes
were contacted (130 of these chose to
participate)
373 families for control were contacted
(323 of these chose to participate)
ABIS-study (All Babies in South-east
Sweden)
Materials
Source: http://www.chriswarham.org.uk/image/732.htm
Water samples were analyzed for zinc
concentration
Samples were analyzed using logistic
regression:
Dependent variable: with diabetes
Explanatory variable: water
parameters
Logarithm of zinc concentration was used
since the data was skewed
Researchers looked at correlation between
low zinc and diabetes prevalence
Methods
Source: http://zincinvestingnews.com/2750-zinc-oxide-used-to-convert-waste-heat-to-electricity.html
Zinc concentration was lower in water
samples of municipalities with higher
incidence of T1D
Water samples of families with a child with
diabetes had a lower concentration of zinc
(mean 2.8g/L)
High concentration of zinc was found to
protect against T1D
Source: Low zinc in drinking water is associated with the risk of type 1 diabetes in
children.

Results
Conclusions:
Only non-Hispanic whites had a correlation between T1D and vitamin D levels
A possible fault with the study is using only military personnel. They could have used individuals of all
backgrounds and ages.
Take-home messages:
Cannot rule out the possibility that the autoimmune process that causes T1D also lowers 25(OH) serum
vitamin D levels
Misclassification (unknown group, ethnicity) could have affected the results
Environmental and genetic factors could affect 25(OH)D levels
Unsolved Problems:
Biological mechanism for how vitamin D protects against T1D is not known, but may involve
immunomodulation in -cell protection
Future research directions:
Determine if the autoimmune process lowers serum vitamin D
Determine the mechanism for vitamin D protection against T1D
Summary and Discussion Vitamin D
Conclusions:
Lower zinc concentrations are associated with higher incidence of T1D
It is suggested you drink tap water with sufficient levels of zinc or take a supplement
Since the study was only done in Sweden, this might only apply to Swedish tap water. The
researchers should do a worldwide study on zinc concentrations in tap water in relation to T1D.
Take-home messages:
Many other studies measured significantly higher concentrations of zinc in low-incidence
municipalities
Previous studies have shown zinc can inhibit enterovirus replication
Zinc could be related to some other environmental factor, since drinking water zinc levels
contributing to a total dietary intake is low
Unsolved Problems:
The environmental factors that could affect zinc intake are unknown
Future research directions:
Determine the environmental factors affecting zinc intake
Summary and Discussion (Zinc)
1. Munger, K. L., Levin, L. I., Massa, J., Horst, R., Orban, T., Ascherio, A. (2013). Preclinical Serum 25-Hydroxyvitamin D Levels
and Risk of Type I Diabetes in a Cohort of US Military Personnel. Am J Epidemiol. 177:5, 411-419.
2. Samuelsson, U., Oikarinen, S., Hyoty, H., Ludvigsson, J. (2011). Low zinc in drinking water is associated with the risk of type 1
diabetes in children. Pediatric Diabetes. 12: 156-164.
References