Serum Trace Elements and Vitamin D Levels in Obese Iraqi Adults with Diabetes and Hypertension

Abstract

Abstract Background:Obesity, type 2 diabetes mellitus, and hypertension are growing public health concerns in Iraq. There is little information regarding levels and roles of vitamin D and trace elements in metabolic homeostasis and concerning the Iraqi population with the above-mentioned metabolic diseases. Objective:This study's aim was to assess the serum levels of nine trace elements and vitamin D (zinc, copper, selenium, ferritin, magnesium, manganese, cadmium, calcium, and potassium) in obese and non-obese Iraqi adults having and not having type 2 diabetes mellitus and hypertension. Methods:This research was carried out at Al-Rifai General Hospital, Thi-Qar, Iraq, between January and June 2024. Eighty-five participants aged between 45 and 65 years were selected and divided into four categories: Group A (n=22, obese with T2DM and hypertension), Group B (n=21, obese without T2DM and hypertension), Group C (n=20, non-obese with T2DM and/or hypertension), and Group D (n=22, healthy non-obese controls). Participants were excluded if they had malignancies, renal or hepatic failure, autoimmune diseases, or had taken supplements recently. Participants were fasted overnight before blood samples were taken. For vitamins, an enzyme-linked immunosorbent assay was used and for trace elements inductively coupled plasma mass spectrometry and atomic absorption spectrometry were used. For the data analysis, ANOVA and post-hoc tests were used to determine relationships with a 95% confidence interval. Significance was set at p < 0.05. Results:Significant differences across all measured parameters. For group A zinc levels were lowest (0.52 ± 0.14 µg/mL) as compared to group D (1.18 ± 0.22 µg/mL, p < 0.001). This correlates to severe depletion in metabolically compromised individuals. For group A, Cu levels were highest (1542.8 ± 186.3 ng/mL) as compared to group D (892.4 ± 124.7 ng/mL, p < 0.001) suggesting chronic inflammation. Selenium and Ferritin showed similar trends across groups A and D.  Magnesium levels were significantly lower in obese groups, group A (1.68 ± 0.21 mg/dL) and group B (1.82 ± 0.19 mg/dL), as compared to control group (2.24 ± 0.18 mg/dL, p < 0.001). Cadmium levels were also noted to be significantly higher in group A (2.64 ± 0.38 ng/mL) as compared to all other groups (p < 0.001). Vitamin D deficiency was also most severe in group A (14.2 ± 4.8 ng/mL) and progressively improved towards group D (32.6 ± 6.4 ng/mL, p < 0.001). Trace element and metabolic marker (fasting blood glucose, HbA1c, and BMI) showed strong correlation. Conclusions:Obesity, combined with type 2 diabetes mellitus and hypertension, results in significant disruption of trace elements and Vitamin D homeostasis in Iraqi adults. Deficiencies of zinc, selenium, magnesium and Vitamin D, along with increased copper and cadmium, elucidate the need for proper nutritional assessment and supplementation in the management of metabolic comorbidities. There is an urgent need for metabolic profiling and nutritional interventions among the Iraqi population with an increasing burden of non-communicable diseases.