Vitamin D Status among Indonesian Healthy Smokers:

A Preliminary Findings

Sri Rezeki Arbaningsih

and Aznan Lelo

Pulmonology Department, Faculty of Medicine, Muhammadiyah University of North Sumatra, Gedung Arca street no.53

Medan Kota-Indonesia

Pharmacology Department, Faculty of Medicine, North Sumatra University, Doktor Mansyur Street no.5 Padang Bulan

MedanBaru-Indonesia

Keywords: Vitamin D, healthy smokers, Indonesia.

Abstract: It is estimated that smoking habit has caused the death of six million people in different parts of the world

each year. This figure is frequently connected with an expanded danger of death from constant non-

transmittable illnesses. Low serum vitamin D levels are related to weakened lung function, expanded

occurrence of infectious sicknesses and inflammation.In smokers an acceleration of pulmonary function

decrease was observed.Chest radiography and spirometry tests were performed, which included samples of

peripheral blood in a population sample of 25 healthy male smokers. Serum 25 (OHD) concentrations were

measured by an electrochemical-luminescent (ECLIA) bond assay. The average level of vitamin D was

found in 27.87 (SD = 7.08). There were no differences between body mass index (BMI) and 25(OHD) value

(p> 0.05), and there were no differences between smoking types and 25(OHD)rates (p> 0.05). Vitamin D

sufficiency is found primarily in healthy smokers, even if they are found in tropical regions such as

Indonesia. It is still believed that vitamin D levels have a substantial clinical benefit in the deterioration of

lung function.

1 INTRODUCTION

Vitamin D level is expanded by presentation to

daylight. Vitamin D inadequacy might be ignored in

Asian nations, maybe on the supposition that

vitamin D deficiency is probably not going to

happen in areas with ample daylight. A few

examinations conveyed crosswise over various

nations in South Asia including Southeast Asia

uncovered broad pervasiveness of vitamin D

inadequacy and deficiency. There are still many

people living in tropical regions such as Indonesia,

suffer from vitamin D deficiency due to many

factors.On the other hand, vitamin D deficiency can

reduce lung defence against disease.This point plans

to know the commonness of vitamin D inadequacy

in Indonesian populace.

Cigarettes have executed numerous individuals

who suck it. Smoking propensities are evaluated to

have caused the deaths of six million individuals in

different parts of the world every year. This figure is

likewise frequently connected with an expanded

danger of death from chonic non-communicable

sicknesses. WHO predicts that by 2025 around 45%

of Indonesia's populace are smokers (WHO,

2015).Indonesia ranks fifth as the largest cigarette

consumer country in the world, the third order as the

country with the highest number of smokers in the

world and the first in Southeast Asia (Susanto et al.,

2011).

Cigarette smoke, particles and other toxic gases

such as fumes from biomass fuels can lead to

pulmonary inflammation, a modified normal

response and progress to Chronic Obstructive

Pulmonary Disease (COPD). This chronic

inflammatory response can trigger the destruction of

parenchymal tissue (the occurrence of emphysema)

and interfere with the mechanism of natural repair

and defense of the body (the occurrence of small

airway fibrosis). This pathological change causes air

trapping and progressive airflow limitations that

cause symptoms of breathlessness and some other

symptoms of COPD symptoms (Vestbo, 2014).

Changes in tissue structure are closely related to the

inflammatory response due to exposure to particle

Arbaningsih, S. and Lelo, A.

Vitamin D Status among Indonesian Healthy Smokers: A Preliminary Findings.

DOI: 10.5220/0008887902310235

In Proceedings of the 7th International Conference on Multidisciplinary Research (ICMR 2018) - , pages 231-235

ISBN: 978-989-758-437-4

231

dust or toxic gases, but the biggest important factor

is the influence of cigarette smoke (Russel, 2002).

Smoking habits can modify vitamin D effect

such as immuno-modulator and anti-inflammatory.

Vitamin D deficiency is associated with respiratory

disorders. Vitamin D can influence lung cell biology

systems, such as the respiratory immune system

(Lange et al., 2012; Hejazi et al., 2016).

In the lung study (2012), pulmonary function of

FEV1 decreased 2-fold in smokers who have

vitamin D deficiency compared to smokers without

vitamin D deficiency. Vitamin D deficiency is often

found in patients with COPD (with levels of 25-

hydroxyvitamin D <20 ng / ml) associated with

disease severity based on FEV1 pulmonary function

evaluation (Janssen, 2010).

The main source of vitamin D is actually formed

in the skin with the help of exposure to ultraviolet

sun-B (UVB). Therefore, this study was conducted

to assess vitamin D concentrate in smokers who did

not have health problems in their lungs, who live in

Medan, as part of Indonesia region, as a country that

is exposed to sunlight throughout the year

2 METHODOLOGY

2.1 Research Design

The design of this research is an analytic research

using cross sectional design. The study was done at

General Hospital of Haji Medan. This research

would be carried out after the approval of the Ethics

Committee of University of North Sumatra. Serum

vitamin D levels was performed in the clinical

pathology laboratory of General Hospital of Haji

Adam Malik Medan.

2.2 Sample

The samples in this study were 25 healthymales who

have no abnormalitiesin the lungs, known by

interpretation result of chest x-ray, spirometry

examinationand physical diagnostic, aged 40-65

years, and smokers. The participants under the study

are selected from hospital staffs (mostly indoor

occupation), andthey are given written informed

consent. Subjects were excluded if they had lung

diseases, hypothyroidism, or if they have a history of

treatment consumption which can influence calcium

and vitamin D metabolism.

2.3 Instrument

The instruments that were used to collect the data in

this research were chest x-ray examination,

spirometry test and laboratory test. The spirometry

was held by using a Minispir spirometer (MIR-

Medical International Research, Italy) MIR

Spirobank II spirometer. Serum of 25-

hydroxyvitamin D (25OHD) concentration was

processed by electro-chemiluminescence binding

assay (ECLIA).

2.4 Data Collection and Analysis

To gather the information, spirometry was

performed. Obstruction results from patient samples

were defined according to the degree of airflow

obstruction based on post-bronchodilator FEV1 as

follows: mild (≥80% of expected value); moderate

(80> FEV1≥50% expected); severe (50%>

FEV1≥30% expected); very serious (<30%

expected) (GOLD, 2017). Fringe blood tests were

taken from an example of 25 men overviewed. In

this manner, the information is in quantitative shape.

The serum measurements for 25-hydroxyvitamin D

was done by its techniques. Vitamin D was

estimated with Elecsys (Roche) and the

electrochemical immunoassay (ECLIA). The status

of human vitamin D was evaluated by measuring the

value of 25 (OH) D. Vitamin D deficiency is

expressed when the concentration of 25 (OH) D <50

nmol / L or <20 ng / ml; while the concentration of

vitamin D deficiency of 25 (OH) D is 51-74 nmol /

L or 21-29 ng / ml. The normal rate of the vitamin D

concentration of 25 (OH) D is> 30 ng / ml (Holick et

al., 2008).

Statistical analyzes were performed with SPSS

software for Windows. Persistent variables were

displayed as mean ± standard deviation and 95

confidence intervals (95% CI) and all out variables,

as rates. The Chi-square test was utilized to decide

the relationship between absolute factors. Normality

test was analyzed for each continuous variables.

3 RESULT

3.1 Demographic Characteristics

This study was followed by 25 healthy males

subjects smoked. The characteristics of sample

subjects are presented in more detail in table 1.

ICMR 2018 - International Conference on Multidisciplinary Research

232

Table 1: Demographic characteristics.

Characteristics N

Age, mean (SD), year 49,96 (4,66)

Body weight, rerata (SD), kg 76,74 (10,97)

Height, rerata (SD), cm 162,7 (7,25)

Body Mass Index, n (%)

Normal 4 (16)

Overweight 21 (84)

Ethnicity, n (%)

Java 10 (40)

Batak 11 (44)

Aceh 1 (4)

Banten 1 (4)

Palembang 1 (4)

Hindustan 1 (4)

Education, n (%)

Did not finish primary school 0

Primary school 1 (4)

Junir high school 1 (4)

Senior high school 17 (68)

Diploma 1 (4)

Bachelor degree 4 (16)

Master degree 1 (4)

Smoking habit, n (%)

Type of cigarette

Keretek 13 (52)

Keretek with filter 7 (28)

Both 5 (20)

Smoker types, n (%)

Light smoker 8 (32)

Moderate smoker 9 (36)

Heavy smoker 8 (32)

There were 4 subjects (16%) with normal body

mass Index (BMI) and 21 subjects (84%) with over

weight BMI. Found 13 subjects who smoked kretek

(52%); subjects who smoke filter types are 7 people

(28%); and 5 subjects who smoked both types

(20%). The number of light smokers being found is

8 subjects (32%), moderate smokers are found 9

subjects (36%) and heavy smokers are found as

many as 8subjects (32%).

The results of vitamin D was presented in table

2showing mean, standard deviation (SD), maximum

minimum and 95% confidence interval (IK).

Table2:Results measurement of vitamin D.

Vitamin D N

Mean 27,87

Median 27,44

SD 7,08

Minimum 17,19

Maximum 53,80

95% CI 24,95-30,79

The mean vitamin D was found at 27.87 ng/ml

(SD= 7.08).The median was found at 27.44

ng/ml.The association of body mass index (BMI)

with serum 25(OH)D level is shown in table 3.

Table 3: Differences of BMI and vitamin D.

Body Mass

Index (BMI)

Vitamin D

Total

(%)

Normal

(%)

Insufisiensi

(%)

Normal 3 (75) 1 (25)

(100)

1,00

Overweight 16 (76,2) 5 (23,8)

(100)

The association of smoker types with serum

25(OH)D level is shown in table 4.

Table 4: Differences of smoker types and vitamin D.

Smoker

types

Vitamin D

Total

(%)

Normal

(%)

Insufisiensi

(%)

Light

smoker

(87,5)

1 (12,5)

(100)

0,62

Moderate

smoker

(71,4)

4 (2,6)

(100)

Heavy

smoker

(66,7)

1 (33,3)

(100)

There wereno differences between body mass

index (BMI) and vitamin D levels (p>0,05), and

there were also no differences between types of

smokers and vitamin D levels (p>0,05).

4 ANALYSIS

In this study we found insufficiency of vitamin D

levels in healthy sample group who smoked with

mean of 27.87 ng/ml(SD =7.08). This is similar to

the results ofKassi et.al.’s (2015) research that

smokers have a low serum 25 (OH) D concentration

than non-smokers.This can be due to several factors.

One of the components that can influence vitamin D

concentration is BMI and long exposure to

daylight.In the sample of healthy group,smokers

found subjects with normal BMI4 people (16%) and

overweight 21 people (84%).

The state of overweight will have a high danger

of vitamin D insufficiency since vitamin D can be

taken by fat cells (Dusso et al., 2005). Those having

a BMI of ≥30 were related to bring down serum 25

(OH) D esteems when contrasted with non-obese

people. Obesity does not influence the limit of the

Vitamin D Status among Indonesian Healthy Smokers: A Preliminary Findings

233

skin to blend vitamin D; however, a considerable

measure of subcutaneous fat changes its discharge in

the course.Factors in the amount of BMI also affect

the body's vitamin D levels.

In addition to the major factors of BMI, long-

term exposure to sunlight also affects vitamin D

levels(Lee et al. 2015). In healthy groups who are

smokers, the sample subjects come from hospital

staff, who are assumed to be more indoors at work.

In this study, there wereno differences between body

mass index (BMI) and vitamin D levels (p>0,05).

In this investigation there were no contrasts

between kinds of smokers and vitamin D levels

(p>0,05). The kinds of smokersswing out not to have

the capacity to decide the high or low levels of

vitamin D in the body

Insufficiency of vitamin D in smokers could be

caused by changes in hepatic metabolism because

smoking increases hepatic degradation of other

steroids such as estrogen. Reduced serum

parathyroid hormone in smokers is due to decreased

secretion or increased hormone degradation. The

decrease in serum concentrations of 1,25 (OH) 2D3

in smokers can also be related to the accumulation of

cadmium in the kidneys. The reduced absorption of

calcium is a consequence of decreasing serum 1,25

(OH) 2D3. Parathyroid hormone and vitamin D

metabolites have a vital job in the control of calcium

homeostasis and bone digestion (Brot et al. 1999).

Nimitphong reports (2013) the commonness of

vitamin D deficiency> 70% in South Asia, and

differs between 6-70% in Southeast Asia. This is in

opposition to the suspicion that vitamin D lack does

not happen in nations with adequate daylight as in

Asia.This report has similarity with this research

findings that the majority of healthy smokers in

Indonesia have vitamin D insuficiency. Factors that

can affect UVB exposure and vitamin D production

in the skin include time, season, ozone and

clouds.Vitamin D concentration is increased by

exposure to sunlight.Urban residents who mostly

spend their time indoors have vitamin D deficiency

(Lee et al. 2015).

Brot et.Al. (1999) found smoking seems to

debilitate the serum levels of 25(OH)D. Smokers

haveeverything considered around 10% decrease of

streaming levels of 25(OH)D.

5 CONCLUSION

Vitamin D sufficiency is found in healthy smokers,

even though they are in tropical regions such as

Indonesia. Vitamin D levels are still thought to have

an important clinical role in impairment of lung

function.

6 RECOMMENDATION

This preliminary study should be continued by using

larger samples to find out various factors that may

affect vitamin D levels. It is recommended that a

smoker should have more ultraviolet exposure

especially UVB to expand their vitamin D formation

in the skin.

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