List Of Fruits Containing Vitamin C

List Of Fruits Containing Vitamin C

Top 10 Foods Highest in Vitamin C

Powered by USDA Nutrition Data

Last Updated: July 28th, 2021

Vitamin C is an essential nutrient required for the maintenance of skin, blood vessels, bones and cartilage, and wound healing. (1,2)

Vitamin C also helps protect cells against oxidative stress, which in turn provides protection against certain diseases, including cancer. (1,3)

Vitamin C, like zinc and vitamin A, also helps support your immune system. (4,5,6)

High vitamin C foods include guavas, bell peppers, kiwifruit, strawberries, oranges, papayas, broccoli, tomatoes, kale, and snow peas. The current daily value (% DV) for vitamin C is 90mg. (7)

Below is a list high vitamin C foods ranked by a common serving size, use the nutrient ranking of over 200 foods high in vitamin C to see the foods highest in vitamin C by nutrient density (per gram), or see rankings of fruits high in vitamin C, and vegetables high in vitamin C.

---

• Introduction
• High Vitamin C Foods
• Printable
• Vitamin C Foods by Nutrient Density (Vitamin C per Gram)
• Other Vitamin C Rich Foods
• About the Data
•  Nutrient Ranking Tool
• Related
• Feedback
• References

#1: Guavas

Vitamin C per Cup	Vitamin C per 100g	Vitamin C per 200 Calories
377mg (419% DV)	228mg (254% DV)	671mg (746% DV)

#2: Kiwifruit

Vitamin C per Cup	Vitamin C per 100g	Vitamin C per 200 Calories
167mg (185% DV)	93mg (103% DV)	304mg (338% DV)

#3: Bell Peppers

Vitamin C per Cup	Vitamin C per 100g	Vitamin C per 200 Calories
152mg (169% DV)	128mg (142% DV)	982mg (1091% DV)

#4: Strawberries

Vitamin C per Cup	Vitamin C per 100g	Vitamin C per 200 Calories
98mg (108% DV)	59mg (65% DV)	368mg (408% DV)

#5: Oranges

Vitamin C per Cup	Vitamin C per 100g	Vitamin C per 200 Calories
96mg (106% DV)	53mg (59% DV)	226mg (252% DV)

#6: Papaya

Vitamin C per Cup	Vitamin C per 100g	Vitamin C per 200 Calories
88mg (98% DV)	61mg (68% DV)	283mg (315% DV)

#7: Broccoli

Vitamin C per Cup	Vitamin C per 100g	Vitamin C per 200 Calories
81mg (90% DV)	89mg (99% DV)	525mg (583% DV)

#8: Tomato

Vitamin C per Cup Cooked	Vitamin C per 100g	Vitamin C per 200 Calories
55mg (61% DV)	23mg (25% DV)	253mg (281% DV)

#9: Snow Peas

Vitamin C per Cup	Vitamin C per 100g	Vitamin C per 200 Calories
38mg (42% DV)	60mg (67% DV)	286mg (317% DV)

#10: Kale

Vitamin C per Cup Cooked	Vitamin C per 100g	Vitamin C per 200 Calories
23mg (26% DV)	18mg (20% DV)	99mg (110% DV)

See All 200 Foods High in Vitamin C

Next ➞

Printable One Page Sheet

Click to Print

Vitamin C Foods by Nutrient Density (Vitamin C per Gram)

Other Vitamin C Rich Foods

About the Data

Data for the curated food lists comes from the USDA Food Data Central Repository.

You can check our data against the USDA by clicking the (Source) link at the bottom of each food listing.

Note: When checking data please be sure the serving sizes are the same. In the rare case you find any difference, please contact us and we will fix it right away.

• Foods High in Vitamin C
• Foods Low in Vitamin C
• Vegetables High in Vitamin C
• Fruits High in Vitamin C
• Vegetarian Foods High in Vitamin C
• Nuts High in Vitamin C
• Beans High in Vitamin C
• Dairy High in Vitamin C
• Breakfast Cereals High in Vitamin C
• Fast Foods High in Vitamin C

View more food groups with the nutrient ranking tool, or see ratios with the nutrient ratio tool.

• Vitamin E Foods
• Beta Carotene Food Sources
• High Lycopene Foods
• High Iron Foods
• High Potassium Foods

feedback

Data Sources and References

1. Mitochondria, Energy and Cancer: The Relationship with Ascorbic Acid. J Orthomol Med. 2010; 25(1): 29–38.
2. Office of Dietary Supplements Fact Sheet: Vitamin C
3. L-ascorbic acid (vitamin C) induces the apoptosis of B16 murine melanoma cells via a caspase-8-independent pathway. Cancer Immunol Immunother. 2003;52:693–698.
4. Vitamin C and Immune Function Nutrients. 2017 Nov; 9(11): 1211.
5. The role of vitamin A and related retinoids in immune function. Nutr Rev. 1998 Jan;56(1 Pt 2):S38-48.
6. Zinc in Human Health: Effect of Zinc on Immune Cells Mol Med. 2008 May-Jun; 14(5-6): 353–357. Published online 2008 Apr 3. doi: 10.2119/2008-00033.Prasad.
7. FDA Daily Values Guidelines
8. U.S. Agricultural Research Service Food Data Central

MyFoodData provides nutrition data tools and articles to help you organize and understand the foods you eat. Read more...

List Of Fruits Containing Vitamin C

Source: https://www.myfooddata.com/articles/vitamin-c-foods.php

Khadi Global Vitamin C Review

Khadi Global Vitamin C Review

A Guide to Vitamin C Serums

leonori/Shutterstock

For 70 years Vitamin C has been one of the biggest weapons in the skin care industry. It's used to make cleansers, moisturizers, lotions, masks, and serums. So what is this powerful vitamin? How can it benefit you? Why should you use serums that contain Vitamin C? We're here to answer all of those burning questions in this complete guide and reveal the many benefits Vitamin C serums offer for your skin.

What Are Vitamin C Serums?

There are many variations of Vitamin C, but the most popular is ascorbic acid, a common ingredient in skincare products. However, all the variations of Vitamin C have anti-inflammatory benefits.

Vitamin C Serums are products that contain a high level of Vitamin C. They're used to treat wrinkles, sagging skin, lighten dark or red spots, prevent breakouts and even your skin tone. Basically, they battle all of those annoying skin issues. There are loads of products out there that claim they'll save your skin, but some can cause damage. Vitamin C is one of the most revered ingredients and conclusive research has shown how effective it can be.

How Are Vitamin C Serums Made?

Well so far we've talked about how incredible Vitamin C is and it sounds like a dream come true doesn't it? It's not all good. In fact, the mighty vitamin is unstable when it's exposed to air and light. Other ingredients need to be used to stabilize it and allow it to deliver amazing results. The serums are combined with ferulic acid and Vitamin E. According to researchers the perfect mixture is 15% Vitamin C with 1% Vitamin E and 0.5% ferulic acid. This makes Vitamin C perform to the best of its abilities, without damaging your skin.

What Does Vitamin C Serum Do for Your Face?

Boosts Collagen Production: Collagen keeps your skin firm and prevents sagging. Environmental factors such as lifestyle choices and pollution can increase the elasticity of your skin, so it's important you try to increase your collagen production.

Hydrates Your Skin: Dry skin is a common issue, but Vitamin C can help to give your skin that much-needed moisture boost. Remember, it doesn't work immediately so you need to keep applying the serum to see results.

Brightens Your Complexion: Dark spots on your skin are caused by the overproduction of melanin. Vitamin C decreases the production and lightens the dark spots to even out your complexion.

Reduces Redness and Inflammation: Conditions such as Rosacea leave many people searching for a magic cure. Vitamin C helps facial redness and inflammation by reducing the appearance of broken capillaries.

Why Should You Be Using Vitamin C Serum?

Don't think Vitamin C serums are just beneficial for your face. They can also shield you from sun damage and reduce stretch marks.

Saves You From The Sun: Prolonged exposure to UV rays can cause long-term damage to your skin. Luckily, Vitamin C is a powerful antioxidant that reduces red sports and prevents sunburn from spreading.

Fades Acne Scars: Acne plagues most of us at some point and we look forward to being free. Most of us get stuck with some scars but Vitamin C helps to fade scars and even out any discoloration.

Reduces Stretch Marks: Yes, Vitamin C serum can even help prevent those unsightly stretch marks by tightening your skin.

Are you ready to change your skin? Add a Vitamin C serum to your beauty regimen and enjoy a glowing complexion.

Khadi Global Vitamin C Review

Source: https://www.bloglines.com/article/a-guide-to-vitamin-c-serums?utm_content=params%3Ao%3D740010%26ad%3DdirN%26qo%3DserpIndex

Is 2000 Mg Of Vitamin C Daily Too Much

Is 2000 Mg Of Vitamin C Daily Too Much

Answer:

Yes, it's possible to take too much vitamin C. Since vitamin C is water-soluble, as are B vitamins (i.e. excess amounts are excreted and do not accumulate in the body), people sometimes assume there is no harm in taking large doses. However, there are potential short-term and long-term problems with taking high doses (500 to 1,000 mg per day) or very high doses (more than 2,000 mg per day) of vitamin C.

Very high doses of vitamin C are known to cause gastric discomfort and diarrhea, and this is the basis for the current upper tolerable daily intake limit of 2,000 mg for adults.

More limited, but concerning, evidence suggests problems with daily doses of just 500 to 1,000 mg of vitamin C. Keep in mind that the recommended daily intake of vitamin C for adults is only 75 mg to 120 mg, with an additional 35 mg for smokers -- see the RDA table below.

Sources

For example, while long-term, low-dose supplementation with vitamin C may help to prevent cataracts, high doses may actually increase the risk. Taking several hundred milligrams of vitamin C daily may also hamper some of the benefits of endurance exercise, as has been found with high doses of other antioxidant vitamins and supplements, such asvitamin E and resveratrol.

High doses of vitamin C may also reduce the effectiveness of certain medications, and increase the risk of liver damage when taking high doses of Tylenol. They may also interfere with tests for cholesterol and blood sugar, and for blood in the stool.

Individuals prone to developing kidney stones or with defects in metabolizing vitamin C or oxalate should also limit vitamin C from supplements.

For more about these effects and the specific amounts of vitamin C associated with them, see the Concerns and Cautions section of the Vitamin C Supplements Review >>

Is 2000 Mg Of Vitamin C Daily Too Much

Source: https://www.consumerlab.com/answers/is-it-possible-to-take-too-much-vitamin-c/too-much-vitamin-c/

Glow Recipe Vitamin C Reviews

Glow Recipe Vitamin C Reviews

Photo Courtesy: The Good Brigade/DigitalVision/Getty Images

Hepatitis is a condition that causes inflammation of your liver. Currently, there are an estimated 6 million people living with hepatitis in the United States, and more than 50,000 people are diagnosed with this disease every year. There are three primary types of hepatitis, and while their symptoms can be similar, they vary largely in the ways they're transmitted. Learning more about each type of hepatitis can help you better understand the condition as a whole.

Hepatitis A is the most easily transmitted of the three viruses. It affects approximately 2,500 people every year in the United States. It typically spreads through feces-contaminated food or water and is found in the feces of people who have the virus. Hepatitis A causes a short-term, acute sickness that most people heal from without treatment. However, it can cause serious illness in some people. This virus is more common in places with underdeveloped sanitation systems.

While doctors can't treat hepatitis A with medication, people who get this virus can manage its symptoms with fluids, rest and good nutrition. There's also a safe and effective vaccine available to protect you against hepatitis A.

What Is Hepatitis B?

Hepatitis B can occur both acutely (meaning it develops quickly and lasts a short time) and chronically (meaning it develops slowly over time and worsens over months or years). According to the Centers for Disease Control and Prevention, up to 2 million people in the United States are chronically affected with hepatitis B. Hepatitis B can be transmitted through sexual activity and exposure to infected blood. It can also be passed from a parent to their newborn child during birth.

Hepatitis B usually causes short-term discomfort that many people recover from completely after about four to eight weeks. However, it can turn into a chronic condition that lasts for years; this is more likely in older adults. Doctors can treat severe chronic hepatitis B with antiviral medications. However, in most cases, treatments focus on proper hydration and nutrition. There's a safe vaccine available to protect you against hepatitis B, too.

What Is Hepatitis C?

Photo Courtesy: BSIP/Getty Images

Approximately 4 million people in the United States are affected with hepatitis C. This form of hepatitis causes a chronic illness in over 50% of people who get this type of the virus. It's the least transmissible of the three viruses and can spread through contact with infected blood.

Hepatitis C occurs more commonly in people who engage in intravenous drug use. If you received a blood transfusion before 1992, you should also get tested for hepatitis C if you haven't previously. Hepatitis C can spread through unprotected sexual intercourse, but this is a less common way to transmit it. While there's no vaccine for chronic hepatitis C, treatments that are available today offer a 95% cure rate.

Chronic hepatitis C can significantly affect how your liver works. It can cause cirrhosis, which means that your normal liver tissue is replaced with scar tissue. It can also cause liver cancer. However, there are medications that can help keep this disease in check. Making lifestyle changes, such as reducing or eliminating alcohol from your diet, can also decrease your chances of experiencing complications. In severe cases, hepatitis C may require a liver transplant.

The varying forms of viral hepatitis affect millions of people in the United States. Chronic hepatitis often has few symptoms in its early stages, so recognizing the associated dangers and getting tested if you've been exposed may save your life. Although there are five types of viral hepatitis, only A, B and C are the forms commonly found in the United States.

Resource Links:

"Hepatitis A, B, and C: Learn the Differences," Immunization Action Coalition

"What's the Difference Between Hepatitis A, B and C?," UNC Health Talk

"The ABCs of Hepatitis," Centers for Disease Control and Prevention

"What's the Difference: Hepatitis B vs Hepatitis C?," Hepatitis B Foundation

MORE FROM SYMPTOMFIND.COM

Glow Recipe Vitamin C Reviews

Source: https://www.symptomfind.com/health/knowing-difference-between-hepatitis-a-b-c?utm_content=params%3Ao%3D740013%26ad%3DdirN%26qo%3DserpIndex

Essano Vitamin C

Essano Vitamin C

A Guide to Vitamin C Serums

leonori/Shutterstock

For 70 years Vitamin C has been one of the biggest weapons in the skin care industry. It's used to make cleansers, moisturizers, lotions, masks, and serums. So what is this powerful vitamin? How can it benefit you? Why should you use serums that contain Vitamin C? We're here to answer all of those burning questions in this complete guide and reveal the many benefits Vitamin C serums offer for your skin.

What Are Vitamin C Serums?

There are many variations of Vitamin C, but the most popular is ascorbic acid, a common ingredient in skincare products. However, all the variations of Vitamin C have anti-inflammatory benefits.

Vitamin C Serums are products that contain a high level of Vitamin C. They're used to treat wrinkles, sagging skin, lighten dark or red spots, prevent breakouts and even your skin tone. Basically, they battle all of those annoying skin issues. There are loads of products out there that claim they'll save your skin, but some can cause damage. Vitamin C is one of the most revered ingredients and conclusive research has shown how effective it can be.

How Are Vitamin C Serums Made?

Well so far we've talked about how incredible Vitamin C is and it sounds like a dream come true doesn't it? It's not all good. In fact, the mighty vitamin is unstable when it's exposed to air and light. Other ingredients need to be used to stabilize it and allow it to deliver amazing results. The serums are combined with ferulic acid and Vitamin E. According to researchers the perfect mixture is 15% Vitamin C with 1% Vitamin E and 0.5% ferulic acid. This makes Vitamin C perform to the best of its abilities, without damaging your skin.

What Does Vitamin C Serum Do for Your Face?

Boosts Collagen Production: Collagen keeps your skin firm and prevents sagging. Environmental factors such as lifestyle choices and pollution can increase the elasticity of your skin, so it's important you try to increase your collagen production.

Hydrates Your Skin: Dry skin is a common issue, but Vitamin C can help to give your skin that much-needed moisture boost. Remember, it doesn't work immediately so you need to keep applying the serum to see results.

Brightens Your Complexion: Dark spots on your skin are caused by the overproduction of melanin. Vitamin C decreases the production and lightens the dark spots to even out your complexion.

Reduces Redness and Inflammation: Conditions such as Rosacea leave many people searching for a magic cure. Vitamin C helps facial redness and inflammation by reducing the appearance of broken capillaries.

Why Should You Be Using Vitamin C Serum?

Don't think Vitamin C serums are just beneficial for your face. They can also shield you from sun damage and reduce stretch marks.

Saves You From The Sun: Prolonged exposure to UV rays can cause long-term damage to your skin. Luckily, Vitamin C is a powerful antioxidant that reduces red sports and prevents sunburn from spreading.

Fades Acne Scars: Acne plagues most of us at some point and we look forward to being free. Most of us get stuck with some scars but Vitamin C helps to fade scars and even out any discoloration.

Reduces Stretch Marks: Yes, Vitamin C serum can even help prevent those unsightly stretch marks by tightening your skin.

Are you ready to change your skin? Add a Vitamin C serum to your beauty regimen and enjoy a glowing complexion.

Essano Vitamin C

Source: https://www.bloglines.com/article/a-guide-to-vitamin-c-serums?utm_content=params%3Ao%3D740010%26ad%3DdirN%26qo%3DserpIndex

Does Vitamin C Protect Against Flu

Does Vitamin C Protect Against Flu

1. Home
2. News

Why vitamin C won't 'boost' your immune system against the coronavirus

(Image credit: Shutterstock)

Vitamin C is extremely unlikely to help people fight off the new coronavirus.

When afflicted with the common cold, many people chug orange juice and swallow vitamin C supplements in an attempt to "boost" their immune systems. But vitamin C supplements don't ward off the common cold in most people, and there's even less evidence that they grant immunity against SARS-CoV-2, the virus that causes COVID-19.

The myth, the legend

Vitamin C, also known as ascorbic acid, became known as an immune-boosting supernutrient after two-time Nobel Prize winner Linus Pauling touted the substance's supposed benefits in a series of books, Live Science previously reported. Pauling claimed that taking large doses of vitamin C could not only prevent the common cold, but also help thwart more severe illnesses like cancer and heart disease.

Since Pauling published his books, in the 1970s, his bolder claims have not stood up to scientific scrutiny. However, recent research does suggest that vitamin C supplements reduce the duration of colds in the general population, according to a 2013 review of several dozen studies.

The review found that vitamin C supplements taken during a cold can reduce the duration of the illness by 8% in adults and 14% in children. Practically, that means that supplementing vitamin C can shorten the duration of a cold by about one day. Participants in each study supplemented vitamin C for varying periods, but generally, the daily dose was at least 200 milligrams.

Several of the reviewed studies included people under intense physical stress, including marathon runners and soldiers training in the Arctic. Among these individuals, those who took vitamin C were about half as likely to catch a cold as those who did not take such supplements. But in the general population, the supplements did not prevent the common cold.

Likewise, no evidence suggests that vitamin C supplements can help prevent COVID-19, Dr. William Schaffner, a professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center in Tennessee, told New York Times Parenting.

"If there's going to be an advantage, it's going to be very modest," Schaffner said.

Some scientists are testing if vitamin C could alleviate symptoms and improve outcomes for patients with COVID-19 — if given in a high enough dose. Researchers at Zhongnan Hospital of Wuhan University launched a clinical trial with 140 patients in February to test whether ultrahigh doses of vitamin C, delivered intravenously, could treat the viral infection more effectively than a placebo. The test group will receive infusions twice a day for seven days, with each infusion containing 12g of vitamin C. (The daily recommendation for an adult man is only 90mg.)

The trial will be completed in September, and no results are yet available, according to ClinicalTrials.gov. In the meantime, Chinese scientists have launched dozens of other clinical trials as well, testing everything from antivirals to antibody therapies to traditional Chinese medicines.

Related: 10 deadly diseases that hopped across species

Beyond the common cold

Although supplements can't ward off the common cold, vitamin C is still important to your health. It serves essential roles in the human body and supports normal immune function, according to a 2017 report in the journal Nutrients.

Vitamin C acts as an antioxidant, meaning it neutralizes free radicals generated by the body's normal metabolism and by exposure to environmental stressors, including ultraviolet radiation and air pollution. Free radicals are charged particles that can damage cells, tissues and genetic material if left unchecked, and thus trigger harmful inflammation.

Besides stopping free radicals, vitamin C helps to activate several key enzymes in the body, which go on to synthesize hormones and build collagen, a tough protein found in skin and connective tissues, according to the 2017 report. These hormones help control the response of the cardiovascular system to severe infections, while collagen fortifies the skin against injury.

Vitamin C may also bolster the fatty membranes in skin and connective tissue, thus protecting organs like the lungs from pathogens, according to cell culture and preclinical studies. When bugs do infiltrate the body, vitamin C helps direct immune cells called neutrophils to the site of infection and defends these cells against free radicals, the 2017 report noted.

In short, the body relies on vitamin C to launch an effective immune response while sustaining minimal damage. However, the body can't make its own vitamin C or store the nutrient efficiently, as the water-soluble vitamin dissolves once ingested and is excreted in the urine, according to the National Institutes of Health (NIH). The best way to meet your daily requirement is to consume vitamin-rich fruits, vegetables and fortified foods.

The recommended dose depends on your age, sex, pregnancy and breastfeeding status, but in general, adult men are recommended to ingest at least 90 milligrams (mg) a day, and adult women should consume at least 75 mg. People who smoke should add 35 mg to their recommended dose, as smoking depletes the body of available vitamin C, according to the NIH.

Note that high doses of vitamin C, exceeding a daily level of 2,000 mg, can cause nausea, diarrhea and abdominal pain in many people, Live Science previously reported. Additionally, men who have had kidney stones in the past and who test high for a chemical called oxalate should avoid supplementing with vitamin C, as the substance may enhance the formation of those types of stones, Stephen Lawson, a researcher at the Linus Pauling Institute at Oregon State University, told Live Science at that time. (The Linus Pauling Institute was originally co-founded by Pauling himself to conduct research on nutrition and its role in health and disease.)

"Be wary of hype and headlines"

While vitamin C supplements pose little risk to consumers, other so-called "immune-boosting" products could be harmful.

Since the COVID-19 outbreak began in the United States, the U.S. Food and Drug Administration (FDA) and the Federal Trade Commission (FTC) have already issued warning letters to seven companies for selling fraudulent products that promise to cure, treat or prevent the viral infection. "These warning letters are just the first step," FTC Chairman Joe Simons said in a news release. "We're prepared to take enforcement actions against companies that continue to market this type of scam."

Note that no evidence suggests that other so-called immune-boosting supplements — such as zinc, green tea or echinacea — help to prevent SARS-CoV-2 infections, Dr. Mark Mulligan, division director of the infectious diseases and vaccine center at NYU Langone Medical Center, told New York Times Parenting. "I do not recommend spending money on supplements for this purpose," Mulligan said.

"The medical profession still doesn't know exactly how to influence the immune system, despite what supplement products may claim," Julie Stefanski, a registered dietitian nutritionist and spokeswoman for the Academy of Nutrition & Dietetics, told The Washington Post.

The FDA does not vet dietary supplements as it does pharmaceutical medications; that means that supplement manufacturers can place new products on the market without first proving that the substances are either safe or effective. The FDA and FTC step in after the fact to police a product that presents "a significant or unreasonable risk of illness or injury or that is otherwise adulterated or misbranded."

These agencies rely heavily on reports from consumers, health care professionals and supplement manufacturers themselves to identify sketchy products and pull them off the market. That said, the FDA encourages consumers to stay informed and "be wary of hype and headlines," saying that unsubstantiated claims crop up on supplement labels all the time and it's often up to you to spot them.

When in doubt, the FDA recommends that you "let your health care professional advise you on sorting reliable information from questionable information." Thankfully, in the case of vitamin C, supplements don't typically cause harmful side effects, unless consumed in excess.

Editor's Note: This story was updated on Mar. 10 to include information about the Vitamin C infusion trial being conducted in China.

• Going viral: 6 new findings about viruses
• The 12 deadliest viruses on Earth
• Top 10 mysterious diseases

Originally published on Live Science .

Nicoletta Lanese is a staff writer for Live Science covering health and medicine, along with an assortment of biology, animal, environment and climate stories. She holds degrees in neuroscience and dance from the University of Florida and a graduate certificate in science communication from the University of California, Santa Cruz. Her work has appeared in The Scientist Magazine, Science News, The San Jose Mercury News and Mongabay, among other outlets.

Does Vitamin C Protect Against Flu

Source: https://www.livescience.com/coronavirus-vitamin-c-myth.html

Do You Need Vitamin C To Absorb Vitamin D

Do You Need Vitamin C To Absorb Vitamin D

• Research
• Open Access
• Published: 08 November 2018

Comparative effects of vitamin D and vitamin C supplementations with and without endurance physical activity on metabolic syndrome patients: a randomized controlled trial

• Mohammad Javad Hosseinzadeh-Attar¹,
• Belal A. Muhammad²,
• Ahmad Esmaillzadeh³ &
• Abdel Hamid El Bilbeisi¹

Diabetology & Metabolic Syndrome volume 10, Article number:80 (2018) Cite this article

• 58k Accesses

• 27 Altmetric

• Metrics details

Abstract

Objective

Vitamin D and C levels have inverse relation with the metabolic syndrome components and they are used as antioxidant supplements during enduring metabolic activities. In the present study, we hypothesized that the intake of vitamin D and/or C with endurance physical activity might reduce the risk of metabolic syndrome.

Methods

A randomized control study recruited 180 participants of both genders, aged between 30 and 50 years. The participants were assigned into six groups receiving different doses of vitamin D or vitamin C with or without physical activities. Data were collected over a period of 3 months, and the results were analyzed using SPSS version 20.

Results

Variations in the effect of the supplements on various body variables including: Fasting plasma glucose, total cholesterol, low-density lipoprotein cholesterol and blood pressure, showed that vitamin D has more influence compared to vitamin C. However, vitamin D and C supplements do not have any effect on weight when consumers are undergoing endurance physical exercise. But vitamin C consumer group has more effect in waist circumference, triglyceride, and high-density lipoprotein, as compared to vitamin D consumer group.

Conclusion

We conclude that, consumption of vitamin D or vitamin C supplements may improves the life of metabolic syndrome patients. However, the combination of physical activities and vitamin supplements maximize the effect, and this combination should be recommended.

Trial registration WHO-ICTRP IRCT20161110030823N2. Registered 01 February 2018. http://apps.who.int/trialsearch/Trial2.aspx?TrialID=IRCT20161110030823N2

Background

Metabolic syndrome (MetS) is a constellation of abnormal cardio metabolic factors that increase risk of cardiovascular disease (CVD) and type 2 diabetes mellitus [1]. MetS is a major health problem worldwide; based on the International Diabetes Federation (IDF) appreciation about one quarter of the world's adult population have MetS [1]. MetS is among dangerous syndromes, which increases the danger of being overtaken by various diseases including CVD, diabetes, dyslipidemia, stroke, osteoarthritis, some type of cancers and mortality [2]. MetS imposes heavy expenses to sanitary therapeutic system and it generally reduces life quality [3]. In fact, insulin resistance and central obesity are considered the main causes of MetS [1,2,3]. In addition, its appear that demographic, lifestyle, and social factors are affecting MetS [2]. Indeed, it has been reported that cigarette consumption and high body mass view are among independent and amendable risk factors for MetS [2]. Nowadays, recognition of considerable challenges related to obesity and its therapeutic solutions all over the lifetime have resulted in great efforts spent toward obesity inhibition [4]. Furthermore, doing regular athletic activities and consuming the antioxidants are among the advised solutions, which are not only affecting the total safety of body, but also affect brain performance [2]. Some of previous studies have reported that people who experience delayed performance physically showed improvement with supervised physical fitness exercises, and the health of people suffering from metabolic diseases improved with an increase in antioxidant intake into their system [4, 5]. Antioxidant supplementations especially vitamin C relieve the body off the stress associated with MetS and vitamin D increase the antioxidant capacity [4, 5]. Some of previous studies show a significant relationship between the amount of vitamin D intake and muscle fatigue; supplements are likely to improve the muscle fatigue through the biological roles that these nutrients play [6, 7]. A change in vitamin D from the normal range alters the muscle performance and activity significantly, especially when exercises of different intensities are involved [8,9,10,11]. Elsewhere studies have reported a reduction of death with frequent intake of vitamin D as well as engaging in aerobic exercises [12,13,14,15,16]. Regarding the relation between serum level of vitamin D and MetS components, different studies have been accomplished in some of which this relation has been confirmed [17,18,19]. It has been shown that low level of serum vitamin D has inverse relation with weight gain, body mass index (BMI), but it does not have significant relation with other components of MetS [17]. Accumulating literature also link vitamin D studies with bones while comparing BMI and general weight gains [14,15,16]. On the other hand, vitamin C however, has completely different functions in an in vitro experiments and in humans [20,21,22]; some previous studies show that, the metabolism of glucose in the insulin resistant people was improved, and the blood pressure was lowered in patients who took vitamin C supplementation [23]. Furthermore, vitamin C and vitamin E supplementation are shown to prevent molecular regulators that trigger the sensitivity of insulin as well antioxidant defense mechanisms through physical activities [24]. Moreover, endurance exercises produce reactive nitrogen and oxygen through the mitochondria [25]. Physical exercises on a regular basis promote the health of the individuals and its play a vital role in treating MetS patients [26,27,28]. In conclusion, the prevalence of MetS is raising worldwide [1]. In addition, vitamin D and vitamin C levels have inverse relation with some of the MetS components such as (BMI, insulin resistant, and high blood pressure) [17, 23], and they are used as antioxidant supplements during enduring metabolic activities [4, 5]. Therefore, understanding the association between the effects of vitamin D and vitamin C supplementations with and without endurance physical activity (PA) on various components of MetS may be helpful in reducing MetS-related premature mortality and improve life quality among MetS patients. Our study was conducted to examine the effects of vitamin D and vitamin C supplementations with and without endurance PA on various components of MetS among MetS patients.

Methods

Research design and study population

The study design for this research is a randomized controlled trial (RCT) [29]. Based on the suggested formulas of this model, the study participants were recruited on the foundation of developed inclusion/exclusion criteria [30]. The subjects underwent a 12 weeks' treatment program (01 March 2016 to 23 May 2016). Participants were randomly assigned into six Groups (Fig. 1): (1) Vitamin C group: who took only 500 mg/day vitamin C supplements [Morning Time]; (2) Vitamin C plus PA group either morning 7:30 A.M. or afternoon after 3:00 P.M.: who participated in 30 min/day of endurance PA and also took 500 mg/day vitamin C supplements. (3) Vitamin D group: who took only 2000 IU/day vitamin D supplements (Morning Time); (4) Vitamin D plus PA group either morning 7:30 P.M. or afternoon after 3:00 P.M.: those who participated in 30 min/day of endurance PA and also took 2000 IU/day vitamin D supplements. (5) Placebo group, who participated in 30 min/day of endurance PA and took a placebo, (6) final group; did not participate in 30 min/day of endurance PA, but took a placebo. Both vitamins and placebo were obtained from Osweh manufacture Iran-Tehran and was prepared to feature the same shape, odor and size of the supplements.

Fig. 1

Flow chart for inclusion and exclusion in the study

Full size image

Sample size and sample determination

In the present study, the sample size was calculated using a previously described formula for parallel clinical trials n = 2 [(z1 − α/2 + z1 − β) 2. s2]/d2 [31]. In this formula, n is number of participants in each group. For estimating sample size, we considered type one (α) and type two errors (β) of .05 and .20 (Power = 80%) respectively, and fasting plasma glucose levels as a key variable. Based on a previous study [31], standard deviation (SD) of plasma glucose levels was 8 mg/dL and the difference in mean (d) was considered to be 5 mg/dL. Where α = .95, β = 20%, study power = 80%, d = 5, and SD = 8.

$${\text{n}} = \frac{{2 \left( {1.96 + 0.85} \right)^{2} \left( 8 \right)^{2} }}{{\left( 7 \right)^{2} }} = 21$$

We reached the sample size of 21 subjects for each group. In addition, to consider probable dropouts, 30 patients were included in each group. At the end, a total of 180 patients with MetS were included in the present study. Participants were distributed into six groups as shown in Fig. 1.

Inclusion and exclusion criteria

Eligibility criteria for participants having MetS, according to IDF definition [1] and the age between 30 and 50 years, both males and females. Individuals who took supplements containing vitamins D and C in the last 3 years were not included in this study. Individuals with type I and type II diabetes who were taking oral hypoglycemic agents or injecting insulin, or any medical therapy affecting the result, smokers, individuals with heart failure, and those who are suffering from renal problems, also individuals with malabsorption syndrome, pregnancy and lactating mothers were all excluded from the study. The exclusion list included patients with history of bariatric surgery and those who are currently using weight-loss medications as illustrated in (Fig. 1).

Data collection

Data collection was performed in the community health and control of communicable disease center. At baseline, standardized general questionnaires were completed for each subject [32]. Additional information regarding demographic, and medical history variables was obtained with an interview-based questionnaire. Past history and any previous treatment for certain disease including hypertension, diabetes, high cholesterol, supplement used, family history of obesity, family history of diabetes, family history of hypertension as well as PA patterns was also recorded.

Anthropometric measurements

Weight (kg) was measured while the subjects with minimal clothe without shoes using a digital scales and records to the nearest 100 g. Height (m) was measured in a standing position, without shoes, using a tape measure. BMI was calculated as weight in kilograms divided by height in meters squared [33]. Waist circumference (WC) was measured at the mid-way between the lower border of the ribs and the iliac crest with the subject in standing position. During the measurement process, it was critical to use the same technician for the purpose of error reduction.

Biochemical analysis

The participants were asked to produce a blood sample of 10 cc, which was collected from the participant at base line 0 and 12 weeks of the study. The blood was collected after overnight fasting for approximately 12 h. The blood samples were taken using the protocol outlined in [34]. Variables of concern in this test were the fasting plasma glucose (FPG) that were measured on the day of blood collection as outlined in [35]. The blood sample was investigated for FPG mg/dL, total cholesterol (TC) mg/dL, triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) mg/dL, high-density lipoprotein cholesterol (HDL-C) mg/dL, vitamin D (ng/mL) and vitamin C (ng/mL).

Assessment of blood pressure

The systolic and diastolic blood pressure was taken from the left arm (mmHg) in the morning during each interview (From baseline and end of study) using the calibrated mercury sphygmomanometer [36]. Participants were seated after relaxing for at least fifteen minutes in a quiet environment, empty bladder. The average of the measurements was recorded.

Assessment of PA

Two times a week for climbing (around 2 h each time) and two times a week for running (around 1 h in the afternoon between 3 and 5 P.M.). Approximately 6 h per week all together [37].

Statistical analysis

We used Kolmogorov–Smirnov test to examine the normal distribution of variables. The analyses were done based on intention-to-treat approach. Baseline general characteristics among different groups were examined using one-way ANOVA for continuous variable and a Chi square test for categorical variables. To determine the effects of vitamin D and vitamin C supplementation and endurance PA on metabolic criteria, we used one-way ANOVA. We used Tukey's post hoc comparisons to identify pairwise differences when we reached a significant finding in ANOVA. P < .05 was considered as statistically significant. All statistical analyses were done using SPSS version 20.

Results

In the present study, 180 patients with MetS were recruited: vitamin D (n = 30), "vitamin D plus 30 min/day PA" (n = 30), vitamin C (n = 30), "vitamin C plus 30 min/day PA" (n = 30), placebo (n = 30) and "placebo plus 30 min/day PA" (n = 30) groups. The study procedure and the flow chart for inclusion and exclusion in the study is shown in Fig. 1. In did, 39 participants excluded from the study because of the following reasons: Five became pregnant, nine did not follow recommended PA, seven had poor compliance to vitamin D supplements, 10 had poor vitamin C supplement, and 8 did not complete the trial. Finally, 141 subjects remained in the study. We included the data for all 141 participants in the baseline and final analysis. The characteristics of the study participants are presented in Table 1. The distribution of participants in terms of mean age among different study groups was not significant (P value > .05). The percentage of gender allocation, family history of obesity, family history of diabetes mellitus and family history of hypertension was not significantly different across the intervention groups (P value > .05 for all). These data suggest that the demographic information at baseline studies is evenly distributed. In addition, the results of the present study demonstrated that, baseline serum vitamin D and vitamin C levels showed no significant difference among groups (P value > .05). There were also no significant differences among the groups in terms of weight, BMI, WC, FPG, SBP, DBP and TC (P value > .05 for all). However, participants who received vitamin C supplements had higher serum levels of TG compared with those who received vitamin D plus PA, vitamin D plus PA and placebo or "placebo plus PA" (P < .001). Participants in the "vitamin D plus PA and placebo plus PA" groups had higher values of HDL-C compared with those in the other groups (P = .046). Furthermore, participants in the vitamin C group had lower levels of LDL-C compared with those in the "placebo plus PA" group (P = .007). Moreover, end of trial means of metabolic characteristic measures among study groups are shown in Table 2. We observed a significant increase in mean serum vitamin D concentrations, in participants who received vitamin D, (Vitamin D group from 10.8 ± 2.8 to 23.2 ± 4.9 ng/mL, or "vitamin D plus PA" from 10.4 ± 3.2 to 29 ± 5.5 ng/mL, P < .001 for all) and a significant increase in vitamin C supplementation also observed (Vitamin C group from .9 ± .4 to 1.4 ± .3 ng/mL or "vitamin C plus PA" from .8 ± .3 to 1.7 ± .3 ng/mL, P < .001 for all). There was also a significant increase in serum levels of vitamin D in those who received "placebo plus PA" (11 ± 4 vs. 18.9 ± 4.5 ng/mL at the end of the study, P < .001). No significant changes in serum levels of vitamin D and vitamin C were seen in participants in the placebo groups (P value > .05). End of trial supplementation did not significantly affect means of anthropometric measures and blood pressure among all groups (P value > .05). Whereas, One-way ANOVA of the end of study FPG showed significant difference between groups (P value < .05), and biochemical indicators across all study groups after intervention shows that, subjects in vitamin D group had lower serum levels of TC compared with the other groups (P < .001) and highest level of TC was observed in placebo group compared to other groups. In terms of TG, vitamin C intake resulted in higher serum levels of TG compared with the other groups (P < .001). Additionally, end of trial means of serum levels of LDL-C was significantly lower in the vitamin D group compared with all of other groups (P < .001). And the participants in vitamin C plus PA group had higher serum levels of HDL-C compared with other groups (P < .001). On the other hand, changes in metabolic criteria across study groups are presented in Table 3. There was a marginally significant difference in changes of BMI, WC, TC, TG, LDL-C, and HDL-C among all groups (P value < .05 for all). No significant changes in serum levels of FPG, SBP and DBP were seen among all groups (P value > .05 for all). Finally, multiple comparison of metabolic criteria across the study groups are presented in Table 4. According to multiple comparison using Tukey method across the study groups, the mean difference change of BMI only lowered in those who took vitamin D and did exercise compared with those who took vitamin D alone (− 1.4 ± .4, P = .029). However, the change was not significant compared to placebo. In addition, WC was significantly lowered in the vitamin C plus PA group compared to placebo (− 2.8 ± 1.0, P = .041) and vitamin D alone (− 4.2 ± 1.0, P < .001). Our results demonstrate that, taking vitamin C with exercise lowered WC to higher level comparing to those who took vitamin C alone (2.9 ± 1.0, P = .021). Taking placebo plus PA also lowered WC compared to vitamin D supplement alone (3.5 ± 1.0, P = .006). Besides, taking vitamin C and doing exercise remarkably lowered WC comparing to those who took vitamin D and exercised (3 ± 1.0, P = .041). Regarding change in lipid profiles a significant changes in serum levels of TC were seen following vitamin D or "vitamin D plus PA" than that in the placebo group (24 ± 8, P = .037; 24 ± 8.2, P = .050) respectively. Beside, either taking vitamin C and "vitamin C plus PA" both significantly lowered TG in comparison to placebo (33.5 ± 10.1, P = .027; 36.2 ± 11.1 P = .017). Interestingly, Table 4 showed that mean of HDL-C was higher in those who took vitamin C and doing PA compared to those vitamin D plus PA (16.2 ± 4.0, P = .002) and placebo plus PA (16.3 ± 4.0, P = .001). Vitamin C with exercise lowered HDL-C more in than taking vitamin C alone (14.2 ± 3.9, P = .005), Vitamin D alone (15.6 ± 3.9, P = .002) and vitamin D plus PA (16.2 ± 4.0, P = .002). Even so, only vitamin D supplement lowered LDL-C more in compared with vitamin C supplement groups (23.4 ± 8.2, P = .055).

Table 1 Baseline characteristics of the study participants

Full size table

Table 2 End of trial means of metabolic characteristic across the study groups

Full size table

Table 3 Change in changes in metabolic criteria across a cross the study groups

Full size table

Table 4 Multiple comparison of BMI, WC, TC, TG, LDL-C and HDL-C across the study groups

Full size table

Discussion

The results of this study show that the demographic characteristics of the participants do not differ significantly when comparing vitamin D to vitamin C treatment, suggesting that vitamin supplements may not have impact on demographic differences. However, elsewhere, studies indicate that vitamin supplements may have different functions in the body hence different age groups may have different needs for vitamin D supplement [38, 39]. The present study excluded participants who are likely having selected medical conditions hence agreeing with Gutierrez et al. [40] study who conducted vitamin D supplement intake among chronically ill patients and found that their vitamin supplement needs are different from healthy individuals. Our finding revealed that vitamin D and C supplements do not have any effect on weight when consumers are undergoing endurance physical exercise. The 12 weeks study did not report any difference in weight that is presumed vitamin D and C influence. Caan et al. [41] showed that vitamin D intake had a supplemental increase in postmenopausal weigh gain. Also, Zittermann et al. [42] showed that intake of vitamin D supplement enhances weight among cardiovascular risk patients. These two studies reported different results from the results of the present study. This may be due to the differences in the physical exercise variables used. In addition, previous studies focused more on supplemental intake of vitamin D as compared to the combination of vitamin C and D [43]. These studies also reported results from a specific population, which was excluded from the present study. Therefore, limited studies were found in the literature to evaluate the comparative effects of vitamin C and D supplement in weight loss and enduring physical exercise in MetS adult population in specific age group (30–50 years) as performed in this study. Furthermore, the current work found no significant interaction effect among participants taking vitamin D and C supplements with simultaneous exercise. However, interestingly, two statistical measures used in this study, one-way ANOVA and ANCOVA, showed different results. These differences were observed after baseline measure adjustment where ANCOVA demonstrated significant differences between BMI and the study vitamin supplement, similar finding was reported by Salehpour et al. [44], and Vimaleswaran et al. [45] reported a causal relationship between obesity and vitamin D, where they found a positive directional relationship between BMI and vitamin D. In our study, vitamin D may be responsible for the changes in BMI shown with ANCOVA analysis. This finding is in agreement with the result obtained by Amrein et al. [46].

Regarding, the changes in WC did not show any significant interaction among the study participants with vitamin D and C. The WC and BMI have been often studied together [47]. In line to our findings, a study performed by Du et al. [48] suggested that WC depends on high weight and individuals with low weight would not show any changes in their WC. Elsewhere, it has been reported that daily vitamin D supplementation (1000 IU) in overweight and obese women shows significant reduction in body fat mass with no effect on WC [44]. Overall, it appears that taking vitamin D alone do not have a significant effect on weight, but when it is combined with endurance PA, it may affect. However, further studies are required to fully observe this aspect. Furthermore, vitamin D supplement and its derivatives have widely been studied due to their connection with CVD [49]. Our results show that there is a significant difference in SBP among individuals who took vitamin D and did the exercise, while no significant interaction for vitamin C was recorded. This might due to the fact that vitamin D supplement aid in relieving blood pressure [50, 51]. However, study reported the audiometric outcomes of the use of vitamin D, suggested that the association of vitamin D and cardio related activities is uncertain; hence no clinical significance can be drawn [52]. In the present study, changes in the FPG did not have any significant interaction effects with vitamin D or C during exercise. Dakhale et al. [53] show that the FPG level for normal individuals should remain less than 250 mg/dL. Moreover, in this study, there was no significant effects on cholesterol levels among patients who took vitamin C supplements, but for vitamin D supplements cholesterol showed increased weight. The reason of vitamin D interaction with cholesterol in the MetS is high level functionality of vitamin D, which add bone mass, which interacts with adipose tissue or fats [50]. For the main study, TG had no significant interaction among study participants who took vitamin D and C supplements. The lack of interaction may due to the source of TG in the meals that participants were taking once a week to keep their TG low [54]. It was highly unlikely to report high level of TG among the study participants. Additionally, LDL-C and HDL-C had opposite results where LDL-C showed significant interaction with vitamin D compared to C, while HDL-C showed a significant interaction with vitamin C compared to D. The opposing results can be explained by differences in functional presence of either LDL-C or HDL-C within the body. Both vitamin C and D impact on metabolic functioning have been discussed in detail by Berge et al. [54], where vitamin bearing high responsibility for the additive and reductive changes in MetS. The main limitations of this study is its small sample size and duration is short which limits the generalizability of our results. However, studies with a larger sample size and longer follow-up period together with measurement of other related vitamins levels may yield more meaningful data on the effects of vitamins supplementations on MetS patients.

Conclusions

We conclude that, consumption of vitamin D or vitamin C supplements may improves the life of metabolic syndrome patients. However, the combination of physical activities and vitamin supplements maximize the effect, and this combination should be recommended.

Abbreviations

MetS:

metabolic syndrome

CVD:

cardiovascular disease

IDF:

International Diabetes Federation

BMI:

body mass index

PA:

physical activity

RCT:

randomized controlled trial

WC:

waist circumference

FPG:

fasting plasma glucose

TC:

total cholesterol

TG:

triglyceride

LDL-C:

low-density lipoprotein cholesterol

HDL-C:

high-density lipoprotein cholesterol

References

1. 1.

   Alberti KGM, Zimmet P, Shaw J. The metabolic syndrome—a new worldwide definition. Lancet. 2005;366(9491):1059–62.

   Article  Google Scholar

2. 2.

   Ebrahimpour P, Fakhrzadeh H, Heshmat R, Ghodsi M, Bandarian F, Larijani B. Metabolic syndrome and menopause: a population-based study. Diabetes Metab Syndr. 2010;4(1):5–9.

   Article  Google Scholar

3. 3.

   Shiwaku K, Nogi A, Kitajima K, Anuurad E, Enkhmaa B, Yamasaki M, et al. Prevalence of the metabolic syndrome using the modified ATP III definitions for workers in Japan, Korea and Mongolia. J Occup Health. 2005;47(2):126–35.

   Article  Google Scholar

4. 4.

   Freiberger E, Häberle L, Spirduso WW, Rixt Zijlstra G. Long-term effects of three multicomponent exercise interventions on physical performance and fall-related psychological outcomes in community-dwelling older adults: a randomized controlled trial. J Am Geriatr Soc. 2012;60(3):437–46.

   Article  Google Scholar

5. 5.

   Small DM, Coombes JS, Bennett N, Johnson DW, Gobe GC. Oxidative stress, anti-oxidant therapies and chronic kidney disease. Nephrology. 2012;17(4):311–21.

   CAS  Article  Google Scholar

6. 6.

   Spradley BD, Crowley KR, Tai C-Y, Kendall KL, Fukuda DH, Esposito EN, et al. Ingesting a pre-workout supplement containing caffeine, B-vitamins, amino acids, creatine, and beta-alanine before exercise delays fatigue while improving reaction time and muscular endurance. Nutr Metab. 2012;9(1):28.

   CAS  Article  Google Scholar

7. 7.

   Wagner CL, McNeil R, Hamilton SA, Winkler J, Cook CR, Warner G, et al. A randomized trial of vitamin D supplementation in 2 community health center networks in South Carolina. Am J Obstet Gynecol. 2013;208(2):137.

   Article  Google Scholar

8. 8.

   Fedirko V, Bostick RM, Long Q, Flanders WD, McCullough ML, Sidelnikov E, et al. Effects of supplemental vitamin D and calcium on oxidative DNA damage marker in normal colorectal mucosa: a randomized clinical trial. Cancer Epidemiol Prev Biomark. 2010;19(1):280–91.

   CAS  Article  Google Scholar

9. 9.

   Mithal A, Bonjour J-P, Boonen S, Burckhardt P, Degens H, Fuleihan GEH, et al. Impact of nutrition on muscle mass, strength, and performance in older adults. Osteoporos Int. 2013;24(5):1555–66.

   CAS  Article  Google Scholar

10. 10.

    Myburgh KH. Polyphenol supplementation: benefits for exercise performance or oxidative stress? Sports Med. 2014;44(1):57–70.

    Article  Google Scholar

11. 11.

    Chowdhury R, Kunutsor S, Vitezova A, Oliver-Williams C, Chowdhury S, Kiefte-de-Jong JC, et al. Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies. BMJ. 2014;348:g1903.

    Article  Google Scholar

12. 12.

    Grandi NC, Breitling LP, Brenner H. Vitamin D and cardiovascular disease: systematic review and meta-analysis of prospective studies. Prev Med. 2010;51(3–4):228–33.

    CAS  Article  Google Scholar

13. 13.

    Scott D, Blizzard L, Fell J, Ding C, Winzenberg T, Jones G. A prospective study of the associations between 25-hydroxy-vitamin D, sarcopenia progression and physical activity in older adults. Clin Endocrinol. 2010;73(5):581–7.

    CAS  Article  Google Scholar

14. 14.

    Beaudart C, Buckinx F, Rabenda V, Gillain S, Cavalier E, Slomian J, et al. The effects of vitamin D on skeletal muscle strength, muscle mass, and muscle power: a systematic review and meta-analysis of randomized controlled trials. J Clin Endocrinol Metab. 2014;99(11):4336–45.

    CAS  Article  Google Scholar

15. 15.

    Pludowski P, Holick MF, Pilz S, Wagner CL, Hollis BW, Grant WB, et al. Vitamin D effects on musculoskeletal health, immunity, autoimmunity, cardiovascular disease, cancer, fertility, pregnancy, dementia and mortality—a review of recent evidence. Autoimmun Rev. 2013;12(10):976–89.

    CAS  Article  Google Scholar

16. 16.

    Stockton K, Mengersen K, Paratz J, Kandiah D, Bennell K. Effect of vitamin D supplementation on muscle strength: a systematic review and meta-analysis. Osteoporos Int. 2011;22(3):859–71.

    CAS  PubMed  Google Scholar

17. 17.

    Paknahad Z, Vasmehjani AA, Maracy MR. Association of serum 25-hydroxyvitamin d levels with markers of metabolic syndrome in adult women in Ramsar, Iran. Women's Health Bull. 2014;1(1):e20124.

    Article  Google Scholar

18. 18.

    Saneei P, Salehi-Abargouei A, Esmaillzadeh A. Serum 25-hydroxy vitamin D levels in relation to body mass index: a systematic review and meta-analysis. Obes Rev. 2013;14(5):393–404.

    CAS  Article  Google Scholar

19. 19.

    Anstey K, Cherbuin N, Budge M, Young J. Body mass index in midlife and late-life as a risk factor for dementia: a meta-analysis of prospective studies. Obes Rev. 2011;12(5):e426–37.

    CAS  Article  Google Scholar

20. 20.

    Gonzalez AB, Hartge P, Cerhan JR, Flint AJ, Hannan L, MacInnis RJ, et al. Body-mass index and mortality among 1.46 million white adults. N Engl J Med. 2010;363(23):2211–9.

    Article  Google Scholar

21. 21.

    Ramful D, Tarnus E, Aruoma OI, Bourdon E, Bahorun T. Polyphenol composition, vitamin C content and antioxidant capacity of Mauritian citrus fruit pulps. Food Res Int. 2011;44(7):2088–99.

    CAS  Article  Google Scholar

22. 22.

    Jun S, Jung E, Kang D, Kim J, Chang U, Suh HJ. Vitamin C increases the fecal fat excretion by chitosan in guinea-pigs, thereby reducing body weight gain. Phytother Res. 2010;24(8):1234–41.

    CAS  PubMed  Google Scholar

23. 23.

    Asemi Z, Zare Z, Shakeri H, Sabihi S-S, Esmaillzadeh A. Effect of multispecies probiotic supplements on metabolic profiles, hs-CRP, and oxidative stress in patients with type 2 diabetes. Ann Nutr Metab. 2013;63(1–2):1–9.

    CAS  Article  Google Scholar

24. 24.

    Barbieri E, Sestili P. Reactive oxygen species in skeletal muscle signaling. J Sign Transduct. 2012;2012:982794.

    Google Scholar

25. 25.

    Gomes EC, Silva AN, Oliveira MR. Oxidants, antioxidants, and the beneficial roles of exercise-induced production of reactive species. Oxid Med Cell Longev. 2012;2012:756132.

    Article  Google Scholar

26. 26.

    Milić S, Štimac D. Nonalcoholic fatty liver disease/steatohepatitis: epidemiology, pathogenesis, clinical presentation and treatment. Dig Dis. 2012;30(2):158–62.

    Article  Google Scholar

27. 27.

    Strasser B. Physical activity in obesity and metabolic syndrome. Ann N Y Acad Sci. 2013;1281(1):141–59.

    Article  Google Scholar

28. 28.

    Turi BC, Codogno JS, Fernandes RA, Monteiro HL. Low levels of physical activity and metabolic syndrome: cross-sectional study in the Brazilian public health system. Cien Saude Colet. 2016;21:1043–50.

    Article  Google Scholar

29. 29.

    Golder S, Loke YK, Bland M. Meta-analyses of adverse effects data derived from randomised controlled trials as compared to observational studies: methodological overview. PLoS Med. 2011;8(5):e1001026.

    Article  Google Scholar

30. 30.

    Stuart EA. Matching methods for causal inference: a review and a look forward. Stat Sci. 2010;25(1):1.

    Article  Google Scholar

31. 31.

    Kaftan AN, Hussain MK. Association of adiponectin gene polymorphism rs266729 with type two diabetes mellitus in Iraqi population. A pilot study. Gene. 2015;570(1):95–9.

    CAS  Article  Google Scholar

32. 32.

    Aalto A-M, Elovainio M, Kivimäki M, Uutela A, Pirkola S. The Beck Depression Inventory and General Health Questionnaire as measures of depression in the general population: a validation study using the composite international diagnostic interview as the gold standard. Psychiatry Res. 2012;197(1–2):163–71.

    Article  Google Scholar

33. 33.

    De Blacam C, Ogunleye AA, Momoh AO, Colakoglu S, Tobias AM, Sharma R, et al. High body mass index and smoking predict morbidity in breast cancer surgery: a multivariate analysis of 26,988 patients from the national surgical quality improvement program database. Ann Surg. 2012;255(3):551–5.

    Article  Google Scholar

34. 34.

    Bull SM. Evidence-based blood conservation education for ICU Nurses: a pre and post-test evaluation of nursing knowledge. 2014. https://uknowledge.uky.edu/dnp_etds/24/.

35. 35.

    Barzin M, Hosseinpanah F, Fekri S, Azizi F. Predictive value of body mass index and waist circumference for metabolic syndrome in 6–12-year-olds. Acta Paediatr. 2011;100(5):722–7.

    Article  Google Scholar

36. 36.

    Rothwell PM, Wilson M, Elwin C-E, Norrving B, Algra A, Warlow CP, et al. Long-term effect of aspirin on colorectal cancer incidence and mortality: 20-year follow-up of five randomised trials. Lancet. 2010;376(9754):1741–50.

    CAS  Article  Google Scholar

37. 37.

    Bauer JM, Verlaan S, Bautmans I, Brandt K, Donini LM, Maggio M, et al. Effects of a vitamin D and leucine-enriched whey protein nutritional supplement on measures of sarcopenia in older adults, the PROVIDE study: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc. 2015;16(9):740–7.

    Article  Google Scholar

38. 38.

    Tang BM, Eslick GD, Nowson C, Smith C, Bensoussan A. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet. 2007;370(9588):657–66.

    CAS  Article  Google Scholar

39. 39.

    Ginde AA, Liu MC, Camargo CA. Demographic differences and trends of vitamin D insufficiency in the US population, 1988–2004. Arch Intern Med. 2009;169(6):626–32.

    CAS  Article  Google Scholar

40. 40.

    Wolf M, Shah A, Gutierrez O, Ankers E, Monroy M, Tamez H, et al. Vitamin D levels and early mortality among incident hemodialysis patients. Kidney Int. 2007;72(8):1004–13.

    CAS  Article  Google Scholar

41. 41.

    Caan B, Neuhouser M, Aragaki A, Lewis CB, Jackson R, LeBoff MS, et al. Calcium plus vitamin D supplementation and the risk of postmenopausal weight gain. Arch Intern Med. 2007;167(9):893–902.

    CAS  Article  Google Scholar

42. 42.

    Zittermann A, Frisch S, Berthold HK, Götting C, Kuhn J, Kleesiek K, et al. Vitamin D supplementation enhances the beneficial effects of weight loss on cardiovascular disease risk markers. Am J Clin Nutr. 2009;89(5):1321–7.

    CAS  Article  Google Scholar

43. 43.

    Rosenblum JL, Castro VM, Moore CE, Kaplan LM. Calcium and vitamin D supplementation is associated with decreased abdominal visceral adipose tissue in overweight and obese adults. Am J Clin Nutr. 2011;95(1):101–8.

    Article  Google Scholar

44. 44.

    Salehpour A, Hosseinpanah F, Shidfar F, Vafa M, Razaghi M, Dehghani S, et al. A 12-week double-blind randomized clinical trial of vitamin D 3 supplementation on body fat mass in healthy overweight and obese women. Nutr J. 2012;11(1):78.

    CAS  Article  Google Scholar

45. 45.

    Vimaleswaran KS, Berry DJ, Lu C, Tikkanen E, Pilz S, Hiraki LT, et al. Causal relationship between obesity and vitamin D status: bi-directional Mendelian randomization analysis of multiple cohorts. PLoS Med. 2013;10(2):e1001383.

    Article  Google Scholar

46. 46.

    Amrein K, Sourij H, Wagner G, Holl A, Pieber TR, Smolle KH, et al. Short-term effects of high-dose oral vitamin D3 in critically ill vitamin D deficient patients: a randomized, double-blind, placebo-controlled pilot study. Crit Care. 2011;15(2):R104.

    Article  Google Scholar

47. 47.

    Romaguera D, Ängquist L, Du H, Jakobsen MU, Forouhi NG, Halkjær J, et al. Food composition of the diet in relation to changes in waist circumference adjusted for body mass index. PLoS ONE. 2011;6(8):e23384.

    CAS  Article  Google Scholar

48. 48.

    Du H, van der A DL, Boshuizen HC, Forouhi NG, Wareham NJ, Halkjaer J, et al. Dietary fiber and subsequent changes in body weight and waist circumference in European men and women. Am J Clin Nutr. 2009;91(2):329–36.

    Article  Google Scholar

49. 49.

    Skaaby T, Husemoen LLN, Pisinger C, Jørgensen T, Thuesen BH, Fenger M, et al. Vitamin D status and changes in cardiovascular risk factors: a prospective study of a general population. Cardiology. 2012;123(1):62–70.

    CAS  Article  Google Scholar

50. 50.

    Wu SH, Ho SC, Zhong L. Effects of vitamin D supplementation on blood pressure. South Med J. 2010;103(8):729–37.

    Article  Google Scholar

51. 51.

    Beveridge LA, Struthers AD, Khan F, Jorde R, Scragg R, Macdonald HM, et al. Effect of vitamin D supplementation on blood pressure: a systematic review and meta-analysis incorporating individual patient data. JAMA Intern Med. 2015;175(5):745–54.

    Article  Google Scholar

52. 52.

    Pittas AG, Chung M, Trikalinos T, Mitri J, Brendel M, Patel K, et al. Systematic review: vitamin D and cardiometabolic outcomes. Ann Intern Med. 2010;152(5):307–14.

    Article  Google Scholar

53. 53.

    Dakhale GN, Chaudhari HV, Shrivastava M. Supplementation of vitamin C reduces blood glucose and improves glycosylated hemoglobin in type 2 diabetes mellitus: a randomized, double-blind study. Adv Pharmacol Sci. 2011;2011:195271.

    PubMed  PubMed Central  Google Scholar

54. 54.

    Berge K, Musa-Veloso K, Harwood M, Hoem N, Burri L. Krill oil supplementation lowers serum triglycerides without increasing low-density lipoprotein cholesterol in adults with borderline high or high triglyceride levels. Nutr Res. 2014;34(2):126–33.

    CAS  Article  Google Scholar

Download references

Authors' contributions

HAF, MJH, BAM and AHB participated in the design of the study, data collection, performed the statistical analysis and drafted the manuscript. MJH, AE and AHB supervising the study and participated in draft review. All authors have read and approved the final version of the manuscript and agree with the order of presentation of the authors. All authors read and approved the final manuscript.

Acknowledgements

The authors thank the staff and participants at the Sulemani and Halabja center for the control of the communicable and chronic disease for their important contributions to the study.

Competing interests

The authors declare that they have no competing interests.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Consent for publication

Not applicable.

Ethics approval and consent to participate

The Ethics Committee of Tehran University of Medical Sciences approved the study protocol, and the trial was registered at the World Health Organization, International Clinical Trails Registry Platform (Code: IRCT20161110030823N2). In addition, written informed consent was also obtained from each participant.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Author information

Affiliations

1. Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Science, International Campus (TUMS-IC), Tehran, Iran

   Halgord Ali M. Farag, Mohammad Javad Hosseinzadeh-Attar & Abdel Hamid El Bilbeisi

2. Halabja Technical Institute, Sulaimani Polytechnic University, Kurdistan, Iraq

   Halgord Ali M. Farag & Belal A. Muhammad

3. Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran

   Ahmad Esmaillzadeh

Corresponding author

Correspondence to Abdel Hamid El Bilbeisi.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Reprints and Permissions

About this article

Cite this article

Farag, H.A.M., Hosseinzadeh-Attar, M.J., Muhammad, B.A. et al. Comparative effects of vitamin D and vitamin C supplementations with and without endurance physical activity on metabolic syndrome patients: a randomized controlled trial. Diabetol Metab Syndr 10, 80 (2018). https://doi.org/10.1186/s13098-018-0384-8

Download citation

• Received: 19 September 2018

• Accepted: 02 November 2018

• Published: 08 November 2018

• DOI : https://doi.org/10.1186/s13098-018-0384-8

Keywords

• Endurance physical activity
• IDF
• Metabolic syndrome
• Vitamin C
• Vitamin D

Do You Need Vitamin C To Absorb Vitamin D

Source: https://dmsjournal.biomedcentral.com/articles/10.1186/s13098-018-0384-8